Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas
Autor(a) principal: | |
---|---|
Data de Publicação: | 2018 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFSCAR |
Texto Completo: | https://repositorio.ufscar.br/handle/ufscar/10603 |
Resumo: | Introduction: The evaluation of patients with shoulder pain is highly influenced by pathoanatomical factors. Special tests and imaging are commonly used to the clinical decision-making. However, some studies have called this model into question suggesting more diversified evaluation systems such as movement-based and psychosocial aspects. Objectives: To verify the association of pathoanatomical factors with the symptom presentation and determine if pathoanatomical factors contribute to the self-reported shoulder function. Methods: Magnetic resonance imaging was used to evaluate in detail pathoanatomical abnormalities in individuals with unilateral shoulder pain. Images in the coronal, sagittal, and axial planes were generated and independently interpreted by a board-certified, orthopedic fellowship trained orthopedic shoulder surgeon and a musculoskeletal radiologist. Frequencies of pathoanatomical abnormalities for both shoulders were compared and the agreement across the evaluators was verified. In order to assess if pathoanatomical factors contributed to the self-reported shoulder function, a multivariate model was built considering the total score of the Disabilities of the Arm, Shoulder, and Hand (DASH) as the dependent variable. Clinical, demographics, pain catastrophizing, and special tests were used as explanatory variables. Results: Both shoulders presented a high prevalence of pathoanatomical abnormalities. Symptomatic shoulders showed the highest frequency of full-thickness tear and glenohumeral osteoarthrosis. Other observed pathoanatomical abnormalities did not show statistically significant differences between both shoulders. Pathoanatomical variables did not contribute to the multivariate model. The group of variables that best explained the selfreported shoulder function were pain intensity at rest, pain catastrophizing level, and acromioclavicular joint tenderness during palpation. Conclusions: Full-thickness rotator cuff tears and the presence of glenohumeral osteoarthrosis seem to be the only pathoanatomical abnormalities associated with the symptoms. Elevated pain catastrophizing levels and pain intensity at rest as well as acromioclavicular joint tenderness were the best explanatory variables to decreased self-reported shoulder function. Health professionals must be aware that most pathoanatomical abnormalities assessed with the magnetic resonance imaging are not related to the symptoms. |
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Barreto, Rodrigo Py GonçalvesCamargo, Paula Rezendehttp://lattes.cnpq.br/7602596349127054Ludewig, Paulahttp://lattes.cnpq.br/6143294885384140d73ca4f7-9594-415c-b2f9-b17da3d8cd8b2018-10-24T11:46:35Z2018-10-24T11:46:35Z2018-10-10BARRETO, Rodrigo Py Gonçalves. Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas. 2018. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/10603.https://repositorio.ufscar.br/handle/ufscar/10603Introduction: The evaluation of patients with shoulder pain is highly influenced by pathoanatomical factors. Special tests and imaging are commonly used to the clinical decision-making. However, some studies have called this model into question suggesting more diversified evaluation systems such as movement-based and psychosocial aspects. Objectives: To verify the association of pathoanatomical factors with the symptom presentation and determine if pathoanatomical factors contribute to the self-reported shoulder function. Methods: Magnetic resonance imaging was used to evaluate in detail pathoanatomical abnormalities in individuals with unilateral shoulder pain. Images in the coronal, sagittal, and axial planes were generated and independently interpreted by a board-certified, orthopedic fellowship trained orthopedic shoulder surgeon and a musculoskeletal radiologist. Frequencies of pathoanatomical abnormalities for both shoulders were compared and the agreement across the evaluators was verified. In order to assess if pathoanatomical factors contributed to the self-reported shoulder function, a multivariate model was built considering the total score of the Disabilities of the Arm, Shoulder, and Hand (DASH) as the dependent variable. Clinical, demographics, pain catastrophizing, and special tests were used as explanatory variables. Results: Both shoulders presented a high prevalence of pathoanatomical abnormalities. Symptomatic shoulders showed the highest frequency of full-thickness tear and glenohumeral osteoarthrosis. Other observed pathoanatomical abnormalities did not show statistically significant differences between both shoulders. Pathoanatomical variables did not contribute to the multivariate model. The group of variables that best explained the selfreported shoulder function were pain intensity at rest, pain catastrophizing level, and acromioclavicular joint tenderness during palpation. Conclusions: Full-thickness rotator cuff tears and the presence of glenohumeral osteoarthrosis seem to be the only pathoanatomical abnormalities associated with the symptoms. Elevated pain catastrophizing levels and pain intensity at rest as well as acromioclavicular joint tenderness were the best explanatory variables to decreased self-reported shoulder function. Health professionals must be aware that most pathoanatomical abnormalities assessed with the magnetic resonance imaging are not related to the symptoms.Introdução: A avaliação de pacientes com dor no ombro é altamente influenciada por fatores patoanatômicos. É comum a utilização de testes especiais ou de exames de imagem para a tomada de decisão clínica. Porém, esse modelo tem sido questionado por alguns estudos que sugerem avaliações baseadas em mecanismos diversos para o surgimento da dor como de alteração de movimento e aspectos psicossociais. Objetivos: Verificar a associação de fatores patoanatômicos com a apresentação de sintomas e determinar se fatores patoanatômicos contribuem para avaliação da função do ombro. Métodos: Ressonância nuclear magnética foi utilizada para avaliação detalhada de alterações patoanatômicas em indivíduos com dor unilateral de ombro. Cortes nos planos coronal, sagital e axial em sequências T1 e T2 foram produzidas e interpretadas de forma independente por um cirurgião ortopédico especializado em cirurgia de ombro e um radiologista especialista em ressonância com ênfase em musculoesquelética. As frequências de alterações patoanatômicas em ambos os ombros foram comparadas e a concordância entre os avaliadores foi avaliada. Para determinar se os fatores patoanatômicos contribuíram para a avaliação da função do ombro, um modelo multivariado utilizando a pontuação total do Disabilities of the Arm, Shoulder, and Hand (DASH) como variável dependente foi criado. Variáveis clínicas e demográficas, catastrofização da dor e testes especiais foram utilizados como variáveis explanatórias. Resultados: Ambos os ombros apresentaram alta prevalência de alterações patoanatômicas. Ombros sintomáticos apresentaram maior frequência de rupturas totais do manguito rotador e artrose glenoumeral. As demais alterações patoanatômicas observadas não demonstraram diferença estatisticamente significante entre os ombros. Variáveis patoanatômicas não contribuíram com o modelo multivariado. O conjunto de variáveis que melhor explicaram a função do ombro foram a intensidade da dor em repouso, nível de catastrofização e presença de dor à palpação na acromioclavicular. Conclusões: Rupturas totais de manguito rotador e presença de osteoartrose glenoumeral parecem ser as únicas alterações patoanatômicas associadas aos sintomas. Níveis elevados de catastrofização e dor em repouso assim como teste de cisalhamento da acromioclavicular positivo foram as melhores variáveis explanatórias para redução de função do ombro. Profissionais da saúde devem estar cientes que a maioria das alterações patoanatômicas avaliadas com a ressonância magnética não estão associadas com os sintomas.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)CAPES: 88881.062155/2014-01porUniversidade Federal de São CarlosCâmpus São CarlosPrograma de Pós-Graduação em Fisioterapia - PPGFtUFSCarSíndrome do impactoLesões de manguito rotadorAvaliaçãoFisioterapiaImpingement syndromeRotator cuff lesionsEvaluationPhysical therapyCIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONALDor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicasShoulder pain: paradox between the pathoanatomical model and clinical measurementsinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis12 meses após a data da defesa600600aae04f0d-e12e-4403-a601-fdda01a4b88binfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFSCARinstname:Universidade Federal de São Carlos (UFSCAR)instacron:UFSCARORIGINALTESE 3_corrigida2.pdfTESE 3_corrigida2.pdfTeseapplication/pdf767772https://repositorio.ufscar.br/bitstream/ufscar/10603/6/TESE%203_corrigida2.pdf7002484de9699bd5d482cd612dbea38aMD56LICENSElicense.txtlicense.txttext/plain; charset=utf-81957https://repositorio.ufscar.br/bitstream/ufscar/10603/7/license.txtae0398b6f8b235e40ad82cba6c50031dMD57TEXTTESE 3_corrigida2.pdf.txtTESE 3_corrigida2.pdf.txtExtracted texttext/plain146904https://repositorio.ufscar.br/bitstream/ufscar/10603/8/TESE%203_corrigida2.pdf.txtc95278854e0ab0f79512e6e29e0971e7MD58THUMBNAILTESE 3_corrigida2.pdf.jpgTESE 3_corrigida2.pdf.jpgIM Thumbnailimage/jpeg5578https://repositorio.ufscar.br/bitstream/ufscar/10603/9/TESE%203_corrigida2.pdf.jpg552a0f688dd205d8a955bd3c3ab363e1MD59ufscar/106032023-09-18 18:31:50.051oai:repositorio.ufscar.br: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Repositório InstitucionalPUBhttps://repositorio.ufscar.br/oai/requestopendoar:43222023-09-18T18:31:50Repositório Institucional da UFSCAR - Universidade Federal de São Carlos (UFSCAR)false |
dc.title.por.fl_str_mv |
Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas |
dc.title.alternative.eng.fl_str_mv |
Shoulder pain: paradox between the pathoanatomical model and clinical measurements |
title |
Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas |
spellingShingle |
Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas Barreto, Rodrigo Py Gonçalves Síndrome do impacto Lesões de manguito rotador Avaliação Fisioterapia Impingement syndrome Rotator cuff lesions Evaluation Physical therapy CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
title_short |
Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas |
title_full |
Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas |
title_fullStr |
Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas |
title_full_unstemmed |
Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas |
title_sort |
Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas |
author |
Barreto, Rodrigo Py Gonçalves |
author_facet |
Barreto, Rodrigo Py Gonçalves |
author_role |
author |
dc.contributor.authorlattes.por.fl_str_mv |
http://lattes.cnpq.br/6143294885384140 |
dc.contributor.author.fl_str_mv |
Barreto, Rodrigo Py Gonçalves |
dc.contributor.advisor1.fl_str_mv |
Camargo, Paula Rezende |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/7602596349127054 |
dc.contributor.advisor-co1.fl_str_mv |
Ludewig, Paula |
dc.contributor.authorID.fl_str_mv |
d73ca4f7-9594-415c-b2f9-b17da3d8cd8b |
contributor_str_mv |
Camargo, Paula Rezende Ludewig, Paula |
dc.subject.por.fl_str_mv |
Síndrome do impacto Lesões de manguito rotador Avaliação Fisioterapia |
topic |
Síndrome do impacto Lesões de manguito rotador Avaliação Fisioterapia Impingement syndrome Rotator cuff lesions Evaluation Physical therapy CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
dc.subject.eng.fl_str_mv |
Impingement syndrome Rotator cuff lesions Evaluation Physical therapy |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
description |
Introduction: The evaluation of patients with shoulder pain is highly influenced by pathoanatomical factors. Special tests and imaging are commonly used to the clinical decision-making. However, some studies have called this model into question suggesting more diversified evaluation systems such as movement-based and psychosocial aspects. Objectives: To verify the association of pathoanatomical factors with the symptom presentation and determine if pathoanatomical factors contribute to the self-reported shoulder function. Methods: Magnetic resonance imaging was used to evaluate in detail pathoanatomical abnormalities in individuals with unilateral shoulder pain. Images in the coronal, sagittal, and axial planes were generated and independently interpreted by a board-certified, orthopedic fellowship trained orthopedic shoulder surgeon and a musculoskeletal radiologist. Frequencies of pathoanatomical abnormalities for both shoulders were compared and the agreement across the evaluators was verified. In order to assess if pathoanatomical factors contributed to the self-reported shoulder function, a multivariate model was built considering the total score of the Disabilities of the Arm, Shoulder, and Hand (DASH) as the dependent variable. Clinical, demographics, pain catastrophizing, and special tests were used as explanatory variables. Results: Both shoulders presented a high prevalence of pathoanatomical abnormalities. Symptomatic shoulders showed the highest frequency of full-thickness tear and glenohumeral osteoarthrosis. Other observed pathoanatomical abnormalities did not show statistically significant differences between both shoulders. Pathoanatomical variables did not contribute to the multivariate model. The group of variables that best explained the selfreported shoulder function were pain intensity at rest, pain catastrophizing level, and acromioclavicular joint tenderness during palpation. Conclusions: Full-thickness rotator cuff tears and the presence of glenohumeral osteoarthrosis seem to be the only pathoanatomical abnormalities associated with the symptoms. Elevated pain catastrophizing levels and pain intensity at rest as well as acromioclavicular joint tenderness were the best explanatory variables to decreased self-reported shoulder function. Health professionals must be aware that most pathoanatomical abnormalities assessed with the magnetic resonance imaging are not related to the symptoms. |
publishDate |
2018 |
dc.date.accessioned.fl_str_mv |
2018-10-24T11:46:35Z |
dc.date.available.fl_str_mv |
2018-10-24T11:46:35Z |
dc.date.issued.fl_str_mv |
2018-10-10 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
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doctoralThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
BARRETO, Rodrigo Py Gonçalves. Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas. 2018. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/10603. |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufscar.br/handle/ufscar/10603 |
identifier_str_mv |
BARRETO, Rodrigo Py Gonçalves. Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas. 2018. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2018. Disponível em: https://repositorio.ufscar.br/handle/ufscar/10603. |
url |
https://repositorio.ufscar.br/handle/ufscar/10603 |
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openAccess |
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Universidade Federal de São Carlos Câmpus São Carlos |
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Programa de Pós-Graduação em Fisioterapia - PPGFt |
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UFSCar |
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Universidade Federal de São Carlos Câmpus São Carlos |
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