The Effects of Pain and Disability Resulting From Shoulder Pathologies On Balance and Mobility
Condition: Shoulder Injuries
MeSH terms: Shoulder Injuries
Study type: Observational [Patient Registry]

Summary: 
      Among the musculoskeletal pathologies, shoulder pain is the most common symptom after back
      and neck pain (1, 2). One out of every three adults experiences shoulder pain and limitation
      in shoulder movements, which affects the functionality of the patients and leads to
      disability. (2) Impairment of one or more sensory inputs coming from the visual,
      somatosensory or afferent pathways from the vestibular system (3-4) causes deterioration of
      balance control and falls (4-5). Since pain affects the somatosensory system, it causes a
      decrease in balance ability. This study will be conducted to examine the effect of pain and
      functionality on balance in shoulder pathologies. Our study included pathologies such as
      impingement, rotator cuff syndrome, frozen shoulder, fracture between November 1, 2022 and
      January 1, 2023; A total of 40 patients, 18 females and 12 males, between the ages of 41-74
      (56.30±9.25) will be included. Sociodemographic information form, Shoulder Pain and
      Disability Index (SPADI), One-leg standing test, 5 sit and stand test, TINetti balance and
      walking test will be evaluated for the included patients. SPSS Version 21.0 program was used
      for statistical analysis. With Pearson Correlation analysis, it will be evaluated whether the
      data are related or not.
    

Detailed description: 
      Upper extremity pathologies are musculoskeletal problems that are common in the community,
      resulting in loss of work force and negative continuation of recreational activities (1,2).
      Among the pathologies of the musculoskeletal system, shoulder pain is the most common symptom
      after back and neck pain (3, 4). One out of every three adults experiences shoulder pain and
      limitation in shoulder movements, which affects the functionality of the patients and leads
      to disability (4). Among these common problems, there are many diseases such as rotator cuff
      injuries, adhesive capsulitis, acromioclavicular joint degenerations, calcific tendinitis and
      instability (5). Impairment of one or more sensory inputs coming from the visual,
      somatosensory or afferent pathways from the vestibular system (6-7) causes deterioration of
      balance control and falls (7-8). Since pain affects the somatosensory system, it causes a
      decrease in balance ability. In addition, pain-induced balance control and muscle inhibition
      pathways share some pathways in the central nervous system (9 ,10). Therefore, muscle
      inhibition mechanisms caused by pain may negatively affect balance ability (10,11). It has
      been proven that patients with shoulder pain have deficiencies in shoulder proprioception as
      well as trunk and lower extremity coordination (10,12). Problem-free and painless upper
      extremity movements are mostly related to the stability of the trunk and this is closely
      related to the stability of the lower extremities and balance control. Any deficiency in
      trunk and lower extremity stability is largely tolerated by compensating the structures
      around the upper extremity by increasing speed and power, and this situation paves the way
      for upper extremity pathologies. It remains unclear whether the lack of balance is a cause or
      a consequence of injury in individuals with shoulder problems (13). Myers et al. reported
      that proprioception and coordination deficiencies greatly affect shoulder problems, therefore
      somatosensory deficiencies in the lower extremity and trunk may cause problems in the upper
      extremity region (14). Other known factors affecting balance, apart from proprioception and
      coordination, are attention (15,16), age (17,18), gender and body mass index (BMI) (19,20).
      Decreased balance can lead to limitation of movement, falls and injuries (21). This situation
      may also require rehabilitation of balance problems caused by upper extremity pathologies.
      There is very little published research investigating the relationship between different
      levels of shoulder pain, balance ability, risk of falling, and fear of falling, covering all
      age groups diagnosed with musculoskeletal shoulder problems. Although it has been shown that
      the balance of patients with shoulder pain is adversely affected, it is not clear how pain
      level and disability affect balance parameters. Therefore, in this study, it was aimed to
      investigate the relationship between pain severity, functionality and balance in shoulder
      pathologies,
    

Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Our study was carried out by Prof. Dr. Bezmialem Vakif University Faculty of Medicine,
        Department of Physical Medicine and Rehabilitation. Dr. It is planned to include patients
        referred by Teoman Aydın. In our study, post-hoc power analysis was performed and it was
        determined that 36 individuals were needed to achieve 95% power with an effect size of
        r:0.50. Considering the possibility of cases dropping out of the study, it is planned to
        include 40 individuals.

        Sociodemographic information form, Shoulder Pain and Disability Index (SPADI), One-leg
        standing test, 5 sit and stand test, TINetti balance and walking test will be evaluated for
        the included patients.
      
Keywords: balance; shoulder pain; mobility; functionality