Pressure pain sensitivity in patients with traumatic first-time and recurrent anterior shoulder dislocation: a cross-sectional analysis

Behnam Liaghat 1 , Henrik Eshoj 1 , 2 , Birgit Juul-Kristensen 1 , Lars Arendt-Nielsen 3  and Søren T. Skou 1 , 4
  • 1 Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  • 2 Quality of Life Research Center, Odense University Hospital, Department of Haematology, Odense, Denmark
  • 3 Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Faculty of Medicine, Aalborg University, Aalborg, Denmark
  • 4 Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
Behnam Liaghat
  • Corresponding author
  • Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  • Email
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Henrik Eshoj
  • Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  • Quality of Life Research Center, Odense University Hospital, Department of Haematology, Odense, Denmark
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Birgit Juul-Kristensen
  • Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Lars Arendt-Nielsen
  • Department of Health Science and Technology, Centre for Sensory-Motor Interaction (SMI), Faculty of Medicine, Aalborg University, Aalborg, Denmark
  • Search for other articles:
  • degruyter.comGoogle Scholar
and Søren T. Skou
  • Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  • Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
  • Search for other articles:
  • degruyter.comGoogle Scholar

Abstract

Background and aims

Traumatic anterior shoulder dislocation (ASD) is frequent in active populations and associated with a 39% higher risk of recurrent dislocation, which may cause persistent shoulder problems, pain, and impaired shoulder-related quality of life. While local and distant pressure pain sensitivity has been demonstrated in other shoulder conditions, little is known about the link between pressure pain sensitivity and ASD. The interesting aspect is whether recurrent dislocation – resulting in symptoms of longer duration – is associated with more pronounced pressure pain sensitivity, or if presence of pressure pain sensitivity may be part of the reasons why patients develop recurrent dislocation. Therefore, this study aimed at evaluating whether patients with recurrent ASD display greater pressure pain sensitivity and more painful body sites than patients with first-time ASD.

Methods

This was a cross-sectional analysis of baseline data from a randomized controlled trial including 34 patients with first-time ASD [82% male, mean (SD) age 26 (7) years] and 22 patients with recurrent ASD [96% male, mean (SD) age 25 (5) years]. Patients were assessed as follows: (1) assessment of local and distant pressure pain sensitivity evaluated by pressure pain thresholds (PPTs) using a handheld algometer on mm. trapezius superior, levator scapula, pectorales major, deltoideus, and tibialis anterior, (2) pain intensity at rest during the previous 24 h, (3) number of ASD, and (4) number of painful body sites on a region-divided body chart.

Results

The PPTs were not significantly different between first-time and recurrent ASD [mean (SD) kPa for m. trapezius superior 264 (110) vs. 261 (88), m. levator scapula 301 (157) vs. 325 (163), m. pectorales major 234 (163) vs. 269 (130), m. deltoideus 290 (166) vs. 352 (173), m. tibialis anterior 420 (202) vs. 449 (184)], two-way ANCOVA, adjusted for sex and age, F (4,263) = 0.29, p = 0.88. For both groups, the PPTs were lower at the shoulder sites than at m. tibialis anterior (difference 117–184 kPa, 95% CI range 33–267). Females had lower PPTs than males (difference 124 kPa, 95% CI 64−183). The number (SD) of painful body sites were 2.2 (1.9) for first-time ASD and 2.6 (5.4) for recurrent ASD, with no between-group differences, one-way ANCOVA, adjusted for sex and age, F (1, 52) = 0.24, p = 0.63. There was a strong correlation between PPTs at the shoulder and lower leg, r = 0.84, p < 0.01.

Conclusions

This study demonstrated no differences in local and distant pressure pain sensitivity or number of painful body sites between patients with first-time and recurrent ASD. Females had lower PPTs than males, and a strong correlation was found between PPTs at the shoulder and lower leg.

Implications

Patients with first-time and recurrent ASD seem to have similar pressure pain sensitivity, but lower PPTs compared to existing normative data, suggesting that it is relevant to evaluate the status of the pain system in these patients to prevent triggering or worsening of their symptoms. However, it remains unanswered how these changes affect the patients’ ability to undergo rehabilitation, symptom response and long-term shoulder function.

  • [1]

    Olds M, Ellis R, Donaldson K, Parmar P, Kersten P. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med 2015;49:913–22.

    • Crossref
    • PubMed
    • Export Citation
  • [2]

    Edouard P, Gasq D, Calmels P, Degache F. Sensorimotor control deficiency in recurrent anterior shoulder instability assessed with a stabilometric force platform. J Shoulder Elbow Surg 2014;23:355–60.

    • Crossref
    • PubMed
    • Export Citation
  • [3]

    Smith RL, Brunolli J. Shoulder kinesthesia after anterior glenohumeral joint dislocation. Phys Ther 1989;69:106–12.

    • Crossref
    • PubMed
    • Export Citation
  • [4]

    Zuckerman JD, Gallagher MA, Cuomo F, Rokito A. The effect of instability and subsequent anterior shoulder repair on proprioceptive ability. J Shoulder Elbow Surg 2003;12:105–9.

    • Crossref
    • PubMed
    • Export Citation
  • [5]

    Levine WN, Flatow EL. The pathophysiology of shoulder instability. Am J Sports Med 2000;28:910–7.

    • Crossref
    • PubMed
    • Export Citation
  • [6]

    Arendt-Nielsen L, Fernandez-de-Las-Penas C, Graven-Nielsen T. Basic aspects of musculoskeletal pain: from acute to chronic pain. J Man Manip Ther 2011;19:186–93.

    • Crossref
    • PubMed
    • Export Citation
  • [7]

    IASP Terminology. 2017. Available at: https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698.

  • [8]

    Herren-Gerber R, Weiss S, Arendt-Nielsen L, Petersen-Felix S, Di Stefano G, Radanov BP, Curatolo M. Modulation of central hypersensitivity by nociceptive input in chronic pain after whiplash injury. Pain Med 2004;5:366–76.

    • Crossref
    • PubMed
    • Export Citation
  • [9]

    Fernandez-de-Las-Penas C, Ge HY, Arendt-Nielsen L, Cuadrado ML, Pareja JA. The local and referred pain from myofascial trigger points in the temporalis muscle contributes to pain profile in chronic tension-type headache. Clin J Pain 2007;23:786–92.

    • Crossref
    • PubMed
    • Export Citation
  • [10]

    Graven-Nielsen T, Arendt-Nielsen L. Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol 2010;6:599–606.

    • Crossref
    • PubMed
    • Export Citation
  • [11]

    Noten S, Struyf F, Lluch E, D’Hoore M, Van Looveren E, Meeus M. Central pain processing in patients with shoulder pain: a review of the literature. Pain Pract 2017;17:267–80.

    • Crossref
    • PubMed
    • Export Citation
  • [12]

    Sanchis MN, Lluch E, Nijs J, Struyf F, Kangasperko M. The role of central sensitization in shoulder pain: A systematic literature review. Semin Arthritis Rheum 2015;44:710–6.

    • Crossref
    • PubMed
    • Export Citation
  • [13]

    Borstad J, Woeste C. The role of sensitization in musculoskeletal shoulder pain. Braz J Phys Ther 2015;19:251–7.

    • Crossref
    • PubMed
    • Export Citation
  • [14]

    Alburquerque-Sendin F, Camargo PR, Vieira A, Salvini TF. Bilateral myofascial trigger points and pressure pain thresholds in the shoulder muscles in patients with unilateral shoulder impingement syndrome: a blinded, controlled study. Clin J Pain 2013;29:478–86.

    • Crossref
    • PubMed
    • Export Citation
  • [15]

    Coronado RA, Simon CB, Valencia C, George SZ. Experimental pain responses support peripheral and central sensitization in patients with unilateral shoulder pain. Clin J Pain 2014;30:143–51.

    • PubMed
    • Export Citation
  • [16]

    Hidalgo-Lozano A, Fernandez-de-las-Penas C, Alonso-Blanco C, Ge HY, Arendt-Nielsen L, Arroyo-Morales M. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study. Exp Brain Res 2010;202:915–25.

    • Crossref
    • PubMed
    • Export Citation
  • [17]

    Hidalgo-Lozano A, Fernandez-de-las-Penas C, Calderon-Soto C, Domingo-Camara A, Madeleine P, Arroyo-Morales M. Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles. Scand J Med Sci Sports 2013;23:66–73.

    • Crossref
    • PubMed
    • Export Citation
  • [18]

    Paul TM, Soo Hoo J, Chae J, Wilson RD. Central hypersensitivity in patients with subacromial impingement syndrome. Arch Phys Med Rehabil 2012;93:2206–9.

    • Crossref
    • PubMed
    • Export Citation
  • [19]

    Gwilym SE, Oag HC, Tracey I, Carr AJ. Evidence that central sensitisation is present in patients with shoulder impingement syndrome and influences the outcome after surgery. J Bone Joint Surg Br 2011;93:498–502.

    • PubMed
    • Export Citation
  • [20]

    Valencia C, Kindler LL, Fillingim RB, George SZ. Investigation of central pain processing in shoulder pain: converging results from 2 musculoskeletal pain models. J Pain 2012;13:81–9.

    • Crossref
    • PubMed
    • Export Citation
  • [21]

    Valencia C, Kindler LL, Fillingim RB, George SZ. Stability of conditioned pain modulation in two musculoskeletal pain models: investigating the influence of shoulder pain intensity and gender. BMC Musculoskelet Disord 2013;14:182.

    • Crossref
    • PubMed
    • Export Citation
  • [22]

    Arendt-Nielsen L, Graven-Nielsen T. Translational musculoskeletal pain research. Best Pract Res Clin Rheumatol 2011;25:209–26.

    • Crossref
    • PubMed
    • Export Citation
  • [23]

    Eshoj H, Rasmussen S, Frich LH, Jensen SL, Sogaard K, Juul-Kristensen B. Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study. BMC Musculoskelet Disord 2019;20:59.

    • Crossref
    • PubMed
    • Export Citation
  • [24]

    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344–9.

    • Crossref
    • PubMed
    • Export Citation
  • [25]

    Skou ST, Roos EM, Simonsen O, Laursen MB, Rathleff MS, Arendt-Nielsen L, Rasmussen S. The efficacy of non-surgical treatment on pain and sensitization in patients with knee osteoarthritis: a pre-defined ancillary analysis from a randomized controlled trial. Osteoarthritis Cartilage 2016;24:108–16.

    • Crossref
    • PubMed
    • Export Citation
  • [26]

    Skou ST, Roos EM, Simonsen O, Laursen MB, Rathleff MS, Arendt-Nielsen L, Rasmussen S. The effects of total knee replacement and non-surgical treatment on pain sensitization and clinical pain. Eur J Pain 2016;20:1612–21.

    • Crossref
    • PubMed
    • Export Citation
  • [27]

    Cohen J, editor. Statistical power analysis for the behavioral sciences, 2nd ed. New York: Routledge, 1998:567.

  • [28]

    Gallo J, Raska M, Kriegova E, Goodman SB. Inflammation and its resolution and the musculoskeletal system. J Orthop Translat 2017;10:52–67.

    • Crossref
    • PubMed
    • Export Citation
  • [29]

    Park G, Kim CW, Park SB, Kim MJ, Jang SH. Reliability and usefulness of the pressure pain threshold measurement in patients with myofascial pain. Ann Rehabil Med 2011;35:412–7.

    • Crossref
    • PubMed
    • Export Citation
  • [30]

    Ribeiro IL, Camargo PR, Alburquerque-Sendin F, Madeleine P, Fernandez-de-las-Penas C, Salvini TF. Topographical pressure pain sensitivity maps of the shoulder region in individuals with subacromial pain syndrome. Man Ther 2016;21:134–43.

    • Crossref
    • PubMed
    • Export Citation
  • [31]

    Vaegter HB, Bjerregaard LK, Redin MM, Rasmussen SH, Graven-Nielsen T. Hypoalgesia after bicycling at lactate threshold is reliable between sessions. Eur J Appl Physiol 2019;119:91–102.

    • Crossref
    • PubMed
    • Export Citation
  • [32]

    Vaegter HB, Dorge DB, Schmidt KS, Jensen AH, Graven-Nielsen T. Test-retest reliability of exercise-induced hypoalgesia after aerobic exercise. Pain Med 2018;19:2212–22.

    • Crossref
    • PubMed
    • Export Citation
  • [33]

    Alsouhibani A, Vaegter HB, Hoeger Bement M. Systemic exercise-induced hypoalgesia following isometric exercise reduces conditioned pain modulation. Pain Med 2019;20:180–90.

    • Crossref
    • PubMed
    • Export Citation
  • [34]

    Nijs J, Goubert D, Ickmans K. Recognition and treatment of central sensitization in chronic pain patients: not limited to specialized care. J Orthop Sports Phys Ther 2016;46:1024–8.

    • Crossref
    • PubMed
    • Export Citation
  • [35]

    Neziri AY, Scaramozzino P, Andersen OK, Dickenson AH, Arendt-Nielsen L, Curatolo M. Reference values of mechanical and thermal pain tests in a pain-free population. Eur J Pain 2011;15:376–83.

    • Crossref
    • Export Citation
  • [36]

    Sheffield D, Biles PL, Orom H, Maixner W, Sheps DS. Race and sex differences in cutaneous pain perception. Psychosom Med 2000;62:517–23.

    • Crossref
    • PubMed
    • Export Citation
  • [37]

    Arendt-Nielsen L, Simonsen O, Laursen MB, Roos EM, Rathleff MS, Rasmussen S, Skou ST. Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months. Eur J Pain 2018;22:1088–102.

    • Crossref
    • PubMed
    • Export Citation
  • [38]

    Coggon D, Ntani G, Palmer KT, Felli VE, Harari R, Barrero LH, Felknor SA, Gimeno D, Cattrell A, Vargas-Prada S, Bonzini M, Solidaki E, Merisalu E, Habib RR, Sadeghian F, Masood Kadir M, Warnakulasuriya SS, Matsudaira K, Nyantumbu B, Sim MR, et al. Patterns of multisite pain and associations with risk factors. Pain 2013;154:1769–77.

    • Crossref
    • PubMed
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

Search