Prevalence and Anatomical Location of Muscle Tenderness among Adults with Nonspecific Shoulder/Neck Pain But without any Traumatic Injuries and other Chronic Disease

 

Vaishnavi Sivakali Subramanian, Dr. Saravana Kumar

¹BDS 1^st Year, Saveetha Dental College, Chennai

²Assistant Professor of Anatomy, Department of Anatomy , Saveetha Dental College, Chennai

 

ABSTRACT:

AIM: The aim of the study is to evaluate the prevalence and anatomical locations of muscle tenderness among adults with nonspecific neck/shoulder pain but without any traumatic injuries and other serious chronic disease. OBJECTIVE : To find various causes for nonspecific neck/shoulder pain. BACKGROUND: Many adults experience bothersome neck/shoulder pain. It is the one of the common symptom in primary care. It can be due to an intrinsic shoulder problem but pain can also be referred from other structure, such as the neck , diaphragm or heart. METHODS: This study required 50 patients those who are suffering from non specific shoulder or neck pain by examining the tenderness for the selected shoulder muscle. Inclusion criteria for this study was confined to the patients with nonspecific shoulder pain with age limit 30-55 ,and duration of pain about more than 6 months. Exclusion criteria for selection of patients for this study were limited to traumatic injuries, any other chronic disease cardiovascular disease, osteoporosis, arthritis and pregnant women. Then examination for muscle tenderness was done by palpating the selected muscles which are Upper Trapezius, Neckextensor, Levator scapulae and Infraspinatus. Based on the patients response during palpation , the examiner used a score of 1-3 corresponding to “ no pain”, moderate pain”, and “ severe pain”. RESULTS: In our present study we found that neck extensors(=0.712>0.500 )and levator scapulae(=0.886>0.500) were significant in Chi square test for muscle tenderness for nonspecific shoulder pain. Whereas Upper trapezius and infra Spinatus are found to be not significant for muscle tenderness .While our study also determined that females have tenderness score much more that males. And while comparing the percentage of tenderness score the muscles between sides (right and left side) upper trapezius and neck extensor were significant at the left side where as the levator scapulae and infra spinatus were more significant in right side of the shoulder. CONCLUSION: Many studies show that only upper trapezius play a major role in shoulder/neck pain.But there are other related muscles that are also significant or a cause for shoulder/neck pain. Therefore as a conclusion of our study ,not only upper trapezius is significant ,but also neck extensor ,levator scapulae and infra spinatus are also significant for tenderness during shoulder/neck pain.Future research should not only focus on upper trapezius but also on levator scapulae, infra spinatus and neck extensor.

 

 

 

INTRODUCTION:

Approximately 1/3rd of working age adults ranging from 25 to 45 years of age are regularly bothered by neck and shoulder pain. Musculoskeletal disorder of the neck and shoulder is highly influenced by prolonged static working positions leading to reduced local blood flow ,accumulation of Ca2+ and other homeostatic changes in active muscle fibers .Usually , the tenderness of the upper trapezius muscle often co-exists with neck /shoulder pain.[1] Chronic neck and shoulder pain (NSP) is a type of musculoskeletal pain typically occurring in middle- and older-aged people [2–4]. The prevalence of NSP is approximately 16% to 78% among the general population[3–5]. The impact of chronic pain on the family includes social activities, life changes, emotional impact, and alteration of future plans [6]. There are many causes, following are considered to be major causes of shoulder or neck pain.

 

Intrinsic shoulder pain:

Rotator cuff disorders and Rotator cuff tears: Failure of tendon healing after rotator cuff repair (RCR) is common, reported in approximately 20% of cases, depending on tear size.[7] Tear recurrence can be related to various factors such as: (1) inadequate strength of the initial repair construct, (2) biological failure to heal despite strong initial fixation and (3) inappropriate postoperative rehabilitation causing structural failure of the repair.[8]

 

Subacromial pain: which may be due to impingement if the humeral head is not depressed sufficiently to slide under the acromion on elevation of the arm. It is also sometimes referred to as subacromial bursitis, tendonitis or tendinopathy. Calcific tendonitis.[1]

 

Glenohumeral disorders: adhesive capsulitis ,arthritis. Acromioclavicular disorders. Biceps tendonitis. Shoulder instability - associated with hypermobility including subluxation or dislocation[1]

 

Extrinsic shoulder pain:

Referred pain: neck pain, myocardial ischaemia, referred diaphragmatic pain. Polymyalgia rheumatica.Malignancy: apical lung cancers, metastases [1]

 

Many people experience soreness of neck/shoulder muscle after prolonged computer work. The soreness is usually present in different neck/shoulder muscle for example: trapezius, lavatory scapulae, neck extensors and infraspinatus. For few the soreness and pain can be for few days or few hours.But for some it persists and aggravates over time and becomes chronic.

 

METHODS:

This study required 50 patients those who are suffering from non specific shoulder or neck pain by examining the tenderness for the selected shoulder muscle. Inclusion criteria for this study was confined to the patients with nonspecific shoulder pain with age limit 30-55 ,and duration of pain about more than 6 months. Exclusion criteria for selection of patients for this study were limited to traumatic injuries, any other chronic disease cardiovascular disease, osteoporosis, arthritis and pregnant women. Then examination for muscle tenderness was done by palpating the selected muscles which are Upper Trapezius, Neckextensor, Levator scapulae and Infraspinatus. Based on the patients response during palpation , the examiner used a score of 1-3 corresponding to “ no pain”, moderate pain”, and “ severe pain” .

 

Upper trapezius	Neck extensors	Levator Scapulae	Infra Spinatus
Using a pinch grip with thumb and index finger , we palpated the upper trapezius muscle from the acromion to the border of the neck [9].	Using index and middle finger ,we palpated neck extensor muscle from the 6th cervical vertebra to below the occipital border [9].	Using index finger with the reinforcement from middle finger, we palpated levator scapulae until the 6th cervical vertebrae[9].	Using index finger with reinforcement from the middle finger , we palpated the spot where infraspinatus is superficial – below the posterior deltoid lateral to medial trapezius [9].

 

RESULTS:

Table 1.1 a) Upper trapezius SIDES (right and left side)

 

Table 1.1b) Chi square test for Upper trapezius tenderness

 

Figure 1.1 a) Graph for Upper trapezius SIDES	Table 1.1 c)Upper trapezius GENDER +SIDES

 

Table 1.1 d) Chi square test for upper trapezius SIDES

                                    

Figure 1.1 b)Graphs for upper trapezius GENDER+ SIDES

 

Table 1.2 a) Neck extensor SIDES (right and left side)	Table 1.2 b)Chi square test for Neck extensor muscle tenderness

  

                                                          

Figure 1.2 a)Graph of Neck extensor SIDES

 

Table 1.2 c) Neck extensor GENDER+SIDES	Table 1.2 d) Chi square Test for Neck extensor SIDES

                   

Figure 1.2 b) Graphs for Neck extensor GENDER+ SIDES

 

Table 1.3 a) Levator scapulae SIDES (right and left sides)	Table 1.3 b)  Chi square test for Levator scapulae tenderness

 

Figure 1.3 a) Graph for levator scapulae SIDES

 

Table 1.3 c)Levator scapulae GENDER+SIDES	Table 1.3 d) Chi square test for Levator scapulae SIDES

 

 

Figure 1.3 b)Graphs for Levator scapulae GENDER +SIDES

 

                     

Table 1.4 a)Infra spinatus SIDES (right and left sides)	Table 1.4 b)Chi square test for Infra spinatus Muscle tenderness

 

Figure 1.4 a)Graph for Infra spinatus SIDES

 

Table 1.4 c)Infra spinatus GENDER+SIDES	Table 1.4 d)Chi square test for Infra spinatus SIDES

 

Figure 1.4 b)	Figure 1.4 c)

 

             

 

From the above tables and graph ,our study shows percentage of tenderness score with significant levels between anatomical location, gender and sides of the shoulder/neck(right and left side).The significance level for Chi- square test :if the value is >0.500 ,it is significant. If the value is<0.500 , it is not significant.

 

Upper trapezius

In females percentage score for severe pain tenderness is 50% in right side and 45% in left side  .Whereas in males it was found to be 50% in right side and 54% in left side.The Chi- square test significance level for upper trapezius muscles between the sides shows that both left and right side are significant. But right side muscle(=0.920 >0.500) is more significant that the left side muscle (=0.665>0.500).The percentage of the tenderness score within the upper trapezius muscle between the right and left sides are found to be 52% in right side and 66% in left side.

 

Neck Extensor

In females percentage score for severe pain tenderness is 55% in right side and 54% in left side. Whereas in males it was found to be 44% in right side and 45% in left side. The Chi- square test significance level for neck extensor  muscles between the sides shows that right side (=0.694>0.500) of the muscle is significant and left side (=0.13<0.500) is not significant. The percentage of the tenderness score within the upper trapezius muscle between the right and left sides are found to be 52% in right side and 66% in left side.

 

Levator Scapulae

In females percentage score for severe pain tenderness is 50% in right side and 37% in left side. Whereas in males it was found to be 50% in right side and 62% in left side. The Chi- square test significance level for levator scapulae  muscles between the sides shows that both the right side muscle (=0.403<0.500) and left side muscle (=0.15<0.500) are not significant .But the percentage of the tenderness score within the Levator scapulae muscle between the right and left sides are found to be 60% in right side and 58% in left side, that is right side tenderness score is more than left side muscle.

 

Infra Spinatus

In females percentage score for severe pain tenderness is 59% in right side and 56% in left side. Whereas in males it was found to be 40% in right side and 44% in left side.The Chi- square test significance level for infra spinatus muscles between the sides shows that right side(=0.127<0.500) of the muscle is not significant and left side(=0.680>0.500) is significant. The percentage of the tenderness score within the infra spinatus muscle between the right and left sides are found to be 64% in right side and 50% in left side.

 

DISCUSSION:

Neck and shoulder pain, back pain and low back pain are common symptoms in the clinical setting.[10]Takasawa et al . reported that the prevalence of neck and  shoulder pain in the Japanese general population was 48.3 % according to the data of medical checkups for the general population [11]. Yoshimura et al. surveyed the prevalence of motor system organs and reported that the prevalence of low back pain in the Japanese general population was 37.7 % [12]. Yalcinkaya et al. investigated whole-body physical fitness parameters including body composition in Turkish patients with chronic neck pain and healthy controls, and reported that the body fat percentage was higher in male patients with chronic neck pain [13]. However, all subjects with chronic neck pain in their study were patients who had been referred to a department of rehabilitation, whereas the subjects in the present study were from the general population. In addition, they did not investigate the association between pain intensity and body composition, unlike the method adopted in the present study. Lizuka et al studied found some association between body composition and neck and shoulder pain (katakori in Japanese) among Japanese subjects, demonstrated that a smaller percentage in the body water ratio was associated with the presence of neck and shoulder pain and that total body muscle mass, appendicular muscle mass, and the AMI were negatively correlated with the intensity of neck and shoulder pain according to the multivariate analyses[10]. Debora et al .studied that people with chronic neck pain demonstrate a reduced ability to maintain an upright posture when distracted. Following intervention with an exercise program targeted at training the craniocervical flexor muscles, subjects with neck pain demonstrated an improved ability to maintain a neutral cervical posture during prolonged sitting[14]. Won et al. found that the mean change in upper trapezius muscle activity decreased significantly in the feel-pain muscle section compared to the non-feel pain section. Thus, changes in the activities of the muscle sections were of more value when studying static or sustained muscle stress, such as that associated with computer work.Their study also shows found no difference between the feel-pain and non-feel-pain sections in mean normalized upper trapezius muscle activity. Higher activity of the upper trapezius muscle can be interpreted as bad or good, and suggests muscle hypertension or postural variation, respectively. Muscle hypertension is present if more activity is needed to maintain the same posture. However, if more muscle activity is used to vary posture, this may help relieve musculoskeletal loading. Therefore, we hypothesized originally that muscle activity would not be useful to detect[15]. Hägg suggested that degeneration of type-1a muscle fibers is caused by overuse, which induces pain in the upper trapezius region). This hypothesis suggests that the pain is caused by a long period of low upper trapezius motor unit recruitment). Sustained activation of this specific muscular region could promote muscular damage, even with a low level of muscular recruitment[16]. A number of authors have explored the possibility that an abnormality in cervical motor control could contribute to the persistence of pain in this region due to factors that perpetuate a mechanical nociceptive mechanism in cervical structures, as well as muscle fatigue, which is inherent to these patients. Several techniques of treating non specific neck pain have been shown to be effective in terms of achieving a clinical improvement in patients, including muscular massage, stretching, specific therapeutic exercises, scapular movements, physiotherapeutic resources (electrothermal), and acupuncture. A study demonstrated the immediate effect of auricular acupuncture (Nogier method) on the electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain and healthy subjects. The effect of this intervention on pain symptoms in patients with NSNP was inconclusive, given that the decreases observed in the true and sham auricular acupuncture treatment protocols were practically the same. (17). In our present study we found that neck extensors (=0.712>0.500) and levator scapulae (=0.886>0.500) were significant in Chi square test for muscle tenderness for nonspecific shoulder pain. Whereas Upper trapezius and infra Spinatus are found to be not significant for muscle tenderness .While our study also determined that females have tenderness score much more than males. And while comparing the percentage of tenderness score the muscles between sides (right and left side) upper trapezius and neck extensor were significant at the left side where as the levator scapulae and infra spinatus were more significant in right side of the shoulder.

 

CONCLUSION:

Many studies show that only upper trapezius play a major role in shoulder/neck pain. But there are other related muscles that are also significant or a cause for shoulder/neck pain. Therefore as a conclusion of our study ,not only upper trapezius is significant ,but also neck extensor ,levator scapulae and infra spinatus are also significant for tenderness during shoulder/neck pain. Future research should not only focus on upper trapezius but also on levator scapulae, infra spinatus and neck extensor.

 

REFFERENCE:

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3)    N. A. Broadhurst, C. A. Barton, L. A. Yelland, D. K. Martin, and J. J. Beilby, “Managing shoulder pain in general practice,” AustralianFamilyPhysician,vol.35,no.9,pp.751–752,2006.

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13) Yalcinkaya H, Ucok K, Ulasli AM, Coban NF, Aydin S, Kaya I, et al. Do male and female patients with chronic neck pain really have different health related physical fitness, depression, anxiety and quality of life. Int J Rheum Dis. 2014 (in press).

14)  Deborah Falla, Gwendolen Jull, Trevor Russell, Bill Vicenzino, Paul Hodges; Effect of Neck Exercise on Sitting Posture in Patients With Chronic Neck Pain . PHYS THER March 6,  2007; 87:408-417

15) Won-gyu Yoo, Comparison of activation and change in the upper trapezius muscle during painful and non-painful computer work; J. Phys. Ther. Sci. 27: 3283–3284, 2015.

16) Hägg GM: Static workloads and occupational myalgia—a new explanation model. Electromyographical Kinesiology. Amsterdam: Elsevier Science, 1991, pp 141–143

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Accepted on 06.10.2016        © RJPT All right reserved

Research J. Pharm. and Tech 2016; 9(12):2407-2414.