Burner Todd, Abbott Daniel, Huber Karri, Stout Monica, Fleming Raymond, Wessel Bambi, Massey Ellen, Rosenthal Ann, Burns Edith
1Medical College of Wisconsin, Milwaukee. 2University of Wisconsin-Milwaukee.
J Geriatr Phys Ther. 2014 Oct-Dec;37(4):154-8. doi: 10.1519/JPT.0b013e3182abe7d6.
Musculoskeletal problems, including shoulder pain, are common in the general population and are often cited as reasons for physician visits. Although many risk factors for shoulder pain are postulated, the effects of shoulder pain on functional level and perceived quality of life are poorly characterized in older adults. In this study, we set out to determine the prevalence and impact of shoulder symptoms and dysfunction in an older adult veteran population.
A chart review, cross-sectional survey, and examination were performed. A sample of 93 individuals, aged 60 years or older, was recruited from a primary clinic outpatient waiting room at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin. Patients were asked about shoulder symptoms and self-assessed health and completed the Stanford Modified Health Assessment Questionnaire. A series of 3 shoulder maneuvers was used to assess shoulder mobility and pain. The presence of diabetes and statin use was documented. A more thorough chart review was performed on individuals who reported shoulder pain and disability.
Severe shoulder pain was common in the study group, reported by 31% of all participants. Functional limitation measured by the Modified Health Assessment Questionnaire and answering "yes" to greater difficulty performing daily tasks was associated with reduced internal rotation, which was present in almost 36% of all participants. Symptoms were often bilateral. No statistically significant risk factors emerged in this small sample, but suggestive trends were apparent. Interestingly, few patients reported discussing these problems with their providers, and shoulder-related problems were documented in only 10% of corresponding problem lists of symptomatic patients.
With an aging population, the high prevalence of shoulder pain may have considerable impact on public health. It will become increasingly important to define risk factors, delineate etiologies, and devise new management strategies for patients with symptomatic shoulder disease.
肌肉骨骼问题，包括肩痛，在普通人群中很常见，并且经常被提及是就医的原因。尽管推测出了许多肩痛的危险因素，但在老年人中，肩痛对功能水平和生活质量感知的影响却鲜有描述。在本研究中，我们着手确定老年退伍军人人群中肩部症状和功能障碍的患病率及影响。
进行了病历回顾、横断面调查及检查。从威斯康星州密尔沃基市克莱门特·J·扎布罗茨基退伍军人事务医疗中心的一家初级诊所门诊候诊室招募了93名年龄在60岁及以上的个体。询问患者肩部症状、自我评估健康状况，并完成斯坦福改良健康评估问卷。采用一系列3种肩部动作来评估肩部活动度和疼痛情况。记录糖尿病的存在情况和他汀类药物的使用情况。对报告有肩痛和残疾的个体进行了更全面的病历回顾。
严重肩痛在研究组中很常见，所有参与者中有31%报告有该症状。通过改良健康评估问卷测量的功能受限以及对日常任务执行难度增加回答“是”与内旋减少相关，几乎36%的参与者存在内旋减少情况。症状通常为双侧性。在这个小样本中未出现统计学上显著的危险因素，但有明显的提示性趋势。有趣的是，很少有患者报告与他们的医疗服务提供者讨论过这些问题，并且在有症状患者相应的问题清单中，仅有10%记录了与肩部相关的问题。
随着人口老龄化，肩痛的高患病率可能对公共卫生有相当大的影响。确定危险因素、明确病因并为有症状的肩部疾病患者制定新的管理策略将变得越来越重要。
