Brindisino Fabrizio, Giovannico Giuseppe, Maselli Filippo
Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
Physiotherapy and Manual Therapy, Physiotherapy Department, Lecce, Italy.
J Back Musculoskelet Rehabil. 2020;33(2):329-337. doi: 10.3233/BMR-171069.
Shoulder pain is one of the most common problems affecting people older than 60 years. Among the shoulder pathologies, the disorders of the periarticular soft tissue (e.g. rotator cuff) are considered to be the most common; moreover, these disorders are found in approximately 75% of patients with seropositive rheumatoid arthritis. The incidence of structural rotator cuff tendon pathology, including full-thickness rotator cuff tendon tears, increases with age. Recent researchers suggested that non-operative treatment of full-thickness rotator cuff tears could be successful in some patients; furthermore, in rheumatoid arthritis patients, there was a greater possibility of developing surgical complications compared with non-rheumatoid arthritis patients.
A case report of a woman, 72 years old, with rheumatoid arthritis, shoulder pain and pseudo-paralytic arm presented with a massive tear of Supraspinatus and Infraspinatus tendon. In accordance with evidence, the case was managed using pain education and exercise therapy for 2.5 months. The shoulder pain, the function and the range of motion improved following a physiotherapy program.
Pain education in combination with exercise therapy was effective for improving pain and function in a full-thickness tear of Supraspinatus and Infraspinatus tendon in a patient also suffering from rheumatoid arthritis.
肩痛是影响60岁以上人群的最常见问题之一。在肩部病变中，关节周围软组织疾病（如肩袖）被认为是最常见的；此外，这些疾病在约75%的血清阳性类风湿性关节炎患者中出现。包括全层肩袖肌腱撕裂在内的结构性肩袖肌腱病变的发生率随年龄增长而增加。最近的研究表明，全层肩袖撕裂的非手术治疗在一些患者中可能会成功；此外，与非类风湿性关节炎患者相比，类风湿性关节炎患者发生手术并发症的可能性更大。
报告一例72岁患有类风湿性关节炎、肩痛和假性麻痹手臂的女性病例，其冈上肌和冈下肌肌腱出现大面积撕裂。根据证据，该病例采用疼痛教育和运动疗法治疗2.5个月。经过物理治疗方案后，肩部疼痛、功能和活动范围得到改善。
疼痛教育与运动疗法相结合，对于改善同时患有类风湿性关节炎的患者冈上肌和冈下肌肌腱全层撕裂的疼痛和功能有效。
