Dor no ombro e sua relação com a coluna cervical

Abstract

The first article had as objectives to verify if the cervical spine preferential direction exercise promotes immediate change in the activity and sequence of activation of the shoulder and shoulder girdle muscles in patients with shoulder pain and to verify if there is difference in the pattern of muscular activity and in the sequence of activation of these muscles between patients with pain complaints with and without the complementary exams diagnosis of shoulder dysfunction. We selected 14 individuals, who were separated into two groups: a group with pain and a complementary diagnosis of shoulder dysfunction and a group with pain and without a complementary diagnosis of shoulder dysfunction, the groups underwent initial evaluation, the exercise of preferential direction was identified, after rest they performed a series of 10 repetitions of the exercise, and then a new electromyographic reassessment. The second article had as objectives to verify if the exercise of preferential direction in the cervical spine promotes reduction of muscular activity and delay in the activation of the upper trapezius muscle after a week and a month of intervention in individuals with shoulder pain, to verify the size of the effect in the activity of the muscles after the exercise of preferential direction in the cervical spine and if it decreases the intensity of pain, functional incapacity, fear of movement and central sensitization through evaluation questionnaires. We selected 9 individuals with shoulder pain complaints over one week who performed cervical exercises daily, 4 sets of 10 repetitions distributed throughout the day and were reevaluated after one week and one month. In both articles, electromyography was used to evaluate the anterior deltoid, medial deltoid, upper trapezius and middle trapezius muscles. Samples were collected in the active movement and isometry in the abduction of the shoulder up to 80 ° in the scapular plane and also the maximum voluntary isometric contraction (MVIC) of each muscle to normalize the activity. For the first article we conclude that there was no immediate change in the activity of the anterior and middle fibers of the deltoid muscle and upper and middle fibers os the trapezius muscle and in the muscle activation sequence of patients with shoulder pain in this study. And no difference was found in muscle activity and in the activation sequence of these muscles between the groups with and without diagnosis by complementary tests of shoulder dysfunction. For the second article, we conclude that the preferential cervical spine exercise promoted a significant reduction of upper trapezius muscle activity, but did not interfere with its activation after one month of intervention in a sample of individuals with chronic shoulder pain. And the preferential direction exercise for the cervical spine promoted a very large effect size for the upper trapezius muscle and am average effect for the anterior deltoid muscle, both between one week and one month of exercise, and also decreased pain intensity, disability and central sensitization in individuals with shoulder pain.

A dor no ombro pode ter diversas causas, dentre elas, disfunções das estruturas que envolvem a articulação e também disfunção da coluna cervical. Os exercícios repetidos de direção preferencial, identificados pela resposta sintomática dos pacientes, podem ser utilizados como forma de tratamento para a dor no ombro. Os objetivos deste estudo são: verificar se o exercício ativo de direção preferencial da coluna cervical promove uma resposta imediata na atividade e na sequência de ativação dos músculos do ombro e cintura escapular em pacientes com dor no ombro e verificar se existe diferença no padrão de atividade muscular e na sequência de ativação dos músculos do ombro e escapulares entre pacientes com queixa de dor no ombro com e sem diagnóstico de exames complementares de disfunção do ombro. Como resultados não foram encontradas mudanças imediatas na atividade dos músculos e na sequência de ativação após os exercícios de direção preferencial e os grupos não se diferenciaram. Nossos achados sugerem que exercícios ativos de direção preferencial para coluna cervical não causam resposta imediata na ativação e na sequência de ativação dos músculos do ombro e cintura escapular em indivíduos com dor no ombro e grupos com e sem diagnóstico complementar por imagem não se diferenciaram neste estudo.

Shoulder pain can have several causes, including dysfunctions of the structures that involve the joint and also dysfunction of the cervical spine. Repeated preferential direction exercises, identified by the patients' symptomatic response, can be used as a form of treatment for shoulder pain. The objectives of this study are: to verify if the active exercise of preferential direction of the cervical spine promotes an immediate response in the activity and sequence of activation of the shoulder and shoulder girdle muscles in patients with shoulder pain and to verify if there is difference in the pattern of activity muscle and following activation of the shoulder and scapular muscles among patients complaining of shoulder pain with and without diagnosis of complementary exams of shoulder dysfunction. As results there were no immediate changes in muscle activity and activation sequence after the preferential direction exercises and the groups did not differentiate. Our findings suggest that active preferential cervical spine exercises do not cause an immediate response to activation and activation of the shoulder and shoulder girdle muscles in individuals with shoulder pain, and groups with and without complementary imaging were not differentiated in this study.

A dor associada a mudanças na atividade muscular pode causar inibição dos músculos e alterações nas respostas motoras. A descompressão da raiz nervosa, identificada pela resposta sintomática, pode ter resposta imediata a exercícios repetidos cervicais e promover mudanças no comportamento dos músculos do ombro e cintura escapular em indivíduos com dor no ombro. Os objetivos do estudo são verificar se o exercício de direção preferencial na coluna cervical promove redução da atividade muscular e atraso na ativação do músculo trapézio superior após uma semana e um mês de intervenção em indivíduos com dor no ombro; e verificar o tamanho do efeito na atividade dos músculos após o exercício de direção preferencial na coluna cervical e se o mesmo diminui a intensidade da dor, incapacidade funcional, medo ao movimento e sensibilização central, avaliados através de questionários específicos. Como resultados, obtivemos que o exercício promoveu redução significativa da atividade do músculo trapézio superior entre uma semana e um mês de exercícios diários, porém não influenciou em seu atraso na ativação. Os resultados apresentaram tamanho do efeito muito grande para o músculo trapézio superior e médio para o músculo deltoide anterior, diminuição significativa da dor, da incapacidade do ombro e da sensibilização central do indivíduo acometido pela dor no ombro. Concluindo que exercícios de direção preferencial para coluna cervical apresentaram respostas positivas na diminuição da atividade do músculo trapézio superior, na diminuição da dor, da incapacidade e da sensibilização central em indivíduos com dor no ombro.

Pain associated with changes in muscle activity may cause muscle inhibition and changes in motor responses. Nerve root decompression, identified by symptomatic response, may respond immediately to repeated cervical exercises and promote changes in the behavior of shoulder and shoulder muscles in individuals with shoulder pain. The objectives of the study are to verify if the exercise of preferential direction in the cervical spine promotes reduction of muscular activity and delay in the activation of the upper trapezius muscle after one week and one month of intervention in individuals with shoulder pain; and to verify the size of the effect on the activity of the muscles after the exercise of preferential direction in the cervical spine and if it reduces the intensity of pain, functional incapacity, fear of movement and central sensitization, evaluated through specific questionnaires. As results, we obtained that the exercise promoted a significant reduction of upper trapezius muscle activity between one week and one month of daily exercises, but did not influence its delay in activation. The results showed a very large effect size for upper and middle trapezius muscle for the anterior deltoid muscle, significant decrease of pain, shoulder disability and central sensitization of the individual affected by shoulder pain. Conclusions: Preferential cervical spine exercises presented positive responses in the reduction of upper trapezius muscle activity, decreased pain, disability and central sensitization in individuals with shoulder pain.