Dor no ombro: paradoxo entre o modelo patoanatômico e medidas clínicas
Abstract
Introduction: The evaluation of patients with shoulder pain is highly influenced by
pathoanatomical factors. Special tests and imaging are commonly used to the clinical
decision-making. However, some studies have called this model into question suggesting
more diversified evaluation systems such as movement-based and psychosocial aspects.
Objectives: To verify the association of pathoanatomical factors with the symptom
presentation and determine if pathoanatomical factors contribute to the self-reported
shoulder function. Methods: Magnetic resonance imaging was used to evaluate in detail
pathoanatomical abnormalities in individuals with unilateral shoulder pain. Images in the
coronal, sagittal, and axial planes were generated and independently interpreted by a
board-certified, orthopedic fellowship trained orthopedic shoulder surgeon and a
musculoskeletal radiologist. Frequencies of pathoanatomical abnormalities for both
shoulders were compared and the agreement across the evaluators was verified. In order
to assess if pathoanatomical factors contributed to the self-reported shoulder function, a
multivariate model was built considering the total score of the Disabilities of the Arm,
Shoulder, and Hand (DASH) as the dependent variable. Clinical, demographics, pain
catastrophizing, and special tests were used as explanatory variables. Results: Both
shoulders presented a high prevalence of pathoanatomical abnormalities. Symptomatic
shoulders showed the highest frequency of full-thickness tear and glenohumeral
osteoarthrosis. Other observed pathoanatomical abnormalities did not show statistically
significant differences between both shoulders. Pathoanatomical variables did not
contribute to the multivariate model. The group of variables that best explained the selfreported shoulder function were pain intensity at rest, pain catastrophizing level, and
acromioclavicular joint tenderness during palpation. Conclusions: Full-thickness rotator
cuff tears and the presence of glenohumeral osteoarthrosis seem to be the only
pathoanatomical abnormalities associated with the symptoms. Elevated pain
catastrophizing levels and pain intensity at rest as well as acromioclavicular joint
tenderness were the best explanatory variables to decreased self-reported shoulder
function. Health professionals must be aware that most pathoanatomical abnormalities
assessed with the magnetic resonance imaging are not related to the symptoms.