Cryotherapy does not impair shoulder joint position sense

doi:10.1016/j.apmr.2003.11.030

Archives of Physical Medicine and Rehabilitation

Volume 85, Issue 8, August 2004, Pages 1241-1246

https://doi.org/10.1016/j.apmr.2003.11.030 Get rights and content

Abstract

Dover G, Powers ME. Cryotherapy does not impair shoulder joint position sense. Arch Phys Med Rehabil 2004;85:1241–6.

Objective

To determine the effects of a cryotherapy treatment on shoulder proprioception.

Design

Crossover design with repeated measures.

Setting

University athletic training and sports medicine research laboratory.

Participants

Thirty healthy subjects (15 women, 15 men).

Intervention

A 30-minute cryotherapy treatment.

Main outcome measures

Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception.

Results

Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application.

Conclusions

Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.

Section snippets

Participants

Thirty volunteers from the university setting, 15 men (mean age ± standard deviation [SD], 23.7±5.5y; height, 180.0±6.4cm; mass, 86.7±18.6kg) and 15 women (mean age ± SD; 20.7±1.4y; height, 165.0±5.5cm; mass, 58.6±6.9kg) participated in the study. Results from a power analysis indicated that 30 subjects were sufficient to identify differences between error scores. Before participating, all subjects signed an informed consent agreement approved by the university’s institutional review board.

Gender differences

We found no significant differences when we compared male and female skin surface temperatures during the cryotherapy session (F_7,196=1.75, P=.100). After the 30 minutes of cryotherapy, the mean male skin temperature ± SD was 13.3°±2.8° and for females skin temperature was 13.0°±2.2°. Therefore, we combined the temperature data across the genders for the rest of the analyses. Moreover, no differences were observed between the percentage of body fat (t=−.798, P=.432) and skinfold thickness (t

Discussion

The primary finding of this study indicates that 30 minutes of cryotherapy does not impair shoulder JPS because no differences were observed when comparing error scores before and immediately after the ice bag treatment. There was no change in repositioning error after treatment, according to analyses that included direction bias and variability factors. These findings conflict with the reports of 2 previous studies17, 18 that investigated cryotherapy and proprioception in the knee and the

Conclusions

The present findings did not support the hypothesis that cryotherapy impairs shoulder JPS. Clinicians should be aware of this information in making decisions during rehabilitation of shoulder injuries.

Suppliers

Acknowledgements

We thank James Cauraugh for his invaluable contributions revising the manuscript.

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Interscalene brachial plexus bolus block versus patient-controlled interscalene indwelling catheter analgesia for the first 48 hours after arthroscopic rotator cuff repair
2018, Journal of Shoulder and Elbow Surgery
We sought to compare the efficacy of interscalene brachial plexus bolus blockade (IBPBB) and patient-controlled interscalene indwelling catheter analgesia (PCIA) for postoperative pain management within 48 hours postoperatively in patients undergoing arthroscopic rotator cuff repairs (ARCR).
Patients undergoing ARCR were randomized into 3 groups by postoperative analgesia method. The IBPBB group received a mixed solution of 16 mL of 0.75% ropivacaine and 4 mL of 2% lidocaine as a bolus postoperatively. The PCIA group received a 10-mL bolus solution of 0.75% ropivacaine (4 mL) and 5% dextrose water (6 mL) just after the operation and continuous infusion of this solution. The control received only meperidine as needed, 12.5 mg, intravenously. Visual analog scale (VAS) pain scores were evaluated for the first 48 hours postoperatively.
For the first 2 hours postoperatively, VAS scores in the IBPBB group were significantly lower than in the PCIA group and control group, but at 12 and 24 hours postoperatively, VAS scores of the IBPBB group were significantly higher than the PCIA group (P < .05). At 48 hours postoperatively, there was no significant difference in VAS scores among the 3 groups (P = .169). The method of analgesia was the only factor affecting pain scores at 24 hours postoperatively (P < .05).
IBPBB provided effective immediate postoperative analgesia until 6 hours postoperatively. Especially until postoperative 2 hours, the VAS pain score was less than 1 point in the IBPBB group; however, there was significant rebound pain at 12 hours after surgery. During the first 24 hours postoperatively, PCIA reduced postoperative pain without rebound pain. Surgeons should choose methods for control of postoperative pain considering the advantages and disadvantages of each analgesic method.
Postoperative pain control after arthroscopic rotator cuff repair
2016, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
Although the theoretical benefits of gabapentin are promising, the use of gabapentin as an adjunct medication after outpatient ARCR has not yet been validated to recommend routine use. Cold therapy to control pain and swelling has been widely used in ARCR.36,61,89 Speer et al reported a prospective study showing that cryotherapy was associated with reduced pain and swelling, decreased opioid use, and better overall sleep quality after rotator cuff repair.106
Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge. Although intravenous and oral opioids are the cornerstone of pain management after orthopedic procedures, they are associated with drowsiness, nausea, vomiting, and increased length of hospital stay. As health care reimbursements continue to become more intimately focused on quality, patient satisfaction, and minimizing of complications, the need for adequate pain control with minimal complications will continue to be a principal focus for providers and institutions alike. We present a review of alternative modalities for pain relief after ARCR, including cryotherapy, intralesional anesthesia, nerve blockade, indwelling continuous nerve block catheters, and multimodal anesthesia. In choosing among these modalities, physicians should consider patient- and system-based factors to allow the efficient delivery of analgesia that optimizes recovery and improves patient satisfaction.
An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend
2016, Physical Therapy in Sport
Citation Excerpt :
Functional impairments in JPS at the knee were also reported by Watanabe et al. (2013) following a cryotherapy application time of 15 min. Studies on the ankle (Hopper, Whittington, & Davis, 1997; La Riviere & Osternig, 1994) and the shoulder (Dover & Powers, 2004; Wassinger, Myers, Gatti, Conley, & Lephart, 2007) have also shown conflicting results. Reductions in JPS are commonly assessed clinically to identify proprioceptive deficits these may indicate that an individual is at risk of injury (Bleakley, McDonough, & MacAuley, 2006; Costello & Donnelly, 2010; Surenkok et al., 2008; Uchio, Ochi, Fujihara, Adichi, Iwasa, & Sakai, 2003; Wassinger et al., 2007; Zazulak, Hewett, Reeves, Goldberg, & Cholewicki, 2007).
The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 min application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend.
Pre- and post-intervention.
University movement analysis laboratory.
Eleven healthy male participants.
Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee.
Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P = .035) and coronal (P = .011) planes during the descent phase of a small knee bend following cryotherapy.
In conclusion a 20 min application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury.
Effect of cryotherapy after elbow arthrolysis: A prospective, single-blinded, randomized controlled study
2015, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
A systematic review conducted by Adie et al12 showed a slight benefit from cryotherapy treatment in blood loss after TKA; however, the transfusion rate was not significantly changed. These benefits were not found in trials performed on shoulders or hips.13,14,21,22 In the current study, we found no significant difference in postoperative hemovac output, but the drain discharge in the first 24 hours postoperatively was slightly less in the cryotherapy group than in the control group.
To investigate the effect of cryotherapy after elbow arthrolysis on elbow pain, blood loss, analgesic consumption, range of motion, and long-term elbow function.
Prospective, single-blinded, randomized controlled study.
University hospital.
Patients (N=59; 27 women, 32 men) who received elbow arthrolysis.
Patients were randomly assigned into a cryotherapy group (n=31, cryotherapy plus standard care) or a control group (n=28, standard care).
Elbow pain at rest and in motion were measured using a visual analog scale (VAS) on postoperative day (POD) 1 to POD 7 and at 2 weeks and 3 months after surgery. Blood loss and analgesic consumption were recorded postoperatively. Elbow range of motion (ROM) was measured before surgery and on POD 1, POD 7, and 3 months after surgery. The Mayo Elbow Performance Score (MEPS) was evaluated preoperatively and 3 months postoperatively.
VAS scores were significantly lower in the cryotherapy group during the first 7 PODs, both at rest and in motion (P<.05). There were no significant differences between the 2 groups in VAS scores at 2 weeks and 3 months after surgery. Less sufentanil was consumed by the cryotherapy group than the control group for pain relief (P<.01). No significant differences were found in blood loss, ROM, and MEPS between the 2 groups (P>.05).
Cryotherapy is effective in relieving pain and reducing analgesic consumption for patients received elbow arthrolysis. The application of cryotherapy will not affect blood loss, ROM, or elbow function.
Exercises for Proprioception and Balance
2013, Canine Rehabilitation and Physical Therapy: Second Edition

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ArticlesCryotherapy does not impair shoulder joint position sense1

Abstract

Objective

Design

Setting

Participants

Intervention

Main outcome measures

Results

Conclusions

Section snippets

Participants

Gender differences

Discussion

Conclusions

Acknowledgements

Brain Res

Exp Neurol

Exp Neurol

Arch Phys Med Rehabil

Arthroscopy

J Shoulder Elbow Surg

Orthop Clin North Am

Arthroscopy

Arthroscopy

Arch Phys Med Rehabil

On the proprio-ceptive system, especially in its reflex aspect

Brain

Peripheral mechanisms of touch and proprioception

Can J Physiol Pharmacol

The sensorimotor system, Part IThe physiologic basis of functional joint stability

J Athl Train

The role of proprioception in the perception and control of human movementtoward a theoretical reassessment

Percept Psychophys

Perceptions of effort and heaviness during fatigue and during the size-weight illusion

Somatosens Mot Res

The effects of muscle fatigue on shoulder joint position sense

Am J Sports Med

Proprioceptive consequences of tendon vibration during movement

J Neurophysiol

Proprioceptive illusions induced by muscle vibrationcontribution by muscle spindles to perception?

Science

Neuromuscular dysfunction following eccentric exercise

Med Sci Sports Exerc

Effort in isometric muscular contractions related to force level and duration

Percept Psychophys

Alterations in bilateral force judgment following strenuous eccentric exercise

Res Q Exerc Sport

The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception

J Orthop Sports Phys Ther

Cooling does not affect knee proprioception

J Athl Train

Does ice immersion influence ankle joint position sense?

Physiother Res Int

Articles
Cryotherapy does not impair shoulder joint position sense1