Sensorimotor Cortex Excitability in Shoulder Impingement Syndrome and the Sensorimotor Excitability and Control in Acute/subacute Stage Related to Development of Chronicity
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Shoulder Impingement Syndrome
- Sponsor
- National Yang Ming Chiao Tung University
- Enrollment
- 40
- Locations
- 1
- Primary Endpoint
- Corticomotor excitability measures - Active motor threshold
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
Shoulder pain is a common musculoskeletal system complaint, accounting for 7-34% of patients in the clinic. The most common shoulder problem is subacromial impingement syndrome (SIS). Up to 45% of individuals with SIS may have unsuccessful treatment and still complain of symptoms after 2 years. This chronicity of pain may not be fully explained by structural injuries or damage, but may be related to sensorimotor changes. Decreased corticospinal excitability and increase inhibition have been found in individuals with SIS. These central motor changes may link to alteration in pain and nociception processing and the somatosensory system, which has been found in individuals with low back pain. Hyperalgesia has been found over both affected and unaffected shoulders in patients with SIS, indicating central and peripheral sensitization. However, no study has investigated whether there are changes in the central somatosensory system. Therefore, the objectives of this proposal are (1) to investigate the corticomotor and somatosensory system in patients with SIS (2) to investigate the relationship between the corticomotor and somatosensory alterations in patients with SIS. Subjects with chronic SIS and healthy subjects were recruited, with 32 people in each group. Electroencephalography (EEG) will be used to collect somatosensory activity, including somatosensory evoked potentials, spectral analysis of EEG oscillations and event-related spectral perturbation (ERSP) of the shoulder movement. Electromyography will be used to record muscle activity. Transcranial magnetic stimulation will be used to test corticomotor excitability, including active motor threshold, motor evoked potentials, cortical silent period, and intracortical inhibition and facilitation. The pressure pain threshold will be collected by a pressure algometer on the muscles of bilateral arms and legs. Pain intensity will be assessed with the Numeric Rating Scale. Shoulder function will be evaluated with the Disability of Arm, Shoulder and Hand questionnaire. Depression will be evaluated with Center for Epidemiologic Studies Depression Scale (CES-D).
Investigators
Yin-Liang Lin
Assistant Professor
National Yang Ming Chiao Tung University
Eligibility Criteria
Inclusion Criteria
- Not provided
Exclusion Criteria
- •have a history of dislocation, fracture, adhesive capsulities, or surgery of upper extremity
- •arm elevation angle less than 150 degrees
- •a history of direct contact injury to the neck or upper extremities within the past 12 months
- •brain injury and neurological impairment
- •inflammatory cause of the pain (e.g., rheumatoid arthritis)
- •psychosis and symptom of headache or dizziness
- •allergy to plaster
- •contraindications to the use of TMS, assessed with a safety screening questionnaire
Outcomes
Primary Outcomes
Corticomotor excitability measures - Active motor threshold
Time Frame: Immediately during the experiment
Active motor threshold (AMT) will be described with the percentage (%) of maximum stimulator output (MSO).
Corticomotor excitability measures - Short interval cortical inhibition
Time Frame: Immediately during the experiment
Short interval cortical inhibition (SICI) will be defined as percentage (%) of conditioning responses vs testing responses while the inter-stimulus interval is below 5 ms
Corticomotor excitability measures - Motor evoked potential
Time Frame: Immediately during the experiment
Motor evoked potential (MEP) will be described with millivolt (mV).
Corticomotor excitability - Area of cortical mapping
Time Frame: Immediately during the experiment
Area of cortical mapping will be described with square millimeter (mm2)
Corticomotor excitability - Volume of cortical mapping
Time Frame: Immediately during the experiment
Volume of cortical mapping will be calculated with multiplying summation of motor evoke potentials on the map (mV) by the area of the map (mm2) with the unit of mV\*mm2
Corticomotor excitability measures - Short interval cortical facilitation
Time Frame: Immediately during the experiment
Short interval cortical facilitation (SICF) will be defined as percentage (%) of conditioning responses vs testing responses while the inter-stimulus interval is above 5 ms
Corticomotor excitability measures - Long-interval intracortical inhibition
Time Frame: Immediately during the experiment
Long-interval intracortical inhibition (LICI) will be defined as percentage (%) of conditioning responses vs testing responses while the inter-stimulus interval is below 5 ms
Corticomotor excitability - Center of gravity of cortical mapping
Time Frame: Immediately during the experiment
Center of gravity of cortical mapping will be described in a x-y coordinate system (mm).
Resting brain activity - resting EEG with eye open/closed
Time Frame: Immediately during the experiment
EEG signals will be processed with power spectrum density analysis to calculate frequency power at Theta (3-8 Hz), alpha (8-13 Hz), beta (13-30 Hz) bands, and Gamma (30 Hz above).
Corticomotor excitability measures - Cortical silent period
Time Frame: Immediately during the experiment
Cortical silent period (CSP) will be measured with millisecond (ms)
Somatosensory cortical activity - Somatosensory evoked potentials
Time Frame: Immediately during the experiment
Somatosensory evoked potentials (SEP) will be described with microvolt (µV) and millisecond (ms).
Event-related synchronization or desynchronization - Movement evoked pain potentials
Time Frame: Immediately during the experiment
Movement evoked pain potentials will be processed with power spectrum density analysis to calculate frequency power at Theta (3-8 Hz), alpha (8-13 Hz), beta (13-30 Hz) bands, and Gamma (30 Hz above) while raising hand.
Muscle activation during arm elevation
Time Frame: Immediately during the experiment
The root mean square of electromyography (EMG) data of the anterior deltoid and infraspinatus will be normalized by the maximum voluntary contraction amplitude (percentage of maximal voluntary contraction, %) and calculated in two segments, including arm elevating and arm lowering.
Secondary Outcomes
- Shoulder pain and function-Taiwan version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire(Immediately during the experiment)
- Depression- Taiwan version of the Center for Epidemiologic Studies Depression Scale (CES-D)(Immediately during the experiment)
- Electrical sensory threshold(Immediately during the experiment)
- Pressure pain thresholds(Immediately during the experiment)
- Electrical pain threshold(Immediately during the experiment)