Is fibromyalgia a cause of failure in the treatment of a painful shoulder?
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ORIGINAL ARTICLE
Is fibromyalgia a cause of failure in the treatment of a painful shoulder? D. Blonna • E. Bellato • E. Marini • N. Barbasetti L. Mattei • F. Fissore • C. Arrigoni • F. Castoldi
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Received: 20 December 2012 / Accepted: 5 February 2013 / Published online: 16 April 2013 Ó Istituto Ortopedico Rizzoli 2013
Abstract Purpose This study aims to review the incidence of fibromyalgia in a cohort of patients who were treated for shoulder pain and address whether a concomitant fibromyalgia could have had detrimental effect on outcomes. Methods The treatment of 286 consecutive patients for shoulder pain was reviewed. Results Eighteen patients (6.3 %) were diagnosed as having fibromyalgia, but in 13 of them (72 %), the diagnosis was initially missed. Five patients received a total of 11 surgeries for treatment of the shoulder. At an average follow-up of 15 months (range 12–27), the average new Oxford shoulder score (OS score) was 49 % (range 6–87 %). The average physical component of the ShortForm-12 Healthy Survey (SF-12) was 36 (range 21–55), and the mental component 30 (range 15–46). The Summary Outcome Determination score (SOD score) was 1.3 (range–3 to 6). Conclusions Fibromyalgia occurs relatively frequently in patients who complain of shoulder pain and it can be a
D. Blonna N. Barbasetti L. Mattei F. Fissore F. Castoldi Department of Orthopaedics and Traumatology, Mauriziano Umberto I Hospital, University of Turin Medical School, Largo Turati, 62, 10128 Turin, Italy E. Bellato (&) C. Arrigoni Department of Orthopaedics and Traumatology, San Luigi Hospital, University of Turin Medical School, Regione Gonzole, 10, 10043 Orbassano, TO, Italy e-mail: [email protected] E. Marini Department of Orthopaedic Oncologic Surgery, Gaetano Pini Hospital, University of Milan Medical School, Piazza Cardinale Andrea Ferrari, 1, 20122 Milano, Italy
cause of failure in the treatment of concomitant painful shoulder conditions. Keywords Fibromyalgia Failure Arthroscopy Shoulder Diagnosis
Introduction Fibromyalgia is a syndrome characterized by chronic, widespread pain in the absence of organic disease, and it is usually associated with other symptoms, such as mood disorders, persistent fatigue, joint stiffness, and insomnia [1–5]. It can affect the patient as single entity or co-exist with other diseases such as rheumatoid arthritis or diabetes [6–10]. The diagnosis of fibromyalgia has become more common in recent years since clinicians have started to recognize fibromyalgia as a distinctive disease and have learned how to make a correct diagnosis. Unfortunately, one of the major difficulties in making the diagnosis of fibromyalgia is that a single symptom is not pathognomonic. On the other hand, if one considers the patient’s overall symptoms, the diagnosis can be easier. The shoulder is one of the anatomical sites most frequently affected by the widespread pain of fibromyalgia syndrome. Unfortunately, the symptoms reported by patients are similar or even identical to the symptoms which are commonly
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