The Effects of Pain and Disability Resulting From Shoulder Pathologies On Balance and Mobility

Upper extremity pathologies are musculoskeletal problems that are common in the community, resulting in loss of work force and negative continuation of recreational activities (1,2). Among the pathologies of the musculoskeletal system, shoulder pain is the most common symptom after back and neck pain (3, 4). One out of every three adults experiences shoulder pain and limitation in shoulder movements, which affects the functionality of the patients and leads to disability (4). Among these common problems, there are many diseases such as rotator cuff injuries, adhesive capsulitis, acromioclavicular joint degenerations, calcific tendinitis and instability (5). Impairment of one or more sensory inputs coming from the visual, somatosensory or afferent pathways from the vestibular system (6-7) causes deterioration of balance control and falls (7-8). Since pain affects the somatosensory system, it causes a decrease in balance ability. In addition, pain-induced balance control and muscle inhibition pathways share some pathways in the central nervous system (9 ,10). Therefore, muscle inhibition mechanisms caused by pain may negatively affect balance ability (10,11). It has been proven that patients with shoulder pain have deficiencies in shoulder proprioception as well as trunk and lower extremity coordination (10,12). Problem-free and painless upper extremity movements are mostly related to the stability of the trunk and this is closely related to the stability of the lower extremities and balance control. Any deficiency in trunk and lower extremity stability is largely tolerated by compensating the structures around the upper extremity by increasing speed and power, and this situation paves the way for upper extremity pathologies. It remains unclear whether the lack of balance is a cause or a consequence of injury in individuals with shoulder problems (13). Myers et al. reported that proprioception and coordination deficiencies greatly affect shoulder problems, therefore somatosensory deficiencies in the lower extremity and trunk may cause problems in the upper extremity region (14). Other known factors affecting balance, apart from proprioception and coordination, are attention (15,16), age (17,18), gender and body mass index (BMI) (19,20). Decreased balance can lead to limitation of movement, falls and injuries (21). This situation may also require rehabilitation of balance problems caused by upper extremity pathologies. There is very little published research investigating the relationship between different levels of shoulder pain, balance ability, risk of falling, and fear of falling, covering all age groups diagnosed with musculoskeletal shoulder problems. Although it has been shown that the balance of patients with shoulder pain is adversely affected, it is not clear how pain level and disability affect balance parameters. Therefore, in this study, it was aimed to investigate the relationship between pain severity, functionality and balance in shoulder pathologies,

Inclusion criteria

• Having a pathology related to the upper extremity shoulder such as Impingement, Rotator cuff tear or repair, Adhesive capsulitis (frozen shoulder),
• Able to communicate
• Individuals between the ages of 40-65 who agreed to participate in the study

Exclusion criteria

• Having vision and hearing problems
• Having other accompanying neurological, psychiatric and/or orthopedic problems other than shoulder pathologies
• Having a pregnancy status