Shoulder function and active motion deficit in patients with rheumatoid arthritis

Abstract

Purpose: To discover whether there are differences between patients with RA with and without active motion deficit in the shoulder (passive ROM greater than active ROM) concerning disease characteristics and shoulder function, and examine the role of active motion deficit in explaining limitations of shoulder function in daily life. Methods: This cross-sectional study included 123 patients with RA having shoulder pain. Disease activity and duration of shoulder pain and disease were registered, active and passive shoulder ROM, pain and muscle strength were measured. Shoulder function in daily life was assessed by Disability of the Arm, Shoulder and Hand (DASH). Results: Patients with active motion deficit (36%) had statistical significant worse scores on disease activity, shoulder pain, muscle strength, and DASH function than those without active motion deficit (p ≤ 0.05). No differences between the groups were found for duration of shoulder pain or disease (p > 0.05). Active motion deficit, passive ROM, muscle strength and pain explained 33.7% of the variation in the DASH function score. Conclusion: Active motion deficit in the shoulder seems frequent in patients with RA. Together with passive ROM, muscle strength and pain, active motion deficit explained about one-third of the limitations in shoulder function in daily life.

Implications for Rehabilitation

• Rheumatoid arthritis (RA) is a chronic inflammatory disease that primarily affects the joints and periarticular tissue. Pain, muscle weakness, and joint destruction may result in reduced range of motion (ROM), which in turn may affect the performance of activities in daily life.

• Shoulder affection is frequent in patients with RA. About one-third of the patients in the present study had an active motion deficit in the shoulders.

• Patients with active motion deficit had more shoulder pain and more impaired shoulder function than those without deficit. Active motion deficit associated with limitations in shoulder function in daily life.

Keywords::

• Rheumatoid arthritis
• shoulder function
• rotator cuff
• muscle weakness
• exercise

Acknowledgements

We would like to thank the physiotherapists who participated in the functional assessments, and the nurses Bodil Riise Bjørneby and Torun Dahl for assessing tender and swollen joints in the DAS28 score, all working at Martina Hansen Hospital. We will also thank Nina K. Vøllestad, University of Oslo for support with the data analysis.

Declaration of Interest: This project has been financially supported by the Norwegian ExtraFoundation for Health and Rehabilitation through EXTRA funds, an institution consisting of 28 voluntary health and rehabilitation organizations, and the legacy Jan A. Pahles forskningslegat. The two organizations have funded the research. They have no financial interest that may affect the work submitted.