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Item Case Presentation: Shoulder pain as a rheumatic manifestation of diabetes mellitus(Association of Kenya Physicians, 2007) Okanga, J. B.; Yossa, G. P.; Association of Kenya Physicians Scientific Conference (11th : Mar. 2007 : Eldoret, Kenya)Shoulder pain, a common musculoskeletal symptom, aetiologically is related to periarticular lesions mainly subacronial impingment (SAI) (90% adults). Articular lesions e.g. Synovvitis adhesive capsulitis (frozen shoulder) etc may be referred to the neck and humeral deltoid insertion. Referred pain from the cervical or thoracic spine, thoracic outlet or subdiaphramatic structures may manifest at the shoulder. Diabetes mellitus syndrome may be complicated by adhesive capsulitis more frequently than in the general population. A case is presented of a 52yr old house wife of high social standing, who has been followed up for 5yrs. Initially left shoulder pain but in the last 2yrs predominantly right shoulder pain, less involvement of the neck, right wrist and right foot. She has been under several clinicians with a frustration long list of probable diagnoses to her ailment. Diabetes mellitus was diagnosed in September 2005 and attacks related to hyperglycaemia/metabolic decompensation. The last attack was in January 2007 which necessitated hospitalization. A visiting rheumatologist confirmed "FROZEN SHOULDER" with diabetes mellitus. A multidisciplinary and multifactorial intervention aimed at multiple risk factors of diabetes syndrome is the way forward. Patient education/nutrition counseling and physiotherapy is the cornerstone of effective management.Item Shoulder Pain after Neck Dissection among Head and Neck Cancer Patients(2009-11-04T18:53:26Z) Wang, Hsiao-Lan; Keck, Juanita F.; Rawl, Susan M.; Buelow, Janice M.; Mikesky, Alan E.Shoulder pain was constantly reported as a problematic symptom causing dysfunction and quality of life interference after neck dissection in head and neck cancer patients. Due to a lack of conceptual framework and inconsistency of instrument selection, a comparison among previous studies was almost impossible, making it difficult to understand the phenomenon. The current study applied the University of California, San Francisco School of Nursing Symptom Management Model. The purposes of the study were to (a) describe the symptom experience of shoulder pain at 1 month after neck dissection, (b) describe the relationships among symptom experience of shoulder pain, functional status, and quality of life, and (c) identify the contextual variables, concurrent symptoms, and/or adherence predicting symptom experience of shoulder pain, functional status, and/or quality of life. This was a descriptive study with a convenience sample of head and neck cancer patients. The data were collected via a medical record review, a self-administered survey, and a physical examination. The data from 29 patients were entered for descriptive statistics, Pearson correlations, and multiple regressions. At 1 month after surgery, 62% of patients reported they had shoulder pain at some point within a week. Their shoulder pain was from mild to moderate. Fifty-nine percent complained that shoulder pain bothered them about the moderated level. In the final model, symptom experience, shoulder pain, was significantly correlated with one outcome, active shoulder abduction, but not the other, total quality of life, generic quality of life, and head and neck quality of life. Active shoulder abduction was significantly correlated with three quality of life measures. Adding significant predictors of symptom experience and outcomes into the final model, there is a potential that the model would be useful to guide treatment strategies. Treatment for myofascial pain of the levator scapulae could relieve shoulder pain after neck dissection and improve head and neck quality of life. Those with level V dissection were high risk populations of developing shoulder pain. Risk factors of quality of life, which were depression, loss of sensation, and radiation would describe how an intervention could change or unchange the patient’s life.