Shoulder Pain

Clin Ter. 2007 Sep-Oct;158(5):397-401.

The new magnetic therapy TAMMEF in the treatment of simple shoulder pain.

[Article in Italian]

Battisti E, Bianciardi L, Albanese A, Piazza E, Rigato M, Galassi G, Giordano N.

Centro TAMMEF, Sezione di Fisica Medica, Dipartimento di Fisica, Università degli Studi di Siena, Italia.


AIMS: Numerous studies have demonstrated the utility of extremely low frequencies (ELF) electromagnetic fields in the treatment of pain. Moreover, the effects of these fields seems to depend on their respective codes (frequency, intensity, waveform). In our study we want to assess the effects of the TAMMEF (Therapeutic Application of a Musically Modulated Electromagnetic Field) system, whose field is piloted by a musical signal and its parameters (frequency, intensity, waveform) are modified in time, randomly varying within the respective ranges, so that all possible codes can occur during a single application.

PATIENTS AND METHODS: Sixty subjects, affected by shoulder periarthritis were enrolled in the study and randomly divided into three groups of 20 patients each: A exposed to TAMMEF, B exposed to ELF, C exposed to a simulated field. All subjects underwent a cycle of 15 daily sessions of 30 minutes each and a clinical examination upon enrollment, after 7 days of therapy, at the end of the cycle and at a follow-up 30 days later.

RESULTS: All the patients of groups A and B completed the therapy without the appearance of side effects: they presented a significant improvement of the subjective pain and the functional limitation, which remained stable at the follow-up examination. In group C, there was no improvement of the pain symptoms or articular functionality.

CONCLUSIONS: This study suggests that the TAMMEF system is efficacious in the control of pain symptoms and in the reduction of functional limitation in patients with shoulder periarthritis. Moreover, the effects of the TAMMEF system cover those produced by the ELF field.

Radiologe. 2004 Jun;44(6):597-603.

Conservative treatment and rehabilitation of shoulder problems

[Article in German]

Paternostro-Sluga T, Zöch C.

Klinik für Physikalische Medizin und Rehabilitation, Allgemeines Krankenhaus der Medizinischen Universität Wien.


The shoulder joint has an important influence on arm- and hand function. Therefore, activities of daily living, working and leisure time can be negatively influenced by diseases of the shoulder joint. Problems of the shoulder joint can be induced by muscular dysbalance and poor body posture. There is a strong relationship between shoulder function and body posture. Conservative treatment and rehabilitation of the shoulder joint aims at improving the local dysfunction of the shoulder joint as well as at improving function and social participation. Antiinflammatory and pain medication, exercise, occupational, electro-, ultrasound and shock wave therapy, massage, thermotherapy and pulsed electromagnetic fields are used as conservative treatments. Exercise therapy aims at improving muscular performance, joint mobility and body posture. Occupational therapy aims at improving functional movements for daily living and work. Electrotherapy is primarily used to relieve pain. Shock wave and ultrasound therapy proved to be an effective treatment for patients with calcific tendinitis. The subacromial impingement syndrome can be effectively treated by conservative therapy.

J Spinal Cord Med. 2004;27(2):138-42.

Treatment of myofascial shoulder pain in the spinal cord injured population using static magnetic fields: a case series.

Panagos A, Jensen M, Cardenas DD.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98195-6490, USA.

OBJECTIVE: Magnetic therapy has been used in the treatment of a wide variety of chronic pain syndromes. It has not been studied in the treatment of myofascial shoulder pain in persons with spinal cord injury (SCI). Because this type of pain is commonly refractory to traditional therapy, alternative treatments often are considered. The primary objective is to determine whether myofascial shoulder pain in persons with SCI can be temporarily ameliorated with static magnetic fields.

DESIGN: Case series.

SETTING: Clinic of a university hospital system.

\PARTICIPANTS: A volunteer sample of 8 participants with SCI; 3 women, 5 men; mean age = 45 years; mean duration of injury = 12.3 years.

INTERVENTIONS: Placement of a commercially available magnet with a static magnetic field of 500 gauss on the affected shoulder for 1 hour.

MAIN OUTCOME MEASURES: Pretreatment and posttreatment scores on the short-form McGill Pain Questionnaire and pressure algometry were compared.

RESULTS: The short-form McGill Pain Questionnaire descriptors demonstrated significant decreases: stabbing, 0.75 +/- 0.71 (P < 0.02); sharp, 0.50 +/- 0.53 (P < 0.033); and tender, 0.88 +/- 0.83 (P < 0.021). They also demonstrated a significant decrease in the present pain intensity of 0.63 +/- 0.52 (P < 0.011). Participants demonstrated a nonsignificant decrease of 0.813 +/- 0.998 (P < 0.55) on the visual analog scale. Pressure algometry was nonsignificant with a difference of 0.062 +/- 1.17 (P < 0.885).

CONCLUSION: Static magnetic fields may decrease the sensory dimensions and intensity of myofascial shoulder pain in persons with SCI.

Cochrane Database Syst Rev. 2003;(2):CD004258.

Physiotherapy interventions for shoulder pain

Green S, Buchbinder R, Hetrick S.

Australasian Cochrane Centre, Monash University, Australasian Cochrane Centre, Locked Bag 29, Clayton, Victoria, Australia.

BACKGROUND: The prevalence of shoulder disorders has been reported to range from seven to 36% of the population (Lundberg 1969) accounting for 1.2% of all General Practitioner encounters in Australia (Bridges Webb 1992). Substantial disability and significant morbidity can result from shoulder disorders. While many treatments have been employed in the treatment of shoulder disorders, few have been proven in randomised controlled trials. Physiotherapy is often the first line of management for shoulder pain and to date its efficacy has not been established. This review is one in a series of reviews of varying interventions for shoulder disorders, updated from an earlier Cochrane review of all interventions for shoulder disorder.

OBJECTIVES: To determine the efficacy of physiotherapy interventions for disorders resulting in pain, stiffness and/or disability of the shoulder.

SEARCH STRATEGY: MEDLINE, EMBASE, the Cochrane Clinical Trials Regiter and CINAHL were searched 1966 to June 2002. The Cochrane Musculoskeletal Review Group’s search strategy was used and key words gained from previous reviews and all relevant articles were used as text terms in the search.

SELECTION CRITERIA: Each identified study was assessed for possible inclusion by two independent reviewers. The determinants for inclusion were that the trial be of an intervention generally delivered by a physiotherapist, that treatment allocation was randomised; and that the study population be suffering from a shoulder disorder, excluding trauma and systemic inflammatory diseases such as rheumatoid arthritis.

DATA COLLECTION AND ANALYSIS: The methodological quality of the included trials was assessed by two independent reviewers according to a list of predetermined criteria, which were based on the PEDro scale specifically designed for the assessment of validity of trials of physiotherapy interventions. Outcome data was extracted and entered into Revman 4.1. Means and standard deviations for continuous outcomes and number of events for binary outcomes were extracted where available from the published reports. All standard errors of the mean were converted to standard deviation. For trials where the required data was not reported or not able to be calculated, further details were requested from first authors. If no further details were provided, the trial was included in the review and fully described, but not included in the meta-analysis. Results were presented for each diagnostic sub group (rotator cuff disease, adhesive capsulitis, anterior instability etc) and, where possible, combined in meta-analysis to give a treatment effect across all trials.

MAIN RESULTS: Twenty six trials met inclusion criteria. Methodological quality was variable and trial populations were generally small (median sample size = 48, range 14 to 180). Exercise was demonstrated to be effective in terms of short term recovery in rotator cuff disease (RR 7.74 (1.97, 30.32), and longer term benefit with respect to function (RR 2.45 (1.24, 4.86). Combining mobilisation with exercise resulted in additional benefit when compared to exercise alone for rotator cuff disease. Laser therapy was demonstrated to be more effective than placebo (RR 3.71 (1.89, 7.28) for adhesive capsulitis but not for rotator cuff tendinitis. Both ultrasound and pulsed electromagnetic field therapy resulted in improvement compared to placebo in pain in calcific tendinitis (RR 1.81 (1.26, 2.60) and RR 19 (1.16, 12.43) respectively). There is no evidence of the effect of ultrasound in shoulder pain (mixed diagnosis), adhesive capsulitis or rotator cuff tendinitis. When compared to exercises, ultrasound is of no additional benefit over and above exercise alone. There is some evidence that for rotator cuff disease, corticosteroid injections are superior to physiotherapy and no evidence that physiotherapy alone is of benefit for Adhesive Capsulitis

REVIEWER’S CONCLUSIONS: The small sample sizes, variable methodological quality and heterogeneity in terms of population studied, physiotherapy intervention employed and length of follow up of randomised controlled trials of physiotherapy interventions results in little overall evidence to guide treatment. There is evidence to support the use of some interventions in specific and circumscribed cases. There is a need for trials of physiotherapy interventions for specific clinical conditions associated with shoulder pain, for shoulder pain where combinations of physiotherapy interventions, as well as, physiotherapy interventions as an adjunct to other, non physiotherapy interventions are compared. This is more reflective of current clinical practice. Trials should be adequately powered and address key methodological criteria such as allocation concealment and blinding of outcome assessor.

J Med Eng Technol. 2002 Nov-Dec;26(6):253-8.

Comparison between the analgesic and therapeutic effects of a musically modulated electromagnetic field (TAMMEF) and those of a 100 Hz electromagnetic field: blind experiment on patients suffering from cervical spondylitis or shoulder periarthritis.

Rigato M, Battisti E, Fortunato M, Giordano N.

Department of Physics, Section of Medical Physics University of Sienna, Italy.

The analgesic-therapeutic efficacy and tolerability of a low-frequency electromagnetic field (ELF), modulated at a frequency of 100 Hz with a sinusoidal waveform and mean induction of a few gauss, has been demonstrated by the authors in numerous previous studies of various hyperalgic pathologies, particularly of the locomotor apparatus. In the present study, the authors tested a new type of all-inclusive field, denoted TAMMEF, whose parameters (frequency, intensity, waveform) are modified in time, randomly varying within the respective ranges, so that all the possible codes can occur during a single application. For the comparison, 150 subjects (118 women and 32 men, between 37 and 66 years of age) were enrolled. They were affected by cervical spondylosis (101 cases) or shoulder periarthritis (49 cases). Unbeknownst to them, they were randomly divided into three groups of 50 subjects. One group was exposed to the new TAMMEF, another group to the usual ELF, and the third group to simulated treatment. The results show that the effects of the new TAMMEF therapy are equivalent to those obtained with the ELF.

Vopr Kurortol Fizioter Lech Fiz Kult. 1994 Jul-Aug;(4):9-12.

The combined use of electromagnetic decimeter waves and deresinated naphthalan in patients with vertebrogenic humeroscapular periarthrosis (its experimental and clinical validation).

[Article in Russian]

Musaev AV, Guse?nova SG, Mamedov AP.


Physicochemical and experimental studies on pond snail neuron were made to validate combined or simultaneous usage of decimeter microwaves and deresinified naphthalane. Clinical and neurophysiological trials in 133 patients with vertebrogenic scapulohumeral periarthritis revealed that the above treatment is clinically beneficial and corrects functional activity of segmental-peripheral neuromotor system.

Vopr Kurortol Fizioter Lech Fiz Kult. 1993 Sep-Oct;(5):34-8.

The cerebral hemodynamics in patients with humeroscapular periarthritis under the influence of decimeter waves and deresinated naphthalan.

[Article in Russian]

Musaev AV, Guse?nova SG.


110 patients with scapulohumeral periarthritis of vertebrogenic origin were exposed to decimetric waves or received salt-free naphthalan. There were also patients who got combined treatment with decimetric waves and salt-free naphthalan. REG recorded positive shifts in cerebral hemodynamics due to these factors utilization.

Arch Phys Med Rehabil. 1991 Apr;72(5):284-7.

Electromagnetic treatment of shoulder periarthritis: a randomized controlled trial of the efficiency and tolerance of magnetotherapy.

Leclaire R, Bourgouin J.

Rehabilitation Medicine Service, Notre Dame Hospital, Montreal, Quebec, Canada.

The potential benefit of magnetotherapy was investigated in 47 consecutive outpatients with periarthritis of the shoulder. Using a controlled triple-blind study design, one group of patients received hot pack applications and passive manual stretching and pulley exercises; the other group received the same therapy plus magnetotherapy. Treatment was administered three times a week. For a maximum of three months, a standardized treatment protocol was used. There was no significant improvement in pain reduction or in range of motion with electromagnetic field therapy. After 12 weeks of therapy, the patients who received magnetotherapy showed mean pain scores of 1.5 (+/- .61 SD) at rest, 2.2 (+/- .76 SD) on movement, and 1.9 (+/- .94 SD), on lying, compared to scores for the control group of 1.4 (+/- .65 SD), 2.2 (+/- .7 SD), and 1.9 (+/- .95 SD), respectively. Linear pain scale scores improved from 71 to 21 for both groups. At 12 weeks the gain in range of motion was mean 109 degrees +/- 46.8 in patients receiving electromagnetic field therapy, compared to 122 degrees +/- 33.4 for the controls (not significant). At entry, the functional handicap score was 53.5 for both groups. At 12 weeks, it was 24 for the magnetotherapy group and 17 for the control group (difference not significant). In conclusion, this study showed no benefit from magnetotherapy in the pain score, range of motion, or improvement of functional status in patients with periarthritis of the shoulder.

Lancet. 1984 Mar 31;1(8379):695-8.

Pulsed electromagnetic field therapy of persistent rotator cuff tendinitis. A double-blind controlled assessment.

Binder A, Parr G, Hazleman B, Fitton-Jackson S.

The value of pulsed electromagnetic fields (PEMF) for the treatment of persistent rotator cuff tendinitis was tested in a double-blind controlled study in 29 patients whose symptoms were refractory to steroid injection and other conventional conservative measures. The treated group (15 patients) had a significant benefit compared with the control group (14 patients) during the first 4 weeks of the study, when the control group received a placebo. In the second 4 weeks, when all patients were on active coils, no significant differences were noted between the groups. This lack of difference persisted over the third phase, when neither group received any treatment for 8 weeks. At the end of the study 19 (65%) of the 29 patients were symptomless and 5 others much improved. PEMF therapy may thus be useful in the treatment of severe and persistent rotator cuff and possibly other chronic tendon lesions.

Vopr Onkol. 1988;34(2):213-7.

Use of physical therapy measures in the rehabilitation of patients having undergone radical mastectomy.

[Article in Russian]

Gerasimenko VN, Voinarevich AO, Grushina TI.

Low-frequency electrotherapy, magnetotherapy, massage, exercise therapy and drugs were used in 90 patients who after radical treatment for breast cancer suffered pain and limited mobility in the shoulder joint. These procedures were intended to treat said complications, to normalize reflexes and to cut down the period of rehabilitative therapy. The treatment proved effective. No untoward effects on the course of the disease were observed within the first 3-5 years.

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