{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:59:26Z","timestamp":1793321966575,"version":"4.5.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The presence of altered nociceptive pain processing in patients with upper extremity tendinopathy\/overuse injury is conflicting. Our aim was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas between patients with upper extremity tendinopathy\/overuse injury and controls.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Five databases were searched from inception to October 15, 2020. The authors selected case-control studies comparing PPTs between individuals with upper extremity tendinopathy\/overuse injury and pain-free controls. Data were extracted for population, diagnosis, sample size, outcome, and type of algometer. Results were extracted by 3 reviewers. The methodological quality\/risk of bias (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development and Evaluation approach) were assessed. Meta-analyses of symptomatic, segment-related, and distant pain-free areas were compared.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The search identified 807 publications with 19 studies (6 shoulder, 13 elbow) eligible for inclusion. The methodological quality ranged from fair (48%) to good (37%). Patients exhibited lower bilateral PPTs than controls at the symptomatic area (affected side: MD = \u2212175.89 kPa [95% CI = \u2212220.30 to \u2212131.48 kPa]; nonaffected side: MD = \u2212104.50 kPa [95% CI = \u2212142.72 to \u221266.28 kPa]) and the segment-related area (affected side: MD = \u2212150.63 kPa [95% CI = \u2212212.05 to \u221289.21 kPa]; nonaffected side: MD = \u2212170.34 kPa [95% CI = \u2212 248.43 to \u221292.25]) than controls. No significant differences in PPTs over distant pain-free areas were observed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Low to moderate quality evidence suggests bilateral hypersensitivity to pressure pain at the symptomatic and contralateral\/mirror areas in patients with upper extremity tendinopathies\/overuse injury. Moderate quality of evidence supports bilateral pressure pain sensitivity in the segment-related area (neck) in lateral epicondylalgia, but not in subacromial impingement syndrome. No evidence of widespread pressure pain hyperalgesia was reported.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact<\/jats:title>\n                  <jats:p>Early identification of people with altered pain modulation could guide clinicians in treatment strategies. This review shows that there is a complex interplay between peripheral and central pain mechanisms in upper extremity tendinopathies\/overuse injuries and that there likely are different subgroups of patients with upper extremity conditions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzab131","type":"journal-article","created":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T19:12:44Z","timestamp":1620760364000},"source":"Crossref","is-referenced-by-count":15,"title":["Evidence of Bilateral Localized, but Not Widespread, Pressure Pain Hypersensitivity in Patients With Upper Extremity Tendinopathy\/Overuse Injury: A Systematic Review and Meta-Analysis"],"prefix":"10.1093","volume":"101","author":[{"given":"C\u00e9sar","family":"Fern\u00e1ndez-de-las-Pe\u00f1as","sequence":"first","affiliation":[{"name":"Department of Physical Therapy , Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorc\u00f3n, Madrid, Spain"},{"name":"C\u00e1tedra Institucional en Docencia , Cl\u00ednica e Investigaci\u00f3n en Fisioterapia: Terapia Manual, Punci\u00f3n Seca y Ejercicio Terap\u00e9utico, Universidad Rey Juan Carlos, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcos J","family":"Navarro-Santana","sequence":"additional","affiliation":[{"name":"Radiology , Rehabilitation and Physiotherapy Department, Universidad Complutense de Madrid, Madrid, Spain"},{"name":"Department of Physical Therapy , Rehabilitaci\u00f3n San Fernando, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua A","family":"Cleland","sequence":"additional","affiliation":[{"name":"Doctor of Physical Therapy Program , Tufts University School of Medicine, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 L","family":"Arias-Bur\u00eda","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy , Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorc\u00f3n, Madrid, Spain"},{"name":"C\u00e1tedra Institucional en Docencia , Cl\u00ednica e Investigaci\u00f3n en Fisioterapia: Terapia Manual, Punci\u00f3n Seca y Ejercicio Terap\u00e9utico, Universidad Rey Juan Carlos, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Plaza-Manzano","sequence":"additional","affiliation":[{"name":"Radiology , Rehabilitation and Physiotherapy Department, Universidad Complutense de Madrid, Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria del Hospital Cl\u00ednico San Carlos , Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"2023011906401245900_ref1","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1136\/bjsports-2015-095422","article-title":"Revisiting the continuum model of 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