{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:41:23Z","timestamp":1792190483845,"version":"4.4.0"},"reference-count":20,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"4","license":[{"start":{"date-parts":[[2011,4,1]],"date-time":"2011-04-01T00:00:00Z","timestamp":1301616000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2011,4]]},"abstract":"<jats:p>Impingement syndrome in the shoulder has generally been considered to be a clinical condition of mechanical origin. However, anomalies exist between the pathology in the subacromial space and the degree of pain experienced. These may be explained by variations in the processing of nociceptive inputs between different patients. We investigated the evidence for augmented pain transmission (central sensitisation) in patients with impingement, and the relationship between pre-operative central sensitisation and the outcomes following arthroscopic subacromial decompression.<\/jats:p>\n                  <jats:p>We recruited 17 patients with unilateral impingement of the shoulder and 17 age- and gender-matched controls, all of whom underwent quantitative sensory testing to detect thresholds for mechanical stimuli, distinctions between sharp and blunt punctate stimuli, and heat pain. Additionally Oxford shoulder scores to assess pain and function, and PainDETECT questionnaires to identify \u2018neuropathic\u2019 and referred symptoms were completed. Patients completed these questionnaires pre-operatively and three months post-operatively.<\/jats:p>\n                  <jats:p>A significant proportion of patients awaiting subacromial decompression had referred pain radiating down the arm and had significant hyperalgesia to punctate stimulus of the skin compared with controls (unpaired t-test, p &lt; 0.0001). These are felt to represent peripheral manifestations of augmented central pain processing (central sensitisation).<\/jats:p>\n                  <jats:p>The presence of either hyperalgesia or referred pain pre-operatively resulted in a significantly worse outcome from decompression three months after surgery (unpaired t-test, p = 0.04 and p = 0.005, respectively).<\/jats:p>\n                  <jats:p>These observations confirm the presence of central sensitisation in a proportion of patients with shoulder pain associated with impingement. Also, if patients had relatively high levels of central sensitisation pre-operatively, as indicated by higher levels of punctate hyperalgesia and\/or referred pain, the outcome three months after subacromial decompression was significantly worse.<\/jats:p>","DOI":"10.1302\/0301-620x.93b4.25054","type":"journal-article","created":{"date-parts":[[2011,4,4]],"date-time":"2011-04-04T19:18:36Z","timestamp":1301944716000},"page":"498-502","source":"Crossref","is-referenced-by-count":144,"title":["Evidence that central sensitisation is present in patients with shoulder impingement syndrome and influences the outcome after surgery"],"prefix":"10.1302","volume":"93-B","author":[{"given":"S. E.","family":"Gwilym","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. C. L.","family":"Oag","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Tracey","sequence":"additional","affiliation":[{"name":"Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. J.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"R1","doi-asserted-by":"crossref","unstructured":"Brox JI.\n                      Regional musculoskeletal conditions: shoulder pain. 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