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If a patient asks 'why does my shoulder hurt?' the conversation will quickly turn to scientific theory and sometimes unsubstantiated conjecture. Frequently, the clinician becomes aware of the limits of the scientific basis of their explanation, demonstrating the incompleteness of our understanding of the nature of shoulder pain. This review takes a(More)
OBJECTIVE To investigate whether placebo controls should be used in the evaluation of surgical interventions. DESIGN Systematic review. DATA SOURCES We searched Medline, Embase, and the Cochrane Controlled Trials Register from their inception to November 2013. STUDY SELECTION Randomised clinical trials comparing any surgical intervention with placebo.(More)
INTRODUCTION The pathogenesis of rotator cuff disease (RCD) is complex and not fully understood. This systematic review set out to summarise the histological and molecular changes that occur throughout the spectrum of RCD. METHODS We conducted a systematic review of the scientific literature with specific inclusion and exclusion criteria. RESULTS A(More)
BACKGROUND Arthroscopic subacromial decompression (ASAD) is a commonly performed surgical intervention for shoulder pain. The rationale is that removal of a bony acromial spur relieves symptoms by decompressing rotator cuff tendons passing through the subacromial space. However, the efficacy of this procedure is uncertain. The objective of this trial was to(More)
The regulatory mechanisms involved in tendon homeostasis and repair are not fully understood. Accumulating data, however, demonstrate that the nervous system, in addition to afferent (sensory) functions, through efferent pathways plays an active role in regulating pain, inflammation, and tissue repair. In normal-, healing- and tendinopathic tendons three(More)
INTRODUCTION The relationship between peripheral tissue characteristics and pain symptoms in soft tissue inflammation is poorly understood. The primary aim of this study was to determine immunohistochemical differences in tissue obtained from patients with persistent pain and patients who had become pain-free after surgical treatment for rotator cuff(More)
OBJECTIVES We set out to evaluate the impact of Foundation Year (FY) training on the doctors who had been through this training system. DESIGN Doctors in training were surveyed using a structured web-based questionnaire. SETTING Postgraduate training in the UK has been the subject of much upheaval in recent years. PARTICIPANTS A total of 1065 doctors(More)
OBJECTIVES The PROximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial has recently demonstrated that surgery is non-superior to non-operative treatment in the management of displaced proximal humeral fractures. The objective of this study was to assess current surgical practice in the context of the PROFHER trial in terms of patient(More)
BACKGROUND Understanding changes in the placebo arm is essential for correct design and interpretation of randomized controlled trials (RCTs). It is assumed that placebo response, defined as the total improvement in the placebo arm of surgical trials, is large; however, its precise magnitude and properties remain to be characterized. To the best of our(More)