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Chang CY, Weng YH, Chang CH, Yang JL, Chen PT, Lin JJ. Neuromuscular electrical stimulation of humeral adductors in subjects with rotator cuff tear. Arch Orthop Trauma Surg 2024; 144:2039-2046. [PMID: 38613614 DOI: 10.1007/s00402-024-05316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION In symptomatic patients with rotator cuff tear, MRI and radiographic studies have ascribed the pain symptom to insufficient humeral head depression during arm elevations. The arm adductors such as the teres major and pectoralis major may contribute to depression of the humerus head during arm elevations. Researchers have demonstrated that neuromuscular electrical stimulation (NMES) of the serratus anterior and lower trapezius can control scapular motions and improve acromiohumeral distance. It is unknown, however, if adductor neuromuscular training could help patients with rotator cuff tear. MATERIALS AND METHODS A cross-sectional study of NMES of the teres major and pectoralis major was conducted on 30 symptomatic subjects with rotator cuff tear. We measured the acromiohumeral distance by ultrasonography and scapular kinematics during arm elevation with a three-dimensional motion tracking system. RESULTS The acromiohumeral distance significantly increased during NMES of the teres major (0.73 mm, p < 0.001). However, the distance significantly decreased with NMES of the pectoralis major (0.78 mm, p < 0.001). Additionally, scapular upward rotation was greater during NMES of the teres major than during NMES of the pectoralis major (3.4°, p < 0.001). Scapular external rotation decreased significantly more during NMES of the pectoralis major than during NMES of the teres major (1.6°, p = 0.003). CONCLUSIONS NMES of the teres major can increase acromiohumeral distance and scapular upward rotation during arm elevation. However, the decreased upward and external rotation of the scapula during arm elevation with NMES of the pectoralis major may be associated with subacromial impingement.
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Affiliation(s)
- Che-Yuan Chang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Rm. 327, 3F., No. 17, Xuzhou Rd. Zhongzheng Dist, Taichung, Taipei City, 100, Taiwan
| | - Yi Hsuan Weng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsun Chang
- Department of Orthopedic Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Lan Yang
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Tsun Chen
- School of Physical Therapy, Master Program in Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Witten A, Mikkelsen K, Wagenblast Mayntzhusen T, Clausen MB, Thorborg K, Hölmich P, Barfod KW. Terminology and diagnostic criteria used in studies investigating patients with subacromial pain syndrome from 1972 to 2019: a scoping review. Br J Sports Med 2023:bjsports-2022-106340. [PMID: 36813537 DOI: 10.1136/bjsports-2022-106340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION There is no recognised terminology, nor diagnostic criteria, for patients with subacromial pain syndrome (SAPS). This is likely to cause heterogeneity across patient populations. This could be a driver of misconceptions and misinterpretations of scientific results. We aimed to map the literature regarding terminology and diagnostic criteria used in studies investigating SAPS. MATERIALS AND METHODS Electronic databases were searched from inception to June 2020. Original peer-reviewed studies investigating SAPS (also known as subacromial impingement or rotator cuff tendinopathy/impingement/syndrome) were eligible for inclusion. Studies containing secondary analyses, reviews, pilot studies and studies with less than 10 participants were excluded. RESULTS 11 056 records were identified. 902 were retrieved for full-text screening. 535 were included. 27 unique terms were identified. Mechanistic terms containing 'impingement' are used less than before, while SAPS is used increasingly. For diagnoses, combinations of Hawkin's, Neer's, Jobe's, painful arc, injection test and isometric shoulder strength tests were the most often used, though this varied considerably across studies. 146 different test combinations were identified. 9% of the studies included patients with full-thickness supraspinatus tears and 46% did not. CONCLUSION The terminology varied considerably across studies and time. The diagnostic criteria were often based on a cluster of physical examination tests. Imaging was primarily used to exclude other pathologies but was not used consistently. Patients with full-thickness supraspinatus tears were most often excluded. In summary, studies investigating SAPS are heterogeneous to an extent that makes it difficult, and often impossible, to compare studies.
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Affiliation(s)
- Adam Witten
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Karen Mikkelsen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Thomas Wagenblast Mayntzhusen
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
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Ting DS, Yang JL, Lin KH, Wang TG, Lin JJ. Alteration in coracohumeral ligament and distance in people with symptoms of subcoracoid impingement. BMC Musculoskelet Disord 2023; 24:58. [PMID: 36683027 PMCID: PMC9869551 DOI: 10.1186/s12891-023-06152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Differentiation between subacromial impingement versus subcoracoid impingement are important for the treatment target. We evaluated the correlations between coracohumeral ligament (CHL) thickness and distance (CHD) and characterized the CHL and subscapularis (SSC) in subcoracoid impingement subjects. METHODS An observational, cross-sectional study was carried out. Twenty subcoracoid impingement subjects and age/gender matched controls were assessed in 4 different shoulder positions by ultrasonography. RESULTS Moderate correlations between CHL thickness with CHD (r = 0.455 in neutral rotation, p = 0.044; r = 0.483 in interior rotation, p = 0.031) were found in subacromial subjects. Subcoracoid impingement subjects had greater CHL thickness (difference = 0.3 mm, effect size = 0.85, p = 0.006), SSC tendon thickness (difference = 0.7 mm, effect size = 0.92, p = 0.01) and SSC/CHD occupation ratio (difference = 8%, effect size = 0.95, p = 0.005) compared with the control. CONCLUSIONS Coracohumeral distance is related to ligament thickness, especially in subacromial impingement subjects. Increased coracohumeral ligament and subscapularis thickness as well as decreased subscapularis/coracohumeral distance occupation ratio are characterized in subcoracoid impingement subjects. These quantitative measurements can be useful in identifying patients at risk of subcoracoid impingement from subacromial impingement.
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Affiliation(s)
- Deng Siang Ting
- grid.19188.390000 0004 0546 0241School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Jing-lan Yang
- grid.412094.a0000 0004 0572 7815Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kwan-Hwa Lin
- grid.19188.390000 0004 0546 0241School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Tyng-Guey Wang
- grid.412094.a0000 0004 0572 7815Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jiu-Jenq Lin
- grid.19188.390000 0004 0546 0241School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan ,grid.412094.a0000 0004 0572 7815Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
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Overbeek CL, Geurkink TH, de Groot FA, Klop I, Nagels J, Nelissen RGHH, de Groot JH. Shoulder movement complexity in the aging shoulder: A cross-sectional analysis and reliability assessment. J Orthop Res 2021; 39:2217-2225. [PMID: 33251589 PMCID: PMC8518861 DOI: 10.1002/jor.24932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Healthy individuals perform a task such as hitting the head of a nail with an infinite coordination spectrum. This motor redundancy is healthy and allows for learning through exploration and uniform load distribution across muscles. Assessing movement complexity within repetitive movement trajectories may provide insight into the available motor redundancy during aging. We quantified complexity of repetitive arm elevation trajectories in the aging shoulder and assessed test-retest reliability of this quantification. In a cross-sectional study using 3D-electromagnetic tracking, 120 asymptomatic subjects, aged between 18 and 70 years performed repetitive abduction and forward/anteflexion movements. Movement complexity was calculated using the Approximate Entropy (ApEn-value): [0,2], where lower values indicate reduced complexity. Thirty-three participants performed the protocol twice, to determine reliability (intraclass correlation coefficient [ICC]). The association between age and ApEn was corrected for task characteristics (e.g., sample length) with multiple linear regression analysis. Reproducibility was determined using scatter plots and ICC's. Higher age was associated with lower ApEn-values during abduction (unstandardized estimate: -0.003/year; 95% confidence interval: [-0.005; -0.002]; p < .001). ICC's revealed poor to good reliability depending on differences in sample length between repeated measurements. The results may imply more stereotype movement during abduction in the ageing shoulder, making this movement prone to the development of shoulder complaints. Future studies may investigate the pathophysiology and clinical course of shoulder complaints by assessment of movement complexity. To this end, the ApEn-value calculated over repetitive movement trajectories may be used, although biasing factors such as sample length should be taken into account.
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Affiliation(s)
- Celeste L. Overbeek
- Department of OrthopaedicsLeiden University Medical CenterLeidenThe Netherlands,Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
| | - Timon H. Geurkink
- Department of OrthopaedicsLeiden University Medical CenterLeidenThe Netherlands,Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
| | - Fleur A. de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
| | - Ilse Klop
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
| | - Jochem Nagels
- Department of OrthopaedicsLeiden University Medical CenterLeidenThe Netherlands
| | | | - Jurriaan H. de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
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Overbeek CL, Gademan MGJ, Kolk A, Visser CPJ, van der Zwaal P, Nagels J, Nelissen RGHH. Reduced psychosocial functioning in subacromial pain syndrome is associated with persistence of complaints after 4 years. J Shoulder Elbow Surg 2021; 30:223-228. [PMID: 32949758 DOI: 10.1016/j.jse.2020.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with subacromial pain syndrome (SAPS) frequently present with coexisting psychosocial problems; however, whether this also associates with long-term outcome is currently unknown. We assessed whether psychosocial functioning in patients with SAPS is associated with persistence of complaints after 4 years of routine care. METHODS In a longitudinal study, 34 patients with SAPS were selected after clinical and radiologic evaluation and assessed at baseline and after 4 years. For the assessment of psychosocial functioning, the RAND-36 questionnaire domains of social functioning, role limitations due to emotional problems, mental health, vitality, and general health were evaluated. Complaint persistence at follow-up was assessed by (1) an anchor question (reduced, persistent, or increased symptoms), (2) change in pain (change in visual analog scale score), and (3) change in quality of life (change in Western Ontario Rotator Cuff index score). RESULTS Lower baseline mental health (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.85-0.98; P = .013), vitality (OR, 0.90; 95% CI, 0.83-0.98; P = .011), and general health (OR, 0.93; 95% CI, 0.88-0.98; P = .009) were associated with persistent complaints as reported by the anchor question, change in visual analog scale score, and change in Western Ontario Rotator Cuff index score. CONCLUSIONS Evaluating psychosocial functioning parallel to physical complaints is currently not standard procedure in the treatment of SAPS. In this study, we showed that factors related to psychosocial functioning are associated with long-term persistence of complaints in SAPS. Future studies may investigate whether a multimodal treatment with assessment of psychosocial functioning may facilitate pain relief and recovery in SAPS.
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Affiliation(s)
- Celeste L Overbeek
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands.
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arjen Kolk
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Peer van der Zwaal
- Department of Orthopaedics, Haaglanden Medical Center, The Hague, The Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands
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Overbeek CL, Tiktak WE, Kolk A, Nagels J, Nelissen RGHH, de Groot JH. Reduced force entropy in subacromial pain syndrome: A cross-sectional analysis. Clin Biomech (Bristol, Avon) 2020; 80:105137. [PMID: 32763626 DOI: 10.1016/j.clinbiomech.2020.105137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Generating a force at the hand requires moments about multiple joints by a theoretically infinite number of arm and shoulder muscle force combinations. This allows for learning and adaptation and can possibly be captured using the complexity (entropy) of an isometrically generated force curve. Patients with Subacromial Pain Syndrome have difficulty to explore alternative, pain-avoiding, motor strategies and we questioned whether loss of motor complexity may contribute to this. We assessed whether patients with Subacromial Pain Syndrome have reduced entropy of an isometrically generated abduction and adduction force curve. METHODS Forty patients and thirty controls generated submaximal isometric ab- and adduction force at the wrist. The force curve was characterized by the magnitude of force variability [standard deviation and coefficient of variation], and the entropy (complexity) of force variability [approximate entropy]. FINDINGS Patients showed reduced entropy both during the abduction (-0.16, confidence interval: [-0.33; -0.00], p: 0.048) and adduction task (-0.20, confidence interval: [-0.37; -0.03], p: 0.024) and reduced force variability during abduction (standard deviation: -0.006, confidence interval: [-0.011; -0.001], p: 0.013 and coefficient of variation: -0.51, confidence interval: [-0.93; -0. 10], p: 0.016). INTERPRETATIONS Isometric force curves of patients with Subacromial Pain Syndrome show reduced complexity compared to asymptomatic controls, which may indicate more narrow and stereotype use of motor options. In future studies, it should be investigated whether the finding of reduced force (motor) entropy indicates functional decline, contributing to decreased ability to acquire and optimize motor strategies in Subacromial Pain Syndrome. LEVEL OF EVIDENCE Level II prognostic study.
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Affiliation(s)
- Celeste L Overbeek
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands.
| | - Willemijn E Tiktak
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands
| | - Arjen Kolk
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands
| | - Jurriaan H de Groot
- Department of Orthopaedics, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands; Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Postzone J-11-R, PO Box 9600, 2300RC Leiden, The Netherlands
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Overbeek CL, Gacaferi H, Schoones JW, Jayakumar P, Vermeulen HM, de Groot JH, Nelissen RGHH, Nagels J. The effect of conservative therapies on proprioception in subacromial pain syndrome: a narrative synthesis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1787511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Celeste L. Overbeek
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Hamez Gacaferi
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan W. Schoones
- Walaeus Library, Leiden University Medical Centre, Leiden, the Netherlands
| | - Prakash Jayakumar
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Henricus M. Vermeulen
- Department of Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurriaan H. de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G. H. H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and Rehabilitation, Leiden University Medical Center, Leiden, the Netherlands
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Kjær BH, de Wandele I, Spanhove V, Juul-Kristensen B, Cools AM. Subacromial space outlet in female patients with multidirectional instability based on hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder measured by ultrasound. J Shoulder Elbow Surg 2020; 29:600-608. [PMID: 31629650 DOI: 10.1016/j.jse.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/03/2019] [Accepted: 08/07/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of the study was to compare the acromiohumeral distance (AHD) between patients diagnosed with hypermobility type of the Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) and healthy controls by evaluating the relative amount the tendon occupies in the subacromial area. Furthermore, the aim was to evaluate if there was a change in AHD with arm elevation within and between groups. METHODS Twenty-nine female patients with hEDS/HSD (aged 34 ± 12.9 years) and 20 healthy controls (aged 33 ± 10.8 years) participated in the study. The supraspinatus tendon (SST) thickness and AHD were measured using ultrasound. The interplay between the SST and the AHD was expressed as the occupation ratio (OcAHD), calculated as the SST thickness as a percentage of AHD. The measures were performed in the resting position and in subsequently 45° and 60° of active arm elevation in the scapular plane. RESULTS The main finding is that patients with hEDS/HSD have a larger subacromial space outlet compared with the controls when measured by ultrasound. Furthermore, in both groups, we found an increased OcAHD during active arm elevation compared with the resting position, which indicates that similar mechanisms occur for patients with hEDS/HSD and healthy controls. CONCLUSION Patients with hEDS/HSD have a larger available subacromial space outlet compared with healthy individuals. OcAHD increased during active arm elevation compared with the resting position in both groups. This knowledge is important when designing rehabilitation exercise programs for shoulder instability patients with abnormal glenohumeral biomechanics.
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark; Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Inge de Wandele
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Valentien Spanhove
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Ann M Cools
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Overbeek CL, Kolk A, de Groot JH, de Witte PB, Gademan MGJ, Nelissen RGHH, Nagels J. Middle-aged adults cocontract with arm ADductors during arm ABduction, while young adults do not. Adaptations to preserve pain-free function? J Electromyogr Kinesiol 2019; 49:102351. [PMID: 31473453 DOI: 10.1016/j.jelekin.2019.102351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/30/2019] [Accepted: 08/20/2019] [Indexed: 02/04/2023] Open
Abstract
Middle-aged individuals cocontract with adductor muscles during abduction. This may be crucial for counteracting deltoid forces, depressing the humerus and ensuring free passage of subacromial tissues underneath the acromion during abduction. We questioned whether adductor co-contraction is always present, or develops during ageing, in which case it may explain the age-related character of common shoulder conditions such as Subacromial Pain Syndrome. In a cross-sectional analysis with electromyography (EMG), activation patterns of the latissimus dorsi, teres major, pectoralis major and deltoid muscle were assessed during isometric force tasks in 60 asymptomatic individuals between 21 and 60 years old. Cocontraction was expressed as the degree of antagonistic activation relative to the same muscle's degree of agonistic activation, resulting in an activation ratio between -1 and 1, where lower values indicate more cocontraction. Using linear regression analyses, we found age-related decreases in the activation ratio of the latissimus dorsi (regression estimate: -0.004, 95% CI: -0.007 to 0.0, p-value: 0.042) and teres major (regression estimate: -0.013, 95% CI: -0.019 to -0.008, p-value: <0.001). In contrast to young individuals, middle-aged individuals showed a high degree of adductor cocontraction during abduction. This may indicate that during ageing, alterations in activation patterns are required for preserving pain-free shoulder function.
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Affiliation(s)
- Celeste L Overbeek
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Arjen Kolk
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurriaan H de Groot
- Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands; Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden, the Netherlands
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Altered Cocontraction Patterns of Humeral Head Depressors in Patients with Subacromial Pain Syndrome: A Cross-sectional Electromyography Analysis. Clin Orthop Relat Res 2019; 477:1862-1868. [PMID: 31107319 PMCID: PMC7000021 DOI: 10.1097/corr.0000000000000745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In approximately 29% to 34% of all patients with subacromial pain syndrome (SAPS) there is no anatomic explanation for symptoms, and behavioral aspects and/or central pain mechanisms may play a more important role than previously assumed. A possible behavioral explanation for pain in patients with SAPS is insufficient active depression of the humerus during abduction by the adductor muscles. Although the adductor muscles, specifically the teres major, have the most important contribution to depression of the humerus during abduction, these muscles have not been well studied in patients with SAPS. QUESTIONS/PURPOSES Do patients with SAPS have altered contraction patterns of the arm adductors during abduction compared with asymptomatic people? METHODS SAPS was defined as nonspecific shoulder pain lasting for longer than 3 months that could not be explained by specific conditions such as calcific tendinitis, full-thickness rotator cuff tears, or symptomatic acromioclavicular arthritis, as assessed with clinical examination, radiographs, and magnetic resonance arthrography. Of 85 patients with SAPS who met the prespecified inclusion criteria, 40 were eligible and agreed to participate in this study. Thirty asymptomatic spouses of patients with musculoskeletal complaints, aged 35 to 60 years, were included; the SAPS and control groups were not different with respect to age, sex, and hand dominance. With electromyography, we assessed the contraction patterns of selected muscles that directly act on the position of the humerus relative to the scapula (the latissimus dorsi, teres major, pectoralis major, and deltoid muscles). Cocontraction was quantified through the activation ratio ([AR]; range, -1 to 1). The AR indicates the task-related degree of antagonist activation relative to the same muscle's degree of agonist activation, equaling 1 in case of sole agonist muscle activation and equaling -1 in case of sole antagonistic activation (cocontraction). We compared the AR between patients with SAPS and asymptomatic controls using linear mixed-model analyses. An effect size of 0.10 < AR < 0.20 was subjectively considered to be a modest effect size. RESULTS Patients with SAPS had a 0.11 higher AR of the teres major (95% CI, 0.01-0.21; p = 0.038), a 0.11 lower AR of the pectoralis major (95% CI, -0.18 to -0.04; p = 0.003), and a 0.12 lower AR of the deltoid muscle (95% CI, -0.17 to -0.06; p < 0.001) than control participants did. These differences were considered to be modest. With the numbers available, we found no difference in the AR of the latissimus dorsi between patients with SAPS and controls (difference = 0.05; 95% CI, -0.01 to 0.12; p = 0.120). CONCLUSIONS Patients with SAPS showed an altered adductor cocontraction pattern with reduced teres major activation during abduction. The consequent reduction of caudally directed forces on the humerus may lead to repetitive overloading of the subacromial tissues and perpetuate symptoms in patients with SAPS. Physical therapy programs are frequently effective in patients with SAPS, but targeted approaches are lacking. Clinicians and scientists may use the findings of this study to assess if actively training adductor cocontraction in patients with SAPS to unload the subacromial tissues is clinically effective. The efficacy of training protocols may be enhanced by using electromyography monitoring. LEVEL OF EVIDENCE Level II, prognostic study.
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Dickerson CR, Cutti AG. The translational value of shoulder biomechanics research. J Electromyogr Kinesiol 2016; 29:1-3. [PMID: 26792417 DOI: 10.1016/j.jelekin.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Clark R Dickerson
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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