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Ehsani F, Taghizadeh Delkhoush C, Mirmohammadkhani M, Ehyaie H. A Comparison of 2 Exercise Protocols in Athletes With Primary Subacromial Impingement Syndrome: A Randomized Clinical Trial. J Sport Rehabil 2024:1-11. [PMID: 39069293 DOI: 10.1123/jsr.2023-0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 07/30/2024]
Abstract
CONTEXT To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. DESIGN A randomized and controlled clinical study. METHODS Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3 days a week for 6 weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. RESULTS The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P < .001), with no significant differences detected between the experimental groups (P > .665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P < .001), while no significant difference was observed between the experimental groups (P > .999). CONCLUSIONS The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities.
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Affiliation(s)
- Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hanna Ehyaie
- Department of Physical Therapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Semnan, Iran
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Manoso-Hernando D, Bailón-Cerezo J, Angulo-Díaz-Parreño S, Reina-Varona Á, Elizagaray-García I, Gil-Martínez A. Shoulder mobility and strength impairments in patients with rotator cuff related shoulder pain: a systematic review and meta analysis. PeerJ 2024; 12:e17604. [PMID: 38948223 PMCID: PMC11214432 DOI: 10.7717/peerj.17604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Background The methods previously proposed in the literature to assess patients with rotator cuff related shoulder pain, based on special orthopedic tests to precisely identify the structure causing the shoulder symptoms have been recently challenged. This opens the possibility of a different way of physical examination. Objective To analyze the differences in shoulder range of motion, strength and thoracic kyphosis between rotator cuff related shoulder pain patients and an asymptomatic group. Method The protocol of the present research was registered in the International Prospective Register of Systematic Review (PROSPERO) (registration number CRD42021258924). Database search of observational studies was conducted in MEDLINE, EMBASE, WOS and CINHAL until July 2023, which assessed shoulder or neck neuro-musculoskeletal non-invasive physical examination compared to an asymptomatic group. Two investigators assessed eligibility and study quality. The Newcastle Ottawa Scale was used to evaluate the methodology quality. Results Eight studies (N = 604) were selected for the quantitative analysis. Meta-analysis showed statistical differences with large effect for shoulder flexion (I2 = 91.7%, p < 0.01, HG = -1.30), external rotation (I2 = 83.2%, p < 0.01, HG = -1.16) and internal rotation range of motion (I2 = 0%, p < 0.01, HG = -1.32). Regarding to shoulder strength; only internal rotation strength showed statistical differences with small effect (I2 = 42.8%, p < 0.05, HG = -0.3). Conclusions There is moderate to strong evidence that patients with rotator cuff related shoulder pain present less shoulder flexion, internal and external rotation range of motion and less internal rotation strength than asymptomatic individuals.
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Affiliation(s)
- Daniel Manoso-Hernando
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | - Javier Bailón-Cerezo
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - Álvaro Reina-Varona
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Unidad de Fisioterapia, Hospital Universitario La Paz-Carlos III (IdiPAZ), Madrid, Spain
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Vila-Dieguez O, Heindel MD, Awokuse D, Kulig K, Michener LA. Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery. Shoulder Elbow 2023; 15:233-249. [PMID: 37325389 PMCID: PMC10268139 DOI: 10.1177/17585732231172166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors. Tendon structure plays a role in RC tendinopathy, with decreased stiffness, increased thickness, and collagen disorganization. Neuromuscular performance deficits of altered kinematics, muscle activation, and force are present in RC tendinopathy, but advanced methods of assessing muscle performance are needed to fully assess these factors. Psychological factors of depression, anxiety, pain catastrophizing, treatment expectations, and self-efficacy are present and predict patient-reported outcomes. Central nervous system dysfunctions also exist, specifically altered pain and sensorimotor processing. Resisted exercise may normalize these factors, but limited evidence exists to explain the relationship of the four proposed domains to trajectory of recovery and defining persistent deficits limiting outcomes. Clinicians and researchers can use this model to understand how exercise mediates change in patient outcomes, develop subgroups to deliver patient-specific approach for treatment and define metrics to track recovery over time. Supporting evidence is limited, indicating the need for future studies characterizing mechanisms of recovery with exercise for RC tendinopathy.
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Affiliation(s)
- Oscar Vila-Dieguez
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Matthew D. Heindel
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Daniel Awokuse
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A. Michener
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Lo CN, Leung BPL, Sanders G, Li MWM, Ngai SPC. The major pain source of rotator cuff-related shoulder pain: A narrative review on current evidence. Musculoskeletal Care 2023; 21:285-293. [PMID: 37316968 DOI: 10.1002/msc.1719] [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] [Indexed: 06/16/2023]
Abstract
BACKGROUND Rotator cuff-related shoulder pain (RCRSP) was proposed to have a complex pain mechanism, but the exact aetiology is still unclear. A recent review summarised the updated research to analyse the traditional concept of shoulder impingement which may not be accurate. Current studies have demonstrated that mechanical factors including a reduction in subacromial space, scapular dyskinesia and different acromial shapes are unlikely directly contributing to RCRSP. AIMS Since the precise RCRSP pain mechanism remains unclear, the aim of this narrative review is to discuss possible sources of pain contributing to RCRSP according to the mechanisms-based pain classifications. RESULTS AND DISCUSSION Research findings on potential mechanical nociceptive factors of RCRSP are conflicting; investigations of neuropathic and central pain mechanisms of RCRSP are limited and inconclusive. Overall, available evidence has indicated moderate to strong correlations between RCRSP and chemical nociceptive sources of pain. CONCLUSION Results from current research may provide new directions for future studies on the aetiology of RCRSP and its clinical management towards a biochemical view instead of the traditional mechanical hypothesis.
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Affiliation(s)
- Chi Ngai Lo
- Family Care Physiotherapy Clinic, Clementi, Singapore
| | - Bernard Pui Lam Leung
- Health and Social Sciences Cluster, Singapore Institute of Technology, Dover, Singapore
- Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Grant Sanders
- Sanders Chiropractic and Fitness, Ohio, Bainbridge, USA
| | | | - Shirley P C Ngai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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González Aroca J, Díaz ÁP, Navarrete C, Albarnez L. Fear-Avoidance Beliefs Are Associated with Pain Intensity and Shoulder Disability in Adults with Chronic Shoulder Pain: A Cross-Sectional Study. J Clin Med 2023; 12:jcm12103376. [PMID: 37240482 DOI: 10.3390/jcm12103376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 05/28/2023] Open
Abstract
Shoulder pain is one of the most common musculoskeletal conditions, and for people over 40 years old, it represents the musculoskeletal pain with the greatest impact on quality of life. Psychological factors, such as fear-avoidance beliefs, are associated with musculoskeletal pain, and several studies suggest that they can influence various treatment outcomes. Our objective was to explore the cross-sectional association between fear-avoidance beliefs and shoulder pain intensity and disability in subjects with chronic shoulder pain. A cross-sectional study was conducted, and 208 participants with chronic unilateral subacromial shoulder pain were recruited. The shoulder pain and disability index assessed pain intensity and disability. The Spanish fear-avoidance components scale assessed the presence of fear-avoidance beliefs. The association between fear-avoidance beliefs and pain intensity and disability was analyzed by means of multiple linear regression models and proportional odds models, reporting odds ratios and 95% confidence intervals. Shoulder and pain disability scores were significantly associated with fear-avoidance beliefs (p < 0.0001, adjusted R-square 0.93, multiple linear regression). There was no evidence of an association between sex and age in this study. The regression coefficient for shoulder pain intensity and disability score was 0.67446. The proportional odds model showed an odds ratio of 1.39 (1.29-1.50) for shoulder pain intensity and disability total score. This study suggests that greater levels of fear-avoidance beliefs are associated with greater levels of shoulder pain and disability in adults with chronic shoulder pain.
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Affiliation(s)
| | | | - Carlos Navarrete
- Department of Mathematics, Faculty of Science, University of La Serena, La Serena 1700000, Chile
| | - Loreto Albarnez
- School of Kinesiology, University of La Serena, La Serena 1700000, Chile
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Reliability of coracohumeral distance and subcoracoid tendons in subacromial pain syndrome. Sci Rep 2023; 13:2383. [PMID: 36765167 PMCID: PMC9918475 DOI: 10.1038/s41598-023-29601-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
This study investigated the intra-rater reliability of a novice ultrasound (US) examiner and the inter-rater reliability of two examiners (novice, expert) in the measures of coracohumeral distance at rest (CHD) and at 60° of elevation without (CHD60) or with weights (CHD60w), tendon thickness of the long head of the biceps (LHB) and subscapularis (SCP). Twenty-one patients with subacromial pain syndrome (SAPS) and 20 asymptomatic participants were included. Intra and inter-rater reliability were tested with intraclass-correlation-coefficient (ICC), differences between raters were analyzed with Bland-Altman plots. Intra-rater reliability for CHD, CHD60 and CHD60w was excellent (ICC = 0.97-0.98) in asymptomatic participants, and good-to-excellent (0.88-0.93) in SAPS, while intra-rater reliability for LHB and SCP was good-to-excellent in asymptomatic participants (0.88-0.97) and in SAPS (0.90-0.92). Inter-rater reliability for CHD, CHD60 and CHD60w was moderate-to-good (0.70-0.90) in asymptomatic participants and good (0.85-0.87) in SAPS, in contrast inter-rater reliability for LHB and SCP was poor in asymptomatic participants (0.10-0.46) and poor-to-moderate (0.49-0.61) in SAPS. Bland-Altman plots revealed systematic and/or proportional bias for tendons' thickness. A novice showed good-to-excellent intra-rater reliability in all US measures, whereas in comparison to an expert a novice can measure reliably CHD, CHD60 and CHD60w, but not LHB and SCP, where more training is recommended.
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Hadjisavvas S, Efstathiou MA, Malliou V, Giannaki CD, Stefanakis M. Risk factors for shoulder injuries in handball: systematic review. BMC Sports Sci Med Rehabil 2022; 14:204. [PMID: 36461053 PMCID: PMC9717475 DOI: 10.1186/s13102-022-00588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Handball is a sport with a high number of severe injuries. The shoulder is one of the most commonly injured joints, with an average prevalence of 17-41%. OBJECTIVE The primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies. METHODS Systematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. RESULTS 1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50-85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player's position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1). CONCLUSION Overall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies. PROTOCOL REGISTRATION PROSPERO ID: CRD42020138233.
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Affiliation(s)
- Stelios Hadjisavvas
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Michalis A. Efstathiou
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Vivian Malliou
- grid.12284.3d0000 0001 2170 8022Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Christoforos D. Giannaki
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Manos Stefanakis
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Differences in Coracohumeral Distance Between the Symptomatic and the Asymptomatic Shoulder in Patients With Unilateral Shoulder Pain and in Healthy Participants: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:515-521. [PMID: 36517268 DOI: 10.1016/j.jmpt.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to analyze whether differences in the coracohumeral distance (CHD) exist between the symptomatic and the asymptomatic shoulder in patients with subacromial pain syndrome and compare with the shoulder of control participants. METHODS This was a cross-sectional, observational study. A sample comprising 62 participants with subacromial pain syndrome was recruited from 3 different primary care centers. The CHD was determined from standardized ultrasonography measures performed on both shoulders at 0° and 60° of shoulder abduction, whereas the dominant arm was measured for the control participants. RESULTS Statistically significant differences in CHD at 0° and 60° were found between the symptomatic and control shoulders (P = .011/P = .002) and between the contralateral asymptomatic shoulder and controls (P = .026/P = .007). CONCLUSION We found differences in CHD at 0° and 60° of shoulder elevation between both the affected and the nonaffected shoulders when compared with healthy shoulders. These results suggest that CHD may be a contributing factor in chronic shoulder pain.
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Shoulder pain across more movements is not related to more rotator cuff tendon findings in people with chronic shoulder pain diagnosed with subacromial pain syndrome. Pain Rep 2021; 6:e980. [PMID: 34938935 PMCID: PMC8687723 DOI: 10.1097/pr9.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/21/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Neither the number nor severity of rotator cuff tendons reported as abnormal was associated with the pain occurrence across clinically relevant arm movements. Introduction: People with chronic shoulder pain commonly report pain during arm movements in daily-life activities. Pain related to movement is commonly viewed as an accurate representation of tissue damage. Thus, when a person reports pain across a variety of movements, this is often understood as indicative of greater damage. Objectives: We aimed to investigate if movement-related pain that occurs across a wider variety of movements was associated with the number or severity of rotator cuff tendons reported as abnormal on a magnetic resonance imaging (MRI). To answer this question, this study was designed in 3 phases. Methods: We recruited 130 individuals with chronic shoulder pain diagnosed with subacromial pain syndrome. First, a list of daily functional activities commonly reported as painful by people with chronic shoulder pain was generated from 3 well-established outcome measures with 30 individuals and a measurement tool was developed with data from further 100 individuals, which demonstrated to have acceptable content validity, construct validity, internal consistency, interrater reliability, and structural validity. Multiple linear regression was then used to evaluate the hypotheses of the study. A direct acyclic graph was used to select variables for linear regression modelling. Results: There was no association between movement-related pain occurrence across movements and the MRI findings. Conclusion: Our study provides evidence that neither the number of rotator cuff tendons reported as abnormal nor the severity of each tendon imaging finding were associated with pain occurrence across movements and activities commonly perceived as painful by people with chronic shoulder pain.
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Hunter DJ, Rivett DA, McKiernan S, Snodgrass SJ. Acromiohumeral distance and supraspinatus tendon thickness in people with shoulder impingement syndrome compared to asymptomatic age and gender-matched participants: a case control study. BMC Musculoskelet Disord 2021; 22:1004. [PMID: 34852803 PMCID: PMC8638187 DOI: 10.1186/s12891-021-04885-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background Shoulder impingement syndrome (SIS) is the most common form of shoulder pain. Conservative and surgical treatments for SIS are often not effective. One such surgical intervention is subacromial decompression, aimed at widening the subacromial space (SAS). A better understanding of the changes in the SAS may help explain the relative ineffectiveness of current interventions. Objective: To measure the acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT) in people with SIS using a case control study. Methods The AHD and STT of 39 participants with SIS ≥3 months and 39 age, gender and dominant arm matched controls were measured using ultrasound imaging. Between-group differences for AHD and STT were compared using t-tests. A linear regression was used to determine if there was a relationship between AHD and STT measures, with group as a covariate. Results Compared to controls (mean age 55.7 years, SD 10.6), individuals with SIS (mean age 57.1 years, SD 11.1) had a significantly larger AHD (mean difference 2.14 mm, 95% CI 1.21, 3.07, p < 0.001) and STT (mean difference 1.25 mm, 95% CI 0.60, 1.90, p < 0.001). The linear regression model indicated an association between AHD and STT (β = 0.59, 95% CI 0.29, 0.89, p < 0.01, R2 = 0.35, n = 78), suggesting that as STT increases in size, so does the AHD. Conclusion Individuals with SIS had a larger AHD and greater STT than controls. These results suggest the SAS is already wider in people with SIS and that the symptoms associated with SIS may be more related to an increased STT than a smaller SAS.
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Affiliation(s)
- Donald J Hunter
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Darren A Rivett
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Sharmaine McKiernan
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW, 2308, Australia
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Charry FB, Martínez MJL, Rozo L, Jurgensen F, Guerrero-Henriquez J. In vivo effects of two shoulder girdle motor control exercises on acromiohumeral and coracohumeral distances in healthy men. J Man Manip Ther 2021; 29:367-375. [PMID: 34260343 PMCID: PMC8725678 DOI: 10.1080/10669817.2021.1950300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Altered motor control and proprioceptive deficits are associated with kinematics dysfunctions and may cause alterations in subacromial space (SAS) that could lead to shoulder pathologies. Dimensions of the subacromial space, as well as interventions aimed at its normal restitution, can be explored by ultrasound (US). OBJECTIVE To describe the effect of two shoulder girdle motor control exercises with cognitive training strategies on SAS dimensions, measured with US. METHODS Cognitive movement control strategies, with visual and haptic feedback were applied on 21 healthy participants. SAS dimensions were measured through in vivo variations of acromiohumeral (AHD) and coracohumeral distances (CHD) using US. RESULTS Our results show that as exercise repetitions are performed, an increasing trend in both measures can be observed, being wider for AHD (i.e. humeral head descent exercise) than CHD (i.e. scapular retraction exercise). CONCLUSION Specific cognitive and motor control exercises improve congruence joint and centering of the humeral head.
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Affiliation(s)
- Fernanda B Charry
- Manual Therapy Master's Degree, Faculty of Rehabilitation Sciences, Andrés Bello University, Santiago, Chile
| | - María Jesús L Martínez
- Manual Therapy Master's Degree, Faculty of Rehabilitation Sciences, Andrés Bello University, Santiago, Chile
| | - Liliana Rozo
- Postgraduate Department of Manual Therapy, Faculty of Rehabilitation Sciences, Andres Bello University, Santiago, Chile
| | - Fernando Jurgensen
- Clinical Applicationist of Ultrasound for General Electric Company, Hoser Ingenieria, Santiago, Chile
| | - Juan Guerrero-Henriquez
- Rehabilitation and Human Movement Sciences Department, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
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Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A. Differences in supraspinatus occupation ratio between the symptomatic, the contralateral asymptomatic shoulder and control subjects: A cross-sectional study. Medicine (Baltimore) 2021; 100:e24734. [PMID: 33578621 PMCID: PMC10545080 DOI: 10.1097/md.0000000000024734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT The relationship between supraspinatus tendon thickness and the acromiohumeral distance (AHD) at both rest position and shoulder elevation is still to be explored in those with chronic shoulder pain. The aim is to compare supraspinatus occupation ratio (OR) at 0° and 60° of shoulder elevation measured by ultrasound imaging in the symptomatic shoulder, the contralateral asymptomatic shoulder and in healthy subjects. This was across-sectional, observational study. A sample of 56 participants with subacromial pain syndrome in their dominant arm was recruited in 3 different primary care centres. Forty participants without shoulder pain were also recruited. The AHD at 0° and 60° of active shoulder abduction as well as the supraspinatus tendon thickness were measured by ultrasound in these groups. Supraspinatus OR at 60° was significantly greater in symptomatic compared to asymptomatic shoulders (P = .04) and healthy shoulders (P = .008). The percentage of change in supraspinatus OR from rest position to 60° was also greater in symptomatic shoulders when comparing with asymptomatic (P = .01) and healthy shoulders (P = .03). No other statistically significant differences for the rest of comparisons were found. Supraspinatus OR may explain shoulder pain in chronic conditions. Further studies at acute and chronic conditions after a physiotherapy treatment are needed to explore its usefulness in clinical practice.
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Affiliation(s)
| | - Manuel Fernandez-Sanchez
- Department of Nursing Physiotherapy and Medicine, University of Almeria, Facultad Ciencias de la Salud, Universidad de Almería, Ctra de Sacramento S/N, Almeria
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, University of Malaga, Spain. Facultad Ciencias de la Salud, Universidad de Malaga, Arquitecto Francisco Penalosa, 3, Malaga
- Instituto de la Investigacion Biomedica de Malaga-IBIMA, Spain
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Park SW, Chen YT, Thompson L, Kjoenoe A, Juul-Kristensen B, Cavalheri V, McKenna L. No relationship between the acromiohumeral distance and pain in adults with subacromial pain syndrome: a systematic review and meta-analysis. Sci Rep 2020; 10:20611. [PMID: 33244115 PMCID: PMC7693267 DOI: 10.1038/s41598-020-76704-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
To determine whether subacromial space (i.e. acromiohumeral distance; AHD, and/or occupation ratio percentage) differs between people with subacromial pain syndrome (SAPS) and those without. To investigate whether there is a correlation between subacromial space and pain or disability in adults with SAPS and whether temporal changes in pain or disability are accompanied by changes in subacromial space. Systematic review and meta-analysis. Fifteen studies with a total of 775 participants were included. Twelve studies were of high quality and three studies were of moderate quality using the modified Black and Downs checklist. There was no between group difference in AHD in neutral shoulder position (mean difference [95% CI] 0.28 [-0.13 to 0.69] mm), shoulder abduction at 45° (-0.02 [-0.99 to 0.96] mm) or 60° (-0.20 [-0.61 to 0.20] mm). Compared to the control group, a greater occupation ratio in neutral shoulder position was demonstrated in participants with SAPS (5.14 [1.87 to 8.4] %). There was no consistent pattern regarding the correlation between AHD and pain or disability in participants with SAPS, and no consistent increase in subacromial space with improvement in pain or disability over time. The results suggest that surgical (e.g. sub-acromial decompression) and non-surgical (e.g. manual therapy, taping, stretching and strengthening) management of subacromial pain syndrome should not focus solely on addressing a potential decrease in subacromial space, but also on the importance of other biopsychosocial factors.
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Affiliation(s)
- Soo Whan Park
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Yuan Tai Chen
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lindsay Thompson
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Andreas Kjoenoe
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Leanda McKenna
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
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Navarro-Ledesma S, Fernandez-Sanchez M, Struyf F, Luque Suarez A. Association of Both Scapular Upward Rotation and Scapulothoracic Muscle Lengths With Shoulder Pain, Function, and Range of Movement. J Manipulative Physiol Ther 2020; 43:824-831. [PMID: 32928568 DOI: 10.1016/j.jmpt.2019.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/23/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our aim was to analyze whether shoulder pain is related to scapular upward rotation (SUR) or to the lengths of the pectoralis minor and levator scapulae muscles. METHODS This cross-sectional, observational study was carried out in 3 primary-care centers; 54 individuals with chronic shoulder pain participated. Scapular upward rotation and the lengths of the pectoralis minor and levator scapulae muscles were assessed. RESULTS The level of association was small between shoulder pain and function and (1) the lengths of the pectoralis minor (r = 0.08, P = .93) and levator scapulae (r = -0.01, P = .57) muscles and (2) SUR at 45° (r = 0.17, P = .21), 90° (r = 0.08, P = .57), and 135° (r = 0.10, P = 0.45) of shoulder elevation. CONCLUSION The relationship was small between shoulder pain and function and (1) SUR (45°, 90°, and 135° of shoulder elevation) and (2) the lengths of the pectoralis minor and levator scapulae muscles. Thus, the use of SUR and pectoralis minor and levator scapulae lengths in shoulder assessment should be undertaken with caution. Other factors such as psychological factors, central/peripheral sensitization, and intrinsic properties of the tissue have to be taken into account.
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Affiliation(s)
| | | | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Alejandro Luque Suarez
- Department of Physiotherapy, Faculty of Health Sciences, University of Málaga, Málaga, Spain; Instituto de la Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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15
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Buyuksireci DE, Tecer D, Bolayir B, Yon MEE, Akturk M, Gunendi Z, Gogus F. Ultrasonographic evaluation of shoulder tendons in patients with Hashimoto's disease. Int J Rheum Dis 2020; 23:1497-1504. [PMID: 32885607 DOI: 10.1111/1756-185x.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the thickness of the shoulder tendons and the measurement of acromiohumeral distance (AHD) in patients with Hashimoto's disease (HD). MATERIAL AND METHODS Twenty-eight patients with subclinical hypothyroid HD, 40 patients with euthyroid HD, and 51 healthy subjects were included. The thicknesses of biceps brachii, subscapularis, supraspinatus, infraspinatus tendons at both shoulders were evaluated with ultrasonography. Serum levels of thyroid stimulated hormone (TSH), free tri-iodothyronine, free thyroxine (FT4), anti-thyroid peroxidase (TPO) and anti-thyroglobulin (anti-TG) antibodies levels were measured. RESULTS Height, weight, body mass index (BMI), free T3 and free T4 levels were similar between the three groups (P = .839, P = .205, P = .374, P = .430 and P = .497, respectively). Biceps brachii, supraspinatus and infraspinatus tendon thicknesses in dominant arm and biceps brachii, subscapularis and infraspinatus tendon thicknesses in non-dominant arm were significantly increased in euthyroid HD compared to healthy controls (P = .003, P = .030, P < .001; P = .035, P = .042, P < .001, respectively). Biceps brachii tendon thickness in dominant arm and subscapularis and supraspinatus tendon thicknesses in non-dominant arms were significantly increased in subclinical hypothyroid HD compared to healthy controls (P = .025; P = .046, P = .017, respectively). However there was no such difference between euthyroid HD and subclinical hypothyroid HD groups (P < .05). There was low correlation between biceps brachii tendon thickness and free T4 level in non-dominant shoulder in patients with HD (r = .272 P = .030). For the rest of the tendons, there was no correlation between TSH, anti-TPO, anti-TG levels and tendon thicknesses in patients with HD. CONCLUSIONS This study suggests that thyroid autoimmunity in HD may lead to an increase in thickness of shoulder tendons.
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Affiliation(s)
- Dilek Eker Buyuksireci
- Department of Physical Medicine and Rehabilitation, Hitit University Erol Olcok Education and Research Hospital, Corum, Turkey
| | - Duygu Tecer
- Rheumatology Clinic, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Basak Bolayir
- Endocrinology and Metabolism Clinic, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | | | - Mujde Akturk
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zafer Gunendi
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Feride Gogus
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Vanderstukken F, Maenhout A, Spanhove V, Jansen N, Mertens T, Cools AM. Quantifying acromiohumeral distance in elite male field hockey players compared to a non-athletic population. Braz J Phys Ther 2019; 24:273-279. [PMID: 31076255 DOI: 10.1016/j.bjpt.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Shoulders of elite field hockey players are loaded continuously during play. Frequent high shoulder loading is known to influence certain shoulder variables, such as acromiohumeral distance. However, the influence of elite field hockey play on acromiohumeral distance is not examined yet. OBJECTIVE To examine the acromiohumeral distance in elite male field hockey players compared to a non-athletic control group. DESIGN Cross-sectional study. METHODS Fifty male participants were included; 25 elite field hockey players (age: 24.0±2.72 years; weight: 77.2±5.29kg; height; 180.5±5.37cm) and 25 age- and gender matched non-athletes (23.0±2.29 years; weight: 75.7±9.53kg; height: 181.8±5.52cm). A Telemed-Colormaster-128 EXT-IZ device was used to bilaterally obtain ultrasound acromiohumeral distance images at 3 different angles of shoulder abduction in the frontal plane. RESULTS Field hockey players showed a bilateral larger acromiohumeral distance at 45° (mean difference: 1.46mm [95% CI 0.46; 2.46]; p=0.005) and 60° (mean difference: 1.07mm [95% CI 0.21; 1.93]; p=0.016) compared to controls. In both groups, a significant but clinically less relevant, side difference was established for the acromiohumeral distance at 60° (mean difference: 0.79mm [95% CI 0.21; 1.34]; p=0.009). CONCLUSION With active shoulder abduction, elite field hockey players show a larger acromiohumeral distance in comparison to non-athletic participants. This may be a protective sport-specific adaptation, to better guard the shoulder from injury. Thus, acromiohumeral distance measurement may help physical therapists/coaches decide which athletes could benefit from specific, additional exercises aimed at enlarging the subacromial space.
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Affiliation(s)
- Fran Vanderstukken
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Annelies Maenhout
- Occupational Therapy Department, Artevelde University College, Ghent, Belgium
| | - Valentien Spanhove
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | | | - Ann Marcelle Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Kim SY, Weon JH, Jung DY, Oh JS. Effect of the scapula-setting exercise on acromio-humeral distance and scapula muscle activity in patients with subacromial impingement syndrome. Phys Ther Sport 2019; 37:99-104. [DOI: 10.1016/j.ptsp.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 11/24/2022]
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Navarro-Ledesma S, Struyf F, Falla D, Luque-Suarez A. Non-traumatic chronic shoulder pain is not associated with changes in rotator cuff interval tendon thickness. Clin Biomech (Bristol, Avon) 2019; 63:147-152. [PMID: 30897462 DOI: 10.1016/j.clinbiomech.2019.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether the thickness of the rotator interval tendons is different when comparing both symptomatic and non-symptomatic sides in people with chronic shoulder pain, and to those free of pain. Furthermore, to calculate the level of association between the rotator interval tendon thicknesses and perceived shoulder pain-function. DESIGN A cross-sectional, observational study. METHOD The supraspinatus, subscapularis and biceps brachii tendon thickness of sixty two patients with chronic shoulder pain were determined from standardized ultrasonography measures performed on both shoulders, whereas only the dominant arm was measured for the control subjects. FINDINGS Supraspinatus, subscapularis and biceps brachii tendon thickness was comparable between sides in the symptomatic group and was also comparable between the symptomatic and asymptomatic participants. In addition, the correlation between the tendon thickness and shoulder pain-function was non-significant. INTERPRETATIONS Tendon thickness was unaltered in people with chronic shoulder pain. These findings do not rule out the possibility that other changes in the tendon are present such as changes in the elastic properties and cell population and this should be explored in future studies.
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Affiliation(s)
- S Navarro-Ledesma
- Department of Physiotherapy, University of Granada, Melilla, Querol Street, 5, 52004 Melilla, Spain; Department of Physiotherapy, University of Malaga, Spain.
| | - F Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, United Kingdom
| | - A Luque-Suarez
- Department of Physiotherapy, University of Malaga, Spain
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de Oliveira FCL, Pairot de Fontenay B, Bouyer LJ, Roy JS. Immediate effects of kinesiotaping on acromiohumeral distance and shoulder proprioception in individuals with symptomatic rotator cuff tendinopathy. Clin Biomech (Bristol, Avon) 2019; 61:16-21. [PMID: 30453120 DOI: 10.1016/j.clinbiomech.2018.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/09/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Kinesiotaping is widely used for the rehabilitation of rotator cuff tendinopathy. It has been argued to reduce symptoms and functional limitations through improvement of proprioceptive feedback. In addition, kinesiotaping has been reported to increase the subacromial space in healthy subjects. However, its effects on the acromiohumeral distance and shoulder proprioception of individuals with rotator cuff tendinopathy have not been ascertained. This study investigated the immediate effects of kinesiotaping on the acromiohumeral distance and shoulder proprioception in individuals with rotator cuff tendinopathy. METHODS Twenty-two individuals with chronic rotator cuff tendinopathy were included. The acromiohumeral distance was measured using an ultrasound scanner at rest and 60° shoulder abduction. Proprioception was measured through active joint repositioning in low- (45°-65°) and mid-amplitude (80°-100°) of shoulder flexion and abduction. A wireless inertial measurement unit system was used to quantify shoulder angles. First, measurements were taken without kinesiotaping. Thereafter, kinesiotaping was applied on the symptomatic shoulder, and the same measurements were retaken. Repeated measures ANOVAs were used for statistical analyses. FINDINGS Kinesiotaping induced a significant increase in acromiohumeral distance at 60° abduction (∆AHD = 0.94 mm; 95%CI: 0.50-1.38, p < 0.001), exceeding the minimal detectable change (0.70 mm). No significant difference was observed in acromiohumeral distance at rest or in proprioception during active joint repositioning in both low- and mid-amplitude (p > 0.05). INTERPRETATION Kinesiotaping led to an immediate increase in acromiohumeral distance at 60° of abduction that, although it seems a minor change (↑10.5%), it may be significant for symptomatic patients, whereas it had no immediate effect on active joint repositioning.
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Affiliation(s)
- Fábio Carlos Lucas de Oliveira
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS-CN, Quebec City, Quebec, G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, G1V 0A6, Canada.
| | - Benoit Pairot de Fontenay
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS-CN, Quebec City, Quebec, G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, G1V 0A6, Canada.
| | - Laurent J Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS-CN, Quebec City, Quebec, G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, G1V 0A6, Canada.
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS-CN, Quebec City, Quebec, G1M 2S8, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, G1V 0A6, Canada.
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Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A. Does the pectoralis minor length influence acromiohumeral distance, shoulder pain-function, and range of movement? Phys Ther Sport 2018; 34:43-48. [DOI: 10.1016/j.ptsp.2018.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/22/2018] [Accepted: 08/21/2018] [Indexed: 12/20/2022]
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21
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Comparison of acromiohumeral distance in symptomatic and asymptomatic patient shoulders and those of healthy controls. Clin Biomech (Bristol, Avon) 2018; 53:101-106. [PMID: 29494815 DOI: 10.1016/j.clinbiomech.2018.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/08/2018] [Accepted: 02/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The reduction of the subacromial space has traditionally been linked to rotator cuff pathology. The contribution of this narrowing, both in the development and maintenance of rotator cuff tendinopathy, is still under debate. The objective of the present study was compare the acromiohumeral distance at 0 and 60 degrees of active shoulder abduction in scapular plane, static position, in both symptomatic and contralateral shoulders, between participants with unilateral rotator cuff related shoulder pain, and in asymptomatic participants. METHOD This was a cross-sectional observational study. Seventy-six participants with chronic shoulder pain were assessed. Forty participants without shoulder pain were also recruited to compare the acromiohumeral distance with symptomatic participants. The acromiohumeral distance was measured at 0 and 60 degrees of active shoulder abduction in all the groups by ultrasound imaging. Mean differences between symptomatic versus contralateral shoulders, and versus healthy controls, were calculated. FINDINGS There were no statistical significant differences (p > .05) in the acromiohumeral distance at 0 degrees of shoulder elevation between the groups. However, significant differences were found at 60° between symptomatic and contralateral shoulder groups (0,51 mm; 95% CI: -0.90 to -0.12). INTERPRETATIONS Differences in shoulder pain perception at 0° are not attributable to acromiohumeral distance differences. However, treatments focused on increasing AHD at 60° could be prescribed, as a significantly reduced AHD was found in symptomatic shoulders when compared with contralateral shoulders. Further research is needed to determine, not only static differences in AHD, but also dynamic differences.
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