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Lawrence RL, Soliman SB, Dalbøge A, Lohse K, Bey MJ. Investigating the multifactorial etiology of supraspinatus tendon tears. J Orthop Res 2024; 42:578-587. [PMID: 37814893 PMCID: PMC10932906 DOI: 10.1002/jor.25699] [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: 03/09/2023] [Revised: 05/23/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
The purpose of this study was to develop a multivariable model to determine the extent to which a combination of etiological factors is associated with supraspinatus tendon tears. Fifty-four asymptomatic individuals (55 ± 4 years) underwent testing of their dominant shoulder. Diagnostic ultrasound was used to assess for a supraspinatus tendon tear. The etiological factors investigated included demographics (age and sex), tendon impingement during shoulder motion (via biplane videoradiography), glenohumeral morphology (via computed tomography imaging), family history of a tear (via self-report), occupational shoulder exposure (via shoulder job exposure matrix), and athletic exposure (via self-report). Univariate relationships between etiological predictors and supraspinatus tears were assessed using logistic regression and odds ratios (ORs), while multivariable relationships were assessed using classification and regression tree analysis. Thirteen participants (24.1%) had evidence of a supraspinatus tear. Individuals with a tear had a higher critical shoulder angle (OR 1.2, p = 0.028) and acromial index (OR 1.2, p = 0.016) than individuals without a tear. The multivariable model suggested that a tear in this cohort can be explained with acceptable accuracy (AUROC = 0.731) by the interaction between acromial index and shoulder occupational exposure: a tear is more likely in individuals with a high acromial index (p < 0.001), and in individuals with a low acromial index and high occupational exposure (p < 0.001). The combination of an individual's glenohumeral morphology (acromial index) and occupational shoulder exposure may be important in the development of supraspinatus tears.
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Affiliation(s)
- Rebekah L. Lawrence
- Program in Physical Therapy, Washington University School of Medicine; St. Louis, MO, USA
- Henry Ford Health; Detroit, MI, USA
| | - Steven B. Soliman
- Henry Ford Health; Detroit, MI, USA
- Department of Radiology, University of Michigan; Ann Arbor, MI, USA
| | - Annett Dalbøge
- Department of Clinical Medicine, Aarhus University; Aarhus, Denmark
- Department of Occupational Medicine, Aarhus University Hospital; Aarhus, Denmark
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine; St. Louis, MO, USA
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Lawrence RL, Richardson LB, Bilodeau HL, Bonath DJ, Dahn DJ, Em MA, Sarkar S, Braman JP, Ludewig PM. Effects of Scapular Angular Deviations on Potential for Rotator Cuff Tendon Mechanical Compression. Orthop J Sports Med 2024; 12:23259671231219023. [PMID: 38435717 PMCID: PMC10906059 DOI: 10.1177/23259671231219023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/14/2023] [Indexed: 03/05/2024] Open
Abstract
Background One proposed mechanism of rotator cuff disease is scapular motion impairments contributing to rotator cuff compression and subsequent degeneration. Purpose To model the effects of scapular angular deviations on rotator cuff tendon proximity for subacromial and internal mechanical impingement risk during scapular plane abduction. Study Design Descriptive laboratory study. Methods Three-dimensional bone models were reconstructed from computed tomography scans obtained from 10 asymptomatic subjects and 9 symptomatic subjects with a clinical presentation of impingement syndrome. Models were rotated to average scapular orientations from a healthy dataset at higher (120°) and lower (subject-specific) humeral elevation angles to investigate internal and subacromial impingement risks, respectively. Incremental deviations in scapular upward/downward rotation, internal/external rotation, and anterior/posterior tilt were imposed on the models to simulate scapular movement impairments. The minimum distance between the rotator cuff insertions and potential impinging structures (eg, glenoid, acromion) was calculated. Two-way mixed-model analyses of variance assessed for effects of scapular deviation and group. Results At 120° of humerothoracic elevation, minimum distances from the supraspinatus and infraspinatus insertions to the glenoid increased with ≥5° changes in upward rotation (1.6-9.8 mm, P < .001) or external rotation (0.9-5.0 mm, P≤ .048), or with ≥10° changes in anterior tilt (1.1-3.2 mm, P < .001). At lower angles, ≥20° changes in most scapular orientations significantly increased the distance between the supraspinatus and infraspinatus insertions and the acromion or coracoacromial ligament. Conclusion A reduction in scapular upward rotation decreases the distance between the rotator cuff tendon insertions and glenoid at 120° humerothoracic elevation. Interpretation is complicated for lower angles because the humeral elevation angle was defined by the minimum distance. Clinical Relevance These results may assist clinical decision making regarding the effects of scapular movement deviations in patients with rotator cuff pathology and scapular dyskinesia and may help inform the selection of clinical interventions.
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Affiliation(s)
- Rebekah L. Lawrence
- Program in Physical Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura B. Richardson
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hannah L. Bilodeau
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dane J. Bonath
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel J. Dahn
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary-Ann Em
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sanjay Sarkar
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan P. Braman
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit Michigan
| | - Paula M. Ludewig
- Division of Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Physical Therapy, University of Minnesota, Minneapolis, Minnesota, USA
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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: 1] [Impact Index Per Article: 1.0] [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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Lawrence RL, Saini G, Staker JL, Ludewig PM. Comparison of rotator cuff to glenoid proximity based on scapulothoracic upward rotation classification. Braz J Phys Ther 2023; 27:100505. [PMID: 37167904 DOI: 10.1016/j.bjpt.2023.100505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Recent evidence suggests that internal impingement, or rotator cuff tendon deformation against the glenoid, occurs during overhead motions and may therefore be a mechanism of pathology even in non-athletes. Clinically, knowing how movement impacts potential injury mechanisms would be useful to guide movement-based treatment strategies. OBJECTIVE To compare the distance between the glenoid and rotator cuff footprint between two groups classified based on scapulothoracic upward rotation (UR) magnitude (i.e., low, high) at 90° humerothoracic elevation. METHODS Shoulder kinematics were quantified during scapular plane abduction in 60 participants using single-plane fluoroscopy. Of these, 40 were subsequently classified as having high or low scapulothoracic UR based on the sample's distribution. The minimum distance between the glenoid and rotator cuff footprint was calculated along with the locations of closest proximity (i.e., proximity centers). Minimum distances and proximity center locations were compared between groups using 2-factor mixed-model ANOVAs. The prevalence of glenoid-to-footprint contact was also compared. RESULTS Glenoid-to-footprint distances consistently decreased as humerothoracic elevation angle increased, and the anterior aspect of the footprint was closest to the posterosuperior glenoid. Minimum distances were not significantly different between UR groups (p≥0.16). However, group differences existed in proximity center locations (p<0.01). Glenoid-to-footprint contact was identified in 75.0% of participants at an average (SD) of 133.6° (3.2°) humerothoracic elevation. CONCLUSION The results of this study suggest that decreased UR as classified and assessed in this study does not significantly impact glenoid-to-footprint distances but does alter the location of the contact, which occurred in most participants.
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Affiliation(s)
- Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, MSC 8502-66-1101, St. Louis, MO 63108, USA; Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA.
| | - Gaura Saini
- Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
| | - Justin L Staker
- Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA; Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
| | - Paula M Ludewig
- Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA; Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
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Lawrence R, Soliman SB, Roseni K, Zauel R, Bey MJ. In vivo evaluation of rotator cuff internal impingement during scapular plane abduction in asymptomatic individuals. J Orthop Res 2023; 41:718-726. [PMID: 35880416 PMCID: PMC9877247 DOI: 10.1002/jor.25423] [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: 02/14/2022] [Revised: 06/17/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023]
Abstract
Internal impingement-or entrapment of the undersurface of the rotator cuff tendon against the glenoid during overhead activities-is believed to contribute to articular-sided tears. However, little is known about internal impingement outside athletic populations. Therefore, the objectives of this study were to (1) describe glenoid-to-footprint distances and proximity centers during dynamic, in vivo motion in asymptomatic individuals, and (2) determine the extent to which these measures differed between individuals with and without a rotator cuff tear. Shoulder kinematics were assessed in 37 asymptomatic individuals during scapular plane abduction using a high-speed biplane radiographic system. Glenoid-to-footprint distances and proximity center locations were calculated by combining the kinematics with computerized tomography-derived bone models. Glenoid-to-footprint contact was presumed to occur when the minimum distance was less than the estimated labral thickness. The condition of the supraspinatus tendon (intact, torn) was assessed using ultrasound. Minimum distances and proximity centers were compared over humerothoracic elevation angles (90°, 110°, 130°, 150°) and between supraspinatus pathology groups using two-factor mixed model analysis of variances. Glenoid-to-footprint minimum distances decreased consistently across elevation angles (p < 0.01) without a significant difference between groups. Contact was estimated to occur in all participants. Proximity centers were generally located on the anterior half of the rotator cuff footprint and on the posterosuperior glenoid. Statement of Clinical Significance: Internal impingement during overhead motions may be a prevalent mechanism of rotator cuff pathology as contact appears to be common and involves the region of the rotator cuff footprint where degenerative rotator cuff tears are thought to originate.
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Affiliation(s)
| | | | - Kevin Roseni
- Bone & Joint Center, Henry Ford Health System, Detroit, MI
| | - Roger Zauel
- Bone & Joint Center, Henry Ford Health System, Detroit, MI
| | - Michael J Bey
- Bone & Joint Center, Henry Ford Health System, Detroit, MI
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Ludewig PM, Saini G, Hellem A, Kahnert EK, Rezvanifar SC, Braman JP, Staker JL. Changing our Diagnostic Paradigm Part II: Movement System Diagnostic Classification. Int J Sports Phys Ther 2022; 17:7-17. [PMID: 35024204 PMCID: PMC8720248 DOI: 10.26603/001c.30177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/28/2021] [Indexed: 12/30/2022] Open
Abstract
Diagnostic classification is a foundational underpinning of providing care of the highest quality and value. Diagnosis is pattern recognition that can result in categories of conditions that ideally direct treatment. While pathoanatomic diagnoses are common and traditional in orthopaedic practice, they often are limited with regard to directing best practice physical therapy intervention. Replacement of pathoanatomic labels with non-specific regional pain labels has been proposed, and occurs frequently in clinical practice. For example non-specific low back pain or shoulder pain of unknown origin. These labels avoid some disadvantages of tissue specific pathoanatomic labels, but are not specific enough to direct treatment. A previously introduced movement system diagnostic framework is proposed and updated with application to shoulder conditions. This framework has potential for broad development and application across musculoskeletal physical therapist practice. Movement system diagnostic classification can advance and streamline practice if considered while recognizing the inherent movement variability across individuals.
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Affiliation(s)
- Paula M Ludewig
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Gaura Saini
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science
| | - Aaron Hellem
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | - Emily K Kahnert
- Department of Rehabilitation Medicine, University of Minnesota Division of Rehabilitation Science; Orofacial Pain & Dental Sleep Medicine Clinic, University of Minnesota School of Dentistry
| | - S Cyrus Rezvanifar
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
| | | | - Justin L Staker
- Department of Rehabilitation Medicine, University of Minnesota Divisions of Physical Therapy & Rehabilitation Science
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