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Andrea LC, Svendsen SW, Frost P, Smidt K, Gelineck J, Christiansen DH, Deutch SR, Hansen TB, Haahr JP, Dalbøge A. Radiographic findings in patients suspected of subacromial impingement syndrome: prevalence and reliability. Skeletal Radiol 2024:10.1007/s00256-024-04675-7. [PMID: 38652296 DOI: 10.1007/s00256-024-04675-7] [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: 08/29/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department. MATERIALS AND METHODS This cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland-Altman plots, or intraclass coefficients. RESULTS A total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81). CONCLUSION Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability.
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Affiliation(s)
- Linda Christie Andrea
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark.
| | - Susanne Wulff Svendsen
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kate Smidt
- Department of Orthopedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - John Gelineck
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - David Høyrup Christiansen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Torben Bæk Hansen
- University Clinic of Hand, Hip and Knee Surgery, Holstebro Regional Hospital, Holstebro, Denmark
| | - Jens Peder Haahr
- Department of Occupational Medicine- University Research Clinic - Danish Ramazzini Centre, Gødstrup Hospital, Herning, Denmark
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
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Eraslan L, Cools A, Yar O, Akkaya S, Duzgun I. Acromiohumeral distance quantification during a variety of shoulder external and internal rotational exercises in recreationally overhead athletes. Res Sports Med 2023; 31:818-830. [PMID: 35287521 DOI: 10.1080/15438627.2022.2052068] [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: 11/11/2021] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
Abstract
To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead athletes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (active-hold) and during ER and IR exercises (isometric and concentric) at five different shoulder-abduction angles (0°, 30°, 45°, 60°, and 90° of abduction). A two-way ANOVA was used to analyze AHD values. Shoulder abduction angle × exercise interaction for AHD was found (F16,304 = 10.92; p < .001; η2 = 0.37). For both isometric and concentric conditions, AHD increased during IR exercises (p < .05) yet decreased during ER exercises (p < .05) when compared with each active-hold positions. Shoulder ER and IR exercises influence the AHD in recreational overhead athletes. A larger AHD was observed during shoulder IR exercises, whereas ER exercises failed to maintain the AHD.
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Affiliation(s)
- Leyla Eraslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Ozan Yar
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selcuk Akkaya
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Irem Duzgun
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Rentz C, Legerlotz K. Handball-specific loading acutely reduces the acromiohumeral distance in experienced handball players and in non-handball experienced athletes. Front Sports Act Living 2022; 4:997401. [PMID: 36187715 PMCID: PMC9524289 DOI: 10.3389/fspor.2022.997401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Context When playing handball, the preservation of the subacromial space, which can be quantified by the acromiohumeral distance (AHD), plays a crucial role for shoulder health of handball players. Acute effects of handball-specific loading on the subacromial space with consideration of individual adaptions resulting from long-term handball-specific loading experience have yet to be determined in order to prevent injuries such as e. g. an impingement of the supraspinatus tendon. Objective To (1) assess the acute effects of handball-specific loading on the AHD in healthy experienced handball players (HB) and non-handball experienced athletes (CG) and (2) to assess the AHD behavior in relation to individual intrinsic factors to identify possible risk factors and the effect of handball-specific experience associated adaptations. Participants 20 HB (10m; 10f) and 20 CG (10m; 10f); 24 ± 5 years. Intervention Handball-specific loading protocol. Main outcome measures The AHD was measured by ultrasonography at 0° and 60° abduction pre and post intervention. Isometric shoulder strength was measured with hand-held dynamometry. Shoulder range of motion (ROM) was measured with goniometry. Results Handball-specific loading led to significantly reduced AHD in the dominant shoulder in the 60° abducted position in both groups (HB: −1.7 ± 2.0 mm; p = 0.001, d = 0.69; CG: −1.1 ± 2.0 mm; p = 0.024, d = 0.37) and in the non-dominant shoulder in 0° (−0.7 ± 1.5 mm; p = 0.038, d = 0.35) and 60° abducted position (−1.3 ± 1.8 mm; p = 0.004, d = 0.69) in HB only. Handball-specific loading enhanced AHD reduction when elevating the shoulder from 0° to 60° in both groups and arms. Larger shoulder abduction strength affected the maintenance of the AHD positively. HB demonstrated less shoulder strength compared to CG, while ROM did not differ. Conclusions Handball-specific loading can affect the ability to preserve the subacromial space which might put handball players at risk for shoulder injuries. Poor shoulder strength can aggravate this mechanism. Therefore, implementation of strengthening exercises of the external rotator and abductor muscles in the training schedule may improve shoulder health of handball players.
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Kocadal O, Tasdelen N, Yuksel K, Ozler T. Volumetric evaluation of the subacromial space in shoulder impingement syndrome. Orthop Traumatol Surg Res 2022; 108:103110. [PMID: 34649000 DOI: 10.1016/j.otsr.2021.103110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/06/2020] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Shoulder impingement syndrome is evaluated radiologically with two-dimensional measurement parameters. None of these measurement parameters accurately reflect the three-dimensional geometry. The purpose of this study was to evaluate the volumetric status of the subacromial space in patients with shoulder impingement syndrome and to investigate its relationship with two-dimensional parameters. HYPOTHESIS The primary hypothesis of this study is that subacromial volume is reduced in patients with impingement syndrome. The second hypothesis is that the sagittal plane morphology of the acromion reflects the subacromial volume better than the coronal plane morphology. PATIENTS AND METHODS This retrospective study consisted of a total of 52 participants: 26 patients with impingement syndrome and 26 controls. Volumetric measurements were performed with using magnetic resonance imaging. The relationship between humerus and acromion was evaluated by acromiohumeral distance. The sagittal plane morphology of the acromion was evaluated with an objective acromial angle, while the coronal plane morphology was evaluated with a lateral acromial angle. The radiological parameters between groups were compared. RESULTS The mean subacromial volume was significantly smaller in the impingement group compared to the control group (p=0.01). The subacromial volume had a negative correlation with the objective acromial angle (R=-0.46; p=0.01) The mean tendon volume was significantly higher in the impingement group (p<0.001). The mean acromiohumeral distance in the impingement group (6.8mm±1.0mm), was calculated to be significantly lower than the control group (10.1mm±1.5mm) (p<0.001). There was a positive moderate correlation between subacromial volume and acromiohumeral distance (R=0.61; p=0.01). DISCUSSION This is the first study to demonstrate a reduction in subacromial volume in patients with impingement syndrome. The sagittal plane morphology of the acromion, rather than the coronal plane, appears to be more closely related to the subacromial volume. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Onur Kocadal
- Yeditepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Neslihan Tasdelen
- Yeditepe University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Korcan Yuksel
- Bayindir Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Turhan Ozler
- Yeditepe University, Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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Hunter DJ, Rivett DA, McKiernan S, Luton R, Snodgrass SJ. Thoracic manual therapy improves pain and disability in individuals with shoulder impingement syndrome compared to placebo: a randomised controlled trial with one year follow-up. Arch Phys Med Rehabil 2022; 103:1533-1543. [PMID: 35331719 DOI: 10.1016/j.apmr.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/09/2022] [Accepted: 03/15/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate if muscle energy technique (MET) to the thoracic spine decreases the pain and disability associated with shoulder impingement syndrome (SIS). DESIGN Single centre, three-arm, randomised controlled trial, single-blind, placebo control with concealed allocation and a 12-month follow-up. SETTING Private osteopathic practice. INTERVENTIONS Participants were randomly allocated to: MET to the thoracic spine (MET-only), MET plus soft tissue massage (MET&STM) or placebo. PARTICIPANTS 3 groups of 25 (n=75) participants ≥ 40 years with SIS received allocated intervention once a week for 15 minutes, 4 consecutive weeks. OUTCOME MEASURES Primary outcome measure: Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. SECONDARY OUTCOME MEASURES Shoulder Pain and Disability Index (SPADI) questionnaire, visual analogue scale (VAS-mm/100) -current, 7-day average, 4-week average, patient specific functional scale (PSFS) and global rating of change (GROC). Measures recorded at baseline, discharge, 4-weeks follow-up, 6-months and 12-months. Also baseline and discharge thoracic posture and range of motion (ROM) measured using an inclinometer. STATISTICAL ANALYSIS Mixed effects linear regression model for DASH, SPADI, VAS, PSFS, GROC and thoracic posture and ROM. RESULTS MET-only group demonstrated significantly greater improvement in pain and disability (DASH, SPADI, VAS 7-day average) compared to placebo at discharge (mean difference DASH=-8.4; 95% CI -14.0,-2.8; SPADI=-14.7;-23.0,-6.3; VAS=-15.5;-24.5,-6.5), 6 -months (-11.1;-18.6,-3.7; -14.9;-26.3,-3.5; -14.1;-26.0,-2.2) and 12 -months (-13.4;-23.9,-2.9; -19.0;-32.4,-5.7; -17.3;-30.9,-3.8). MET&STM group also demonstrated greater improvement in disability, but not pain compared to placebo at discharge (DASH=-8.2;-14.0,-2.3; SPADI= -13.5;-22.3,-4.8) and 6 months (-9.0;-16.9,-1.2; -12.4;-24.3,-0.5). For the PSFS, MET-only improved compared to placebo at discharge (1.3;0.1,2.5) and 12 months (1.8;0.5,3.2); MET&STM at 12 months (1.7;0.3,3.0). GROC: MET-only improved compared to placebo at discharge (1.5;0.9,2.2) and 4 weeks (1.0;0.1,1.9); MET&STM at discharge (1.2;0.5,1.9) and 6 months (1.2;0.1,1.3). There were no differences between MET-only and MET&STM, and no between-group differences in thoracic posture or ROM. CONCLUSION MET of the thoracic spine with or without STM improved the pain and disability in individuals over 40 with SIS and may be recommended as a treatment approach for SIS.
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Affiliation(s)
- Donald J Hunter
- Department of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Darren A Rivett
- Department of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sharmaine McKiernan
- Department of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Renae Luton
- Department of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Suzanne J Snodgrass
- Department of Physiotherapy, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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Seliverstova EG, Sinkin MV, Kordonsky AY, Aleinikova IB, Tikhomirov IV, Grin AA. [Electrodiagnostic evaluation in differential diagnosis and neurosurgical treatment of radiculopathies caused by spine disorders. Diagnostic value and methodology]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:109-118. [PMID: 35412720 DOI: 10.17116/neiro202286021109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED One of the most common causes of radiculopathy requiring neurosurgical treatment is a herniated disc. Magnetic resonance imaging (MRI) is still the main diagnostic approach for this lesion. However, MRI does not allow assessing the functional state of the root. Neurophysiological examination assesses the function of peripheral nervous system. These methods are used for differential diagnosis of causes of neurological symptoms and determine the level of the nerve root injury. OBJECTIVE To assess the role of electromyography including paraspinal muscle mapping in diagnosis of radiculopathies following spine diseases. MATERIAL AND METHODS We have analyzed literature data in the Scopus, Pubmed, and RSCI databases and selected 93 references for primary reviewing. Final analysis enrolled the manuscripts with a detailed description of neurophysiological examinations and data on sensitivity/specificity of these methods. RESULTS Needle electromyography (EMG) is the most informative neurophysiological method for diagnosis of radicular damage. Sensitivity of EMG is up to 90% for lumbosacral radiculopathy. Electromyography of the paraspinal muscles can be used in case of of cervical, thoracic and lumbar radiculopathy in addition to EMG of limb muscles. Therefore sensitivity increases to 100%. Diagnostic value of nerve conduction study (NCS) is low, and performing NCS without EMG is not useful. CONCLUSION In neurosurgical practice electrodiagnostic (EDX) should be performed for differential diagnosis of radiculopathy and peripheral nervous system lesions, to determine the level of radicular compression, and when physical examination does not correspond with neuroimaging or MRI is not possible to perform.
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Affiliation(s)
- E G Seliverstova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - M V Sinkin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A Yu Kordonsky
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - I B Aleinikova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - I V Tikhomirov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - A A Grin
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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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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Yilmazturk K, Birinci M, Kuyucu E, Bulbul AM. Is shoulder geometry important for rotator cuff tears? Int J Clin Pract 2021; 75:e15005. [PMID: 34739181 DOI: 10.1111/ijcp.15005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study is aiming to evaluate some specific anatomic shoulder parameters such as the lateral acromial angle (LAA), acromial index (AI), coracohumeral distance (CHD) and critical shoulder angle (CSA) in rotator cuff tears. METHODS A total of 100 cases consisting of 50 patients with rotator cuff tears and 50 patients without rotator cuff tears, who underwent shoulder MRI (mangnetic resonance imaging) examination in Istanbul Medipol University Orthopedics and Traumatology Department, participated in this study. In this retrospective study, CCA, LAA, AI and CSA were evaluated in MRI in order to shed light on the theories of rotator cuff tears. RESULTS There was no significant difference (P ˃ .05) in acromial index and coracohumeral distance in the patient group. Lateral acromial angle and critical shoulder angle were significantly different in the patient group compared to the control group (P < .05). There was a weak negative correlation between CSA and CHD. CONCLUSION In our study, we found that patients with smaller LAA and higher CSA values in MRI images are prone to have rotator cuff tears. Further studies are needed in order to evaluate whether this association has predictive value.
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Affiliation(s)
- Kerem Yilmazturk
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Clinical Anatomy PhD Program, Graduate School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Murat Birinci
- Department of Orthopaedics & Traumatology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ersin Kuyucu
- Medical Park Bahcelievler Hospital, Department of Orthopaedics and Traumatology, Altinbas Universitesi, Istanbul, Turkey
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The critical shoulder angle, the acromial index, the glenoid version angle and the acromial angulation are associated with rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:2257-2263. [PMID: 32671437 DOI: 10.1007/s00167-020-06145-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the critical shoulder angle (CSA), acromion index (AI), acromion angulation (AA) and glenoid version angle (GVA) between patients with full-thickness rotator cuff tears (RCTs) and patients with intact rotator cuffs. METHODS Between 2014 and 2018, the CSA, AI, AA and GVA were measured in consecutively included patients aged > 40 years who underwent shoulder arthroscopy for full-thickness RCTs. A total of 437 patients with RCTs and a mean age of 51.2 years (± 5.8) were included, 35.7% of whom were male. In the control group, there were n = 433 patients (36.3% male) with an intact rotator cuff, and the mean age was 50.7 years (± 5.3). RESULTS The mean AI for the RCT group was 0.7 ± 0.1, which was significantly higher than the mean AI for the control group (0.6 ± 0.1, p < 0.001). The mean CSA for the RCT group was 33.6° ± 3.9°, which was significantly higher than the mean CSA for the control group (31.5° ± 4°, p < 0.001). The mean AA for the RCT group was 13.9° ± 9°, which was significantly higher than the mean AA for the control group (12.4 ± 8.6, p = 0.012). The mean GVA for the RCT group was - 3.5° ± 4.6° and significantly retroverted compared with the mean GVA for the control group (- 2.2° ± 4.6°, p < 0.001). The cutoff values determined by the ROC curve analyses were as follows: 0.6 for AI, 31.4° for CSA, 9.6° for AA and - 2.6° for GVA. CONCLUSION The CSA, AI, GVA and AA values measured by MRI were determined to be significantly related to full-thickness rotator cuff ruptures. The AI, CSA, AA and GVA may be considered risk factors for degenerative rotator cuff tears. Assessing the CSA, AI, GVA and AA can be helpful for diagnostic evaluation of patients with full-thickness RCTs. LEVEL OF EVIDENCE III.
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Kim H, Choi S, Park SB, Song HS. Evaluation of acromial spur using ultrasonography. Clin Shoulder Elb 2021; 24:15-20. [PMID: 33652507 PMCID: PMC7943378 DOI: 10.5397/cise.2020.00332] [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: 12/09/2020] [Accepted: 01/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The presence of an acromial spur implies a rotator cuff disorder due to impingement between the acromial spur and the rotator cuff. The purpose of the study was to observe acromial spurs using ultrasonography and to compare measurements between plain radiographs and sonograms. METHODS We retrospectively enrolled 51 consecutive patients with acromial spurs, which were interpreted on preoperative plain radiographs (supraspinatus outlet view and 30° caudal tilt) and preoperative sonograms. The ultrasonography transducer was held vertically and continuously moved laterally, which corresponded to the long axis of the long head of the biceps. The distance from the most distal margin of the original acromion to the most projected point of the acromial spur was measured. RESULTS No significant difference was found between the plain radiograph and ultrasonography measurements (p=0.186). A moderate to strong correlation was detected between the ultrasonography and supraspinatus outlet-view measurements (r=0.776, p=0.000). CONCLUSIONS Anteriorly projected acromial spurs were well-visualized by ultrasonography. No discrepancy in acromial spur length was detected between the use of plain radiography (supraspinatus outlet view and 30° caudal-tilt view) and ultrasonography. The correlation coefficients between the plain radiography and ultrasonography measurements exceeded 0.7.
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Affiliation(s)
- Hyungsuk Kim
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Syungkyun Choi
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Bin Park
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim HS, Joo SH, Lim HS, Kim HW. Feasibility of the acromion index as a reference of severity of stratified supraspinatus tendon injury: a secondary analysis. Acta Radiol 2020; 61:1661-1667. [PMID: 32202135 DOI: 10.1177/0284185120911188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The acromion index (AI) is the acromial lateral extension above the head of the humerus. Some researchers have advocated that the AI indicates the severity of the tear size of the full-thickness supraspinatus tendon. PURPOSE To validate the reproducibility of the AI between shoulder magnetic resonance imaging (MRI) and standard X-ray and to verify whether the AI is a useful index for stratifying the severity of supraspinatus tendon injuries, as well as full-thickness tears. MATERIAL AND METHODS We enrolled 200 patients with impingement syndrome who were subsequently evaluated with standard X-ray of the shoulder in the anteroposterior view, as well as an MRI. We performed a pilot study to validate the reproducibility of the AI using standard X-ray and MRI, and to compare the AI between these imaging modalities. The severity of supraspinatus tendon injury was classified into four groups (0 = no evidence of injury, 1 = partial tear, 2 = full-thickness tear, and 3 = complete rupture) based on an official reading of the shoulder MRI. We compared the AIs of both modalities between the groups. RESULTS Intraclass correlation coefficients of the AIs between the two examiners were 0.819 for MRI and 0.808 for plain X-ray. The mean AI from standard X-ray was greater than that from MRI (P<0.0001). There was no statistical correlation between the AI and the severity of supraspinatus tendon injury. CONCLUSION Our findings indicate that the AI cannot be generally used as a predictive reference for the stratified severities of supraspinatus tendon injury.
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Affiliation(s)
- Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Ilsan, Republic of Korea
| | - Seung Ho Joo
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Ilsan, Republic of Korea
| | - Hyun Sun Lim
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Ilsan, Republic of Korea
| | - Hye Won Kim
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, Catholic University of Korea, Bucheon, Republic of Korea
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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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Zeng YM, Xu C, Zhang K, Yu DG, Zhang J. Prediction of Rotator Cuff Injury Associated with Acromial Morphology: A Three-Dimensional Measurement Study. Orthop Surg 2020; 12:1394-1404. [PMID: 33200577 PMCID: PMC7670155 DOI: 10.1111/os.12774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the relationship between the acromial morphology and the related rotator cuff injury using a three‐dimensional (3D) measurement technology. Methods For the present study, 226 patients (113 men and 113 women) who underwent shoulder Coarthroscopy from June 2015 to December 2019 at the Department of Orthopedics at our hospital were selected retrospectively. A total of 113 shoulder joints of age‐matched healthy people were selected as the control group. A 3D model coordinate system of the shoulder was established based on CT scan images. Patients were grouped according to the condition of the rotator cuff injury during surgery. The patients whose rotator cuff tear site corresponded to the 3D osseous proliferative structure of the acromion were classified into the impingement injury group (II group). The other patients were classified into the non‐impingement injury group (NII group). The acromiohumeral interval (AHI), the acromial anterior protrusion (AAP), the acromial inferior protrusion (AIP), the acromioclavicular angle (AC angle), the distance from the most medial edge of the acromial anterolateral protrusion (AALP) to the most lateral point of acromion (MLPA) (a), the distance from the most posteromedial edge of the AALP to the MLPA (b), the anteroposterior diameters of the AALP (c), and the proportion of anteroposterior diameters of AALP to the anteroposterior diameters of acromion, (c/c + d) × 100(%), were measured using the 3D shoulder model. Results The results of the intraobserver (<5%) and interobserver variability (>87%) analysis found the parameters to have high intraobserver and interobserver concordance. There were no significant differences in age among the control group, the NII group, and the II group (P = 0.8416). There were significant differences in AAP among the three groups (P = 0.0374). The results were the same for men and women, respectively. The AAP in the control group and the NII group did not show a difference, while the AAP in the II group was increased by 26.9% (P = 0.015) and 25% (P = 0.023), respectively, compared with the NII group and the control group. AHI, AIP, and AC angles did not show significant differences among the three groups (P > 0.05). The (a) and (b) of the II group were significantly larger than those of the NII group; P‐values were 0.0119 and 0.0003, respectively. The (a) and (b) in patients with rotator cuff injuries were larger than in the normal population (P < 0.05). The above results were the same for men and women. This suggested that the larger width of the AALP might cause the related rotator cuff injury. The (c/c + d) in the II group was significantly larger than those in the control and the NII groups, with P‐values of 0.0005 and 0.0021, respectively. The risk of rotator cuff injury due to subacromial impingement was increased when the maximum width of the medial–lateral edge of the AALP exceeded 16.8 mm (17.4 mm in men, 15.1 mm in women), the maximum width of the posterior edge of the AALP exceeded 12.9 mm (13.8 mm in men,12.7 mm in women), or the anteroposterior diameters of the AALP exceeded the anteroposterior diameters of the acromion by 33.5%. Conclusion We could predict the occurrence and development of the related rotator cuff injury in symptomatic patients with specific 3D changes in their acromion and intervene in the acromion of such patients as early as possible to prevent possible rotator cuff injuries in the future.
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Affiliation(s)
- Yi-Ming Zeng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Xu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - De-Gang Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hunter DJ, Rivett DA, McKeirnan S, Smith L, Snodgrass SJ. Relationship Between Shoulder Impingement Syndrome and Thoracic Posture. Phys Ther 2020; 100:677-686. [PMID: 31825488 DOI: 10.1093/ptj/pzz182] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/20/2019] [Accepted: 08/21/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Shoulder impingement syndrome (SIS) is the most common form of shoulder pain and a persistent musculoskeletal problem. Conservative and invasive treatments, aimed at the shoulder joint, have had limited success. Research suggests shoulder function is related to thoracic posture, but it is unknown whether thoracic posture is associated with SIS. OBJECTIVE The objective of this study was to investigate whether there is a relationship between SIS and thoracic posture. DESIGN This was a case control study. METHODS Thoracic posture of 39 participants with SIS and 39 age-, gender-, and dominant arm-matched controls was measured using the modified Cobb angle from a standing lateral radiograph. Thoracic range of motion (ROM) was also measured using an inclinometer. Between-group differences were compared using t tests. The relationship between thoracic posture and thoracic ROM was determined with linear regression. RESULTS Twenty women and 19 men with SIS (mean age = 57.1 years, SD = 11.1) and 39 age-matched, gender-matched, and dominant arm-matched controls (mean age = 55.7years, SD = 10.6) participated. Individuals with SIS had greater thoracic kyphosis (mean difference = 6.2o, 95% CI 2.0-10.4) and less active thoracic extension (7.8o, 95% CI = 2.2-13.4). Greater thoracic kyphosis was associated with less extension ROM (ie, more flexion when attempting full extension: β = 0.71, 95% CI = 0.45-0.97). LIMITATIONS These cross-sectional data can only demonstrate association and not causation. Both radiographic measurements and inclinometer measurements were not blinded. CONCLUSION Individuals with SIS had a greater thoracic kyphosis and less extension ROM than age- and gender-matched healthy controls. These results suggest that clinicians could consider addressing the thoracic spine in patients with SIS.
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Affiliation(s)
- Donald J Hunter
- BAppSc(Osteo), MOsteo, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Darren A Rivett
- BAppSc(Phty), MAppSc(ManipPhty), PhD, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle
| | - Sharmain McKeirnan
- BAppSc(MedRadTech), Hons, PhD, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle
| | - Lyn Smith
- MB BCh, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle
| | - Suzanne J Snodgrass
- BSc(PhysTher), MMedSc(Physio), PhD, Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle
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Klasan A, Malcherczyk D, Neri T, Saul J, Schofer MD, Heyse TJ, El-Zayat BF. Reporting on acromion morphology: classifications demonstrate significant correlation. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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BaĞcier F, Geler KÜlcÜ D, Yorulmaz E, Altunok EÇ. Intra- and Inter-Rater Reliability of Ultrasound Measurements of Supraspinatus Tendon Thickness, Acromiohumeral Distance, and Occupation Ratio in Patients With Shoulder Impingement Syndrome. Arch Rheumatol 2020; 35:385-393. [PMID: 33458662 PMCID: PMC7788650 DOI: 10.46497/archrheumatol.2020.7515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 11/10/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives This study aims to evaluate the intra- and inter-rater reliability coefficients of the supraspinatus tendon thickness, acromiohumeral distance, and occupation ratio in patients with shoulder impingement syndrome. Patients and methods The study included 83 patients (21 males, 62 females; mean age 51.6±11.0 years; range, 26 to 70 years) with shoulder impingement syndrome. The supraspinatus tendon thickness, acromiohumeral distance, and occupation ratio values were obtained one week apart by two observers. The intraclass correlation coefficient (ICC), minimum detectable change, and standard error of measurement were calculated. Results The first observer had excellent intra-rater reliability in all measurements (ICC >0.90) with minimum detectable change of 0.740-0.047 mm and standard error of measurement of 0.017-0.26 mm. The second observer had excellent intra-rater reliability in supraspinatus tendon thickness and acromiohumeral distance measurements (ICC >0.90) with minimum detectable change of 0.498-0.770 mm and standard error of measurement of 0.18-0.28 mm and good intra-rater reliability in the occupation ratio measurement (ICC; 0.75-0.90) with minimum detectable change of 0.060 mm and standard error of measurement of 0.022 mm. Inter-rater reliability coefficients were 0.916 (95% confidence interval [CI]; 0.873-0.945) for supraspinatus tendon thickness, 0.943 (95% CI; 0.914-0.963) for acromiohumeral distance with minimum detectable change of 0.673 mm and standard error of measurement of 0.243 mm and 0.790 (%95 CI; 0.693-0.853) for occupation ratio with minimum detectable change of 0.077 mm and standard error of measurement of 0.028 mm. Conclusion These findings suggest that ultrasonographic measurements of the supraspinatus tendon thickness, acromiohumeral distance and occupation ratio can be reliable and consistent for clinical evaluation of patients with shoulder impingement syndrome in terms of supporting diagnosis and monitoring the treatment effect.
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Affiliation(s)
- Fatih BaĞcier
- Department of Physical Theraphy and Rehabilitation, Kars Harakani State Hospital, Kars, Turkey
| | - Duygu Geler KÜlcÜ
- Department of Physical Theraphy and Rehabilitation, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Elem Yorulmaz
- Department of Physical Theraphy and Rehabilitation, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey
| | - Elif Çiğdem Altunok
- Department of Biostatistics and Medical Informatics, Yeditepe University, Faculty of Medicine, Istanbul, Turkey
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Stelter J, Malik S, Chiampas G. The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries. Emerg Med Clin North Am 2020; 38:103-124. [DOI: 10.1016/j.emc.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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18
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Joo Y, Cho HR, Kim YU. Evaluation of the cross-sectional area of acromion process for shoulder impingement syndrome. Korean J Pain 2020; 33:60-65. [PMID: 31888319 PMCID: PMC6944366 DOI: 10.3344/kjp.2020.33.1.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/12/2022] Open
Abstract
Background Anatomic changes in the acromion have been considered a main cause of shoulder impingement syndrome (SIS). To evaluate the relationship between SIS and the acromion process, we devised a new morphological parameter called the acromion process cross-sectional area (APA). We hypothesized that the APA could be an important morphologic diagnostic parameter in SIS. Methods We collected APA data from 95 patients with SIS and 126 control subjects who underwent shoulder magnetic resonance imaging (MRI). Then we measured the maximal cross-sectional area of the bone margin of the acromion process on MRI scans. Results The mean of APAs were 136.50 ± 21.75 mm2 in the male control group and 202.91 ± 31.78 mm2 in the male SIS group; SIS patients had significantly greater APAs (P < 0.001). The average of APAs were 105.38 ± 19.07 mm2 in the female control group and 147.62 ± 22.90 mm2 in the female SIS group, and the SIS patients had significantly greater APAs (P < 0.001). The optimal APA cut-off in the male group was 165.14 mm2 with 90.2% sensitivity, 91.4% specificity, and an area under the curve (AUC) of 0.968. In the female group, the optimal cut-off was 122.50 mm2 with 85.2% sensitivity, 84.9% specificity, and an AUC of 0.928. Conclusions The newly devised APA is a sensitive parameter for assessing SIS; greater APA is associated with a higher possibility of SIS. We think that this result will be helpful for the diagnosis of SIS.
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Affiliation(s)
- Young Joo
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
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Billaud A, Cruz-Ferreira E, Pesquer L, Abadie P, Carlier Y, Flurin PH. Does the critical shoulder angle decrease after anterior acromioplasty? Arch Orthop Trauma Surg 2019; 139:1125-1132. [PMID: 30868217 DOI: 10.1007/s00402-019-03163-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION No clinical studies to date have analyzed the critical shoulder angle (CSA) following anterior acromioplasty. Our study's main objective was to measure the change in the CSA after acromioplasty. MATERIALS AND METHODS Ninety patients were included in this retrospective series. The CSA and the type of acromion were evaluated before and after surgery. RESULTS The average CSA for patients before surgery was 35.9° (± 3.7, 26.2, 44.2) and 33° after the acromioplasty (± 3.5, 24.8, 41.4). The decrease was significant and 2.9° on average (± 2.2, - 2.2, 11.9, p = 0.000). Preoperatively, 58% of patients had a CSA ≥ 35° (n = 52) and 24% postoperatively (n = 22, p = 0.000). CONCLUSIONS Standardized anterior acromioplasty allows for a significant decrease in the CSA without lateral resection of the acromion. This study confirms the tight link between the CSA and the anterior acromion as well as the interest of this angle to quantify acromioplasty whether anterior or lateral. LEVEL OF EVIDENCE Level IV, Case Series, Retrospective design.
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Affiliation(s)
- Anselme Billaud
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France.
| | | | - Lionel Pesquer
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Pierre Abadie
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
| | - Yacine Carlier
- Clinique du Sport-CCOS, 2 Rue Georges Negrevergne, 33700, Mérignac, France
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Pepe M, Kocadal O, Gunes Z, Calisal E, Aksahin E, Aktekin CN. Subacromial space volume in patients with rotator cuff tear: The effect of surgical repair. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:419-422. [PMID: 30268741 PMCID: PMC6318497 DOI: 10.1016/j.aott.2018.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/12/2018] [Accepted: 08/29/2018] [Indexed: 11/28/2022]
Abstract
Objective The aim of this study was to evaluate the effect of the rotator cuff tear repair on subacromial space volume. Methods We retrospectively identified 21 eligible patients (5 males and 16 females; mean age: 56.4 (range; 46–71) years) who had shoulder arthroscopy for unilateral full-thickness small to medium rotator cuff tear and normal controlateral shoulder joint. The mean follow-up time was 16.1 (range; 12–25) months. Preoperative and postoperative 1 year bilateral shoulder MRIs and Constant scores were reviewed. Subacromial volume was calculated by using Osirix software. Pre-, postoperative and healthy side (contralateral control group) subacromial volumes were recorded. Paired sample and t-tests were used to compare the pre- and postoperative groups. Independent sample t-tests were used to compare the healthy and pre- and postoperative groups. The correlation between the changes in the subacromial volume and the shoulder Constant score were analyzed using Pearson correlation analyses. Results The mean subacromial volume of the preoperative group was 2.95 cm3 (range; 1.53–4.23) and the postoperative group was 3.59 cm3 (range; 2.12–4.84). The volume increase was statistically significant (p < 0.05). The mean subacromial volume of the control group was 3.93 cm3 (range; 2.77–5.03), and the difference between the preoperative group and the control group was statistically significant. There was no significant difference found between the postoperative group and the control group (p = 0.156). There was no significant correlation found between the volume and the constant score changes (r = 0.170, p = 0.515). Conclusion The subacromial space volume significantly decreases in full-thickness rotator cuff tears smaller than 3 cm and the surgical repair increases the subacromial volume significantly. Level of evidence Level IV; Diagnostic Study.
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Affiliation(s)
- Murad Pepe
- Department of Orthopaedics and Traumatology, University of Amasya, Amasya, Turkey.
| | - Onur Kocadal
- Department of Orthopaedics and Traumatology, University of Yeditepe, Istanbul, Turkey
| | - Zafer Gunes
- Department of Orthopaedics and Traumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emre Calisal
- Department of Orthopaedics and Traumatology, University of Amasya, Amasya, Turkey
| | - Ertugrul Aksahin
- Orthopaedics and Traumatology, Medical Park Hospital, Ankara, Turkey
| | - Cem Nuri Aktekin
- Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
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Harput G, Guney-Deniz H, Düzgün İ, Toprak U, Michener LA, Powers CM. Active Scapular Retraction and Acromiohumeral Distance at Various Degrees of Shoulder Abduction. J Athl Train 2018; 53:584-589. [PMID: 29963904 DOI: 10.4085/1062-6050-318-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Performing shoulder-abduction exercises with scapular retraction has been theorized to reduce the potential for shoulder impingement. However, objective data to support this premise are lacking. OBJECTIVE To evaluate the influence of active scapular retraction on acromiohumeral distance (AHD) at 4 shoulder-abduction angles using real-time ultrasound. DESIGN Cross-sectional study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty asymptomatic individuals (10 men, 10 women; age = 22.9 ± 2.8 years, height = 169.3 ± 9.5 cm, mass = 65.5 ± 12.9 kg) were recruited. MAIN OUTCOME MEASURE(S) Real-time ultrasound images of AHD were obtained during nonretracted and retracted scapular conditions at 0°, 45°, 60°, and 90° of shoulder abduction. A 2-factor analysis of variance with repeated measures was used to evaluate the influence of shoulder retraction on AHD across shoulder-abduction angles. RESULTS A scapular-retraction condition × shoulder-abduction-angle interaction for AHD was found ( F3,57 = 4.56, P = .006). The AHD was smaller at 0° (10.5 versus 11.2 mm, respectively; t19 = 2.22, P = .04) but larger at 90° (9.4 versus 8.7 mm, respectively; t19 = -2.30, P = .04) of shoulder abduction during the retracted than the nonretracted condition. No differences in AHD were observed between conditions at 45° ( t19 = 1.45, P = .16) and 60° ( t19 = 1.17, P = .86) of abduction. CONCLUSIONS The observed differences in AHD at 0° and 90° of shoulder abduction were small and did not exceed the established minimal detectable change for either angle. Our findings suggest that active scapular retraction during shoulder abduction has a minimal influence on AHD at 0° and 90° in healthy individuals. Further investigations are needed to determine whether scapular retraction influences AHD in individuals with subacromial impingement.
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Affiliation(s)
- Gulcan Harput
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hande Guney-Deniz
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - İrem Düzgün
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Uğur Toprak
- Department of Radiology, Osmangazi University, Eskisehir, Turkey
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles
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Tran G, Cowling P, Smith T, Bury J, Lucas A, Barr A, Kingsbury SR, Conaghan PG. What Imaging-Detected Pathologies Are Associated With Shoulder Symptoms and Their Persistence? A Systematic Literature Review. Arthritis Care Res (Hoboken) 2018. [PMID: 29513925 PMCID: PMC6099421 DOI: 10.1002/acr.23554] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective Shoulder symptoms are common, and imaging is being increasingly used to help with management. However, the relationship between imaging and symptoms remains unclear. This review aims to understand the relationship between imaging‐detected pathologies, symptoms, and their persistence. Methods A systematic review using Medline, EMBASE, Cochrane, and grey literature was conducted to April 2017. The cross‐sectional and longitudinal relationships between imaging‐detected abnormalities and symptoms were analyzed and associations qualitatively characterized by a best‐evidence synthesis based on study design, covariate adjustment, and the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Modalities included ultrasound, magnetic resonance imaging (MRI), radiographs, positron emission tomography (PET), bone scintigraphy, and computed tomography. Results A total of 6,569 abstracts was screened and 56 articles were included. In total, 50 studies did not adjust for covariates and 36 analyzed individual pathologies only. The majority of studies showed conflicting results. There was no significant association between most imaging features and symptoms among high‐quality, cross‐sectional studies. There was low‐quality evidence that enhancement of the joint capsule on MRI and increased uptake on PET were associated with symptoms in adhesive capsulitis. Based on high‐quality longitudinal studies, enlarging rotator cuff tears were associated with an increased incidence of symptoms. Conclusion There were conflicting results on the association of imaging features with shoulder symptoms and their persistence. The existing evidence was very low in quality, based on the GRADE methodology. Further high‐quality studies are required to understand the relationship between imaging and shoulder symptoms and to determine the appropriate role of imaging in care pathways.
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Affiliation(s)
| | - Paul Cowling
- Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Julie Bury
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | | | | | - Philip G Conaghan
- University of Leeds, Leeds, and Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, Nottingham, UK
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Kongmalai P, Apivatgaroon A, Chernchujit B. Morphological classification of acromial spur: correlation between Rockwood tilt view and arthroscopic finding. SICOT J 2017; 3:4. [PMID: 28074776 PMCID: PMC5225834 DOI: 10.1051/sicotj/2016039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 11/07/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose and hypothesis: Acromion spur is the extrinsic factor for impingement syndrome and rotator cuff tear. The Rockwood tilt view can be used to evaluate prominence of the anterior acromion, however no study has shown the correlation of findings between the Rockwood tilt view and the arthroscopic finding. METHODS We developed the arthroscopic classification of acromion spur as type 1 flat spur, type 2 bump spur, type 3 heel spur, type 4 keel spur, and type 5 irregular spur. Patients with rotator cuff syndrome who underwent arthroscopic surgery were recruited. Two observers were asked to classify the type of spur from arthroscopic findings and Rockwood tilt views separately in random pattern. The prevalence of supraspinatus tendon tear was also recorded as no tear, partial-thickness tear, and full-thickness tear. RESULTS The keel spur (33.9%) was the most common finding followed by the heel spur (27.8%). The correlation was high especially for the heel, the keel, and the irregular spur (75.47%, 74.03%, and 72.73%, respectively.) These three types of spurs have a high prevalence of full thickness of supraspinatus tendon tear. CONCLUSION The Rockwood tilt view can be used to evaluate the morphology of an acromion spur, especially the at-risk spur that correlates highly with the full-thickness supraspinatus tendon tear. The arthroscopic classification will also be a useful tool to improve communication between the surgeon and the guide for appropriate treatment in a rotator cuff tear patient when encountering the heel, keel, and irregular spur.
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Affiliation(s)
- Pinkawas Kongmalai
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Paholyothin Road, Khlong Luang, Rangsit, Pathum Thani 12121, Thailand
| | - Adinun Apivatgaroon
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Paholyothin Road, Khlong Luang, Rangsit, Pathum Thani 12121, Thailand
| | - Bancha Chernchujit
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Paholyothin Road, Khlong Luang, Rangsit, Pathum Thani 12121, Thailand
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Watts AR, Williams B, Kim SW, Bramwell DC, Krishnan J. Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria. Shoulder Elbow 2017; 9:31-41. [PMID: 28572848 PMCID: PMC5441616 DOI: 10.1177/1758573216663201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/04/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Shoulder impingement syndrome (SIS) is a common diagnosis for patients with pain and dysfunction of the shoulder. Variations in the signs and symptoms might lead to uncertainty regarding the definition of SIS. The aim of this review is to explore the participant selection criteria used in the literature when investigating SIS and to assess differences in criteria among treating professions. METHODS This is a PRISMA systematic review of publications from 2009 to 2014 from MEDLINE, PubMed, The Cochrane Library, Embase, Scopus and CINAHL. RESULTS Ninety-seven articles met inclusion criteria for this review. Twenty-five different surgical and nonsurgical treatments were investigated. Impingement-specific index tests were used in all studies. Exclusion index tests were used in 62% of studies. Twenty index tests were identified. Radiological investigations were reported in 53% of all studies, of which a further 53% reported using two or more radiological investigations. CONCLUSIONS This systematic review has illustrated that studies investigating SIS test for various signs and symptoms, which is in keeping with describing the condition as a 'syndrome'. However, there are inconsistencies in participant selection criteria between health disciplines, highlighting a need for harmonization of the selection criteria in the form of an international editorial consensus.
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Affiliation(s)
- Amy R. Watts
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Ben Williams
- Department of Orthopaedics, Flinders Medical Centre, Adelaide, Australia
| | - Susan W. Kim
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Donald C. Bramwell
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Jeganath Krishnan
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
- Department of Orthopaedics, Flinders Medical Centre, Adelaide, Australia
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Harput G, Guney H, Toprak U, Kaya T, Colakoglu FF, Baltaci G. Shoulder-Rotator Strength, Range of Motion, and Acromiohumeral Distance in Asymptomatic Adolescent Volleyball Attackers. J Athl Train 2016; 51:733-738. [PMID: 27813683 DOI: 10.4085/1062-6050-51.12.04] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sport-specific adaptations at the glenohumeral joint could occur in adolescent athletes because they start participating in high-performance sports in early childhood. OBJECTIVE To investigate shoulder-rotator strength, internal-rotation (IR) and external-rotation (ER) range of motion (ROM), and acromiohumeral distance (AHD) in asymptomatic adolescent volleyball attackers to determine if they have risk factors for injury. DESIGN Cross-sectional study. SETTING University laboratory. PARTICIPANTS Thirty-nine adolescent high school-aged volleyball attackers (22 boys, 17 girls; age = 16.0 ± 1.4 years, height = 179.2 ± 9.0 cm, mass = 67.1 ± 10.9 kg, body mass index = 20.7 ± 2.6 kg/m2). MAIN OUTCOME MEASURE(S) Shoulder IR and ER ROM, total-rotation ROM, glenohumeral IR deficit, AHD, and concentric and eccentric strength of the shoulder internal and external rotators were tested bilaterally. RESULTS External-rotation ROM was greater (t38 = 4.92, P < .001), but IR ROM (t38 = -8.61, P < .001) and total ROM (t38 = -3.55, P = .01) were less in the dominant shoulder, and 15 athletes had a glenohumeral IR deficit (IR ROM loss > 18°). We observed greater concentric internal-rotator (t38 = 2.89, P = .006) and eccentric external-rotator (t38 = 2.65, P = .01) strength in the dominant than in the nondominant shoulder. The AHD was less in the dominant shoulder (t38 = -3.60, P < .001). CONCLUSIONS Adolescent volleyball attackers demonstrated decreased IR ROM, total ROM, and AHD and increased ER ROM in their dominant shoulder. Therefore, routine screening of adolescent athletes and designing training programs for hazardous adaptive changes could be important in preventing shoulder injuries.
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Affiliation(s)
- Gulcan Harput
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Hande Guney
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ugur Toprak
- Department of Radiology, Ankara Numune Hospital, Turkey
| | - Tunca Kaya
- Department of Radiology, Ankara Numune Hospital, Turkey
| | - Fatma Filiz Colakoglu
- Department of Physical Education and Sports Teaching, Gazi University, Ankara, Turkey
| | - Gul Baltaci
- Department of Physical Therapy and Rehabilitation, Private Güven Hospital, Ankara, Turkey
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Heterogeneous MR arthrography findings in patients with subacromial impingement syndrome – Diagnostic subgroups? J Electromyogr Kinesiol 2016; 29:64-73. [DOI: 10.1016/j.jelekin.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/28/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022] Open
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Balke M, Liem D, Greshake O, Hoeher J, Bouillon B, Banerjee M. Differences in acromial morphology of shoulders in patients with degenerative and traumatic supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc 2016; 24:2200-5. [PMID: 25547273 DOI: 10.1007/s00167-014-3499-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/22/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Distinct characteristics of acromial morphology seem to be one factor for the development of degenerative supraspinatus tendon tears. Thus, it is questionable whether patients with traumatic tendon tears also present these parameters. The hypothesis of the present study was that the acromial morphology of patients with degenerative supraspinatus tendon tears differs from patients with traumatic tears. METHODS One hundred and thirty-six patients that were treated by arthroscopic rotator cuff repair from 2010 to 2013 were included in this study. Seventy-two patients had degenerative (group 1), and 64 had traumatic (group 2) supraspinatus tendon tears. On preoperative radiographs the Bigliani type, acromial slope, acromiohumeral (AH) distance, lateral acromial angle (LAA), acromion index (AI), and critical shoulder angle (CSA) were measured. Medians of these parameters as well as of age of both groups were compared using the t test. RESULTS The percentaged distribution of the Bigliani type differed (group 1 vs. 2: type 1: 18/38, type 2: 56/55, type 3: 26/8). All parameters showed significant differences between degenerative and traumatic tears. Slope: 21.2° (SD 7.6°) versus 19.2° (SD 7.9°, p = 0.026), AH distance: 8.4 mm (SD 2.3 mm) versus 9.9 mm (SD 1.9 mm, p = 0.0006), LAA: 77.0° (SD 4.0°) versus 82.5° (SD 4.7°, p < 0.0001), AI: 0.77 (SD 0.07) versus 0.73 (0.06, p = 0.0239), and CSA: 36.8° (SD 3.6°) versus 35.3° (SD 2.9°, p = 0.007). An LAA <70° or an AH distance of <5 mm only occurred in degenerative tears. Patients with degenerative tears were significantly older (60 vs. 54 years). CONCLUSIONS The hypothesis that the acromial morphology of patients with degenerative supraspinatus tendon tears differs from patients with traumatic tears was confirmed. Shoulders with degenerative tears show a narrower subacromial space and a larger lateral extension as well as a steeper angulation of the acromion than with traumatic tears. Thus, the results of this study support the theory of external impingement as a cause for degenerative rotator cuff tears. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Maurice Balke
- Sportsclinic Cologne, Cologne-Merheim Medical Center, University of Witten-Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany. .,Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center, University of Witten-Herdecke, Cologne, Germany.
| | - Dennis Liem
- Department of Orthopaedic Surgery, University Hospital Muenster, Münster, Germany
| | - Oliver Greshake
- Sportsclinic Cologne, Cologne-Merheim Medical Center, University of Witten-Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Juergen Hoeher
- Sportsclinic Cologne, Cologne-Merheim Medical Center, University of Witten-Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center, University of Witten-Herdecke, Cologne, Germany
| | - Marc Banerjee
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Center, University of Witten-Herdecke, Cologne, Germany
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Gumina S, Arceri V, Fagnani C, Venditto T, Catalano C, Candela V, Nisticò L. Subacromial Space Width: Does Overuse or Genetics Play a Greater Role in Determining It? An MRI Study on Elderly Twins. J Bone Joint Surg Am 2015; 97:1647-52. [PMID: 26491128 DOI: 10.2106/jbjs.o.00379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Age and peripheral microcirculation disorders are the main causes of rotator cuff degeneration. Acromion variants may affect subacromial space width, causing a pathological narrowing of the space that may compromise the cuff integrity. However, it is not clear if the subacromial space width is genetically determined or if it changes according to loading conditions. To clarify this unresolved question, we performed an MRI (magnetic resonance imaging) study with the aim of evaluating the acromiohumeral distance in a group of elderly monozygotic and dizygotic twins, and we analyzed the obtained data using the twin design to separate the contributions of shared and unique environments. METHODS We identified twenty-nine pairs of elderly twins. On MRI scans, we evaluated the acromiohumeral distance and health status of the rotator cuff tendons. Heritability, defined as the proportion of total variance of a specific characteristic in a particular population due to a genetic cause, was estimated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment, due to environmental factors that contribute to twin and sibling similarity, was calculated as the difference between the monozygotic correlation coefficient and the heritability index. One-way ANOVA (analysis of variance) was used to estimate the differences among job categories, both in the total cohort and within zygosity groups. RESULTS The intraclass correlation coefficient was substantially higher for monozygotic than for dizygotic twins, indicating a high degree of concordance of the acromiohumeral distance in pairs of individuals who shared 100% of their genes. The heritability index was 0.82, and shared and unique environmental contributions were both 0.09. There were no significant differences among subjects in different job categories, either in the total cohort (p = 0.685) or within the monozygotic (p = 0.719) and dizygotic groups (p = 0.957). CONCLUSIONS The acromiohumeral distance is mainly genetically determined and only marginally influenced by external factors.
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Affiliation(s)
- S Gumina
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - V Arceri
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - C Fagnani
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. E-mail address:
| | - T Venditto
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - C Catalano
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - V Candela
- Departments of Orthopaedics and Traumatology (S.G., V.A., and V.C.), Rehabilitation (T.V.), and Radiologic Sciences (C.C.), University of Rome Sapienza, Piazzale Aldo Moro 5, 00185 Rome, Italy. E-mail address for S. Gumina:
| | - L Nisticò
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy. E-mail address:
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Ertan S, Ayhan E, Güven MF, Kesmezacar H, Akgün K, Babacan M. Medium-term natural history of subacromial impingement syndrome. J Shoulder Elbow Surg 2015. [PMID: 26212760 DOI: 10.1016/j.jse.2015.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We evaluated the factors that affect the natural course of subacromial impingement syndrome in patients without rotator cuff tears. METHODS In total, 63 patients were included. During the first evaluation, we recorded each patient's age, gender, profession, body mass index (BMI), hand dominance, alcohol and tobacco consumption, comorbidities, causative event of pain, presence of a functional limitation, duration of symptoms, shoulder scores (American Shoulder and Elbow Surgeons [ASES], Constant-Murley, and visual analog scale), history of subacromial steroid injections, and magnetic resonance imaging (MRI) classification. A subacromial lidocaine injection test was performed to confirm the diagnosis, and patients were initially treated conservatively. Of the 63 patients, 7 underwent a subsequent surgical procedure. We recalled the patients and questioned them about recurrences. According to their answers, the patients were grouped as follows: group 1, no recurrence; group 2, relapsing course; and group 3, chronic course. We compared the groups regarding the factors proposed to affect the course of the disease. RESULTS The mean follow-up time was 8.45 ± 0.9 years. There were no significant differences regarding gender, profession, hand dominance, alcohol consumption, smoking, comorbidities, causative event of pain, visual analog scale score, or history of subacromial steroid injections between groups. The patients in group 1 were significantly younger than those in group 2 (P = .038). The mean BMI value of the group 1 patients was significantly lower than that of the group 3 patients (P = .034). Patients with a functional limitation besides pain tended to have a relapsing course. The Constant-Murley and ASES scores were significantly higher for patients in group 1 than for patients in group 2 (P = .024 and P = .041, respectively). The duration of symptoms was significantly shorter (<3 months) in group 1 (P = .001). Most of the patients in group 1 had reversible changes on MRI (P = .038). CONCLUSION In our study, younger age, lower BMI, more functional capacity, a shorter symptomatic period, reversible changes on MRI, and higher Constant and ASES scores at the first evaluation were good prognostic factors.
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Affiliation(s)
- Sema Ertan
- Department of Orthopaedics and Traumatology, Ceylanpinar State Hospital, Şanlıurfa, Turkey.
| | - Egemen Ayhan
- Department of Hand Surgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Mehmet F Güven
- Department of Orthopaedics and Traumatology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hayrettin Kesmezacar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey
| | - Kenan Akgün
- Department of Physical Medicine and Rehabilitation, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muharrem Babacan
- Department of Orthopaedics and Traumatology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Marcheggiani Muccioli GM, Wykes P, Hundle B, Grassi A, Roatti G, Funk L. Effects of a synovial fluid substitute on early recovery after arthroscopic subacromial decompression of the shoulder. Musculoskelet Surg 2014; 99:121-6. [PMID: 25346096 DOI: 10.1007/s12306-014-0341-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this pilot study was to determine whether the use of a synovial fluid substitute (Viscoseal) after arthroscopic subacromial decompression (ASD) of the shoulder was safe (primary outcome) and effective in reducing the postsurgical pain on the day of surgery and the time from surgery to discharge (secondary outcomes), compared with patients undergoing standard ASD alone. METHODS Forty-six patients with primary isolated shoulder subacromial impingement were randomly assigned to either undergo SAD alone (control group: n = 21) or to receive 10 ml Viscoseal into the subacromial space at the end of the procedure (treatment group: n = 25). RESULTS No adverse events were reported in either group. All clinical scores improved significantly in each group from preoperative to 12-week follow-up (p < 0.01). The Viscoseal group experienced significantly (p = 0.001) less severe pain 4 h after the surgery {mean 54.0 ± 43.1, median 50 [interquartile range (IQR) 0-100]} and shorter time from surgery to discharge [mean 5.2 ± 1.4, median 5 (IQR 4-6)] than the control group [mean 102.4 ± 40.2, median 100 (IQR 50-150) and mean 11.0 ± 5.3, median 12 (IQR 6-16), respectively]. The Viscoseal group also required less analgesia postoperatively than the control group in the first 8 h: 24% of the Viscoseal required no analgesia, while all patients in the control group required analgesia; 24% of the control group required opiates compared with 4% in the Viscoseal group. CONCLUSION Viscoseal was safe and well tolerated after shoulder arthroscopy. It provided excellent pain relief and a faster discharge time after ASD of the shoulder. The use of Viscoseal should be investigated in larger randomized controlled trials and for other shoulder arthroscopy procedures. LEVEL OF EVIDENCE Level II, Pilot Prospective Comparative Study.
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Affiliation(s)
- G M Marcheggiani Muccioli
- Laboratorio di Biomeccanica ed Innovazione Tecnologica - Istituto Ortopedico Rizzoli, University of Bologna, via di Barbiano, 1/10, 40100, Bologna, Italy,
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Kim H, Kim B, Shim J, Kwon H, Jung J. Comparative analysis of acromiohumeral distances according to the locations of the arms and humeral rotation. J Phys Ther Sci 2014; 26:97-100. [PMID: 24567684 PMCID: PMC3927051 DOI: 10.1589/jpts.26.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/12/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the potential effects of resistance exercise according to the positions of the arms and the rotation of the humerus on the subhumeral acromial space. [Subjects] The study subjects were 34 subjects without shoulder pain. [Methods] Ultrasonographic measurements of the acromiohumeral distance of the subjects were made at three shoulder positions: 90° flexion, scaption at 90° abduction, and 90° abduction in an upright sitting position. The subjects were instructed to vertically push against a table to the maximum level with the humerus in internal, neutral, and external rotation. The measurements were made three times in each position. [Results] There was a significant difference in acromiohuneral distance between neutral and internal rotation of the humerus, and between external rotation and internal rotation of the humerus. In the scaption position, there was a significant difference between neutral and internal rotation of the humerus, and between external rotation and internal rotation of the humerus. In the 90° flexion position, there was a significant difference between neutral and internal rotation, and between neutral and external rotation. There was a significant difference between the flexion position and the abduction position, and between the flexion position and the scaption position. In terms of the internal rotation of the humerus, there was a significant difference between 90° flexion and 90° abduction. [Conclusion] These findings can be applied in exercises prescribed to increase the acromiohumeral distance and to aid the treatment and evaluation of shoulder dysfunctions.
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Affiliation(s)
- Haroo Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Boin Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Jemyung Shim
- Department of Physical Therapy, College of Health and Sciences, Kangwon National University, Republic of Korea
| | - Haeyeon Kwon
- Department of Physical Therapy, Graduate School, Catholic University of Pusan, Republic of Korea
| | - Juhyeon Jung
- Department of Physical Therapy, Rehabilitation Center, Gimhae Good morning Hospital
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Cranial humerus translation, deltoid activation, adductor co-activation and rotator cuff disease - different patterns in rotator cuff tears, subacromial impingement and controls. Clin Biomech (Bristol, Avon) 2014; 29:26-32. [PMID: 24238958 DOI: 10.1016/j.clinbiomech.2013.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 10/19/2013] [Accepted: 10/21/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Arm adductor co-activation during abduction has been reported as a potential compensation mechanism for a narrow subacromial space in patients with rotator cuff dysfunction. We assessed differences in acromiohumeral distance at rest and the amount of humerus translation during active abduction and adduction in patients with rotator cuff tears (n=20) and impingement (n=30) and controls (n=10), controlled for deltoid, pectoralis major, latissimus dorsi and teres major activation (electromyography). METHODS During the acquirement of shoulder radiographs, subjects performed standardized isometric arm abduction and adduction tasks. EMG's were normalized between -1 and 1 using the "Activation Ratio", where low values express (pathologic) co-activation, e.g. adductor activation during abduction. FINDINGS In patients with cuff tears mean rest acromiohumeral distance was 7.6mm (SD=1.6): 3.5mm narrower compared to patients with impingement (95%-CI: 2.4-4.5) and 1.3mm narrower compared to controls (95%-CI: -0.1-2.7). Both during abduction and adduction tasks, cranial translation was observed with equal magnitudes for patients and controls, with average values of 2.3 and 1.7mm, respectively. Where patients with cuff tears had lower adductor Activation Ratios (i.e. more adductor co-activation during abduction), no association between abductor/adductor muscle activation and acromiohumeral distance was found. INTERPRETATION The subacromial space is narrower in patients with rotator cuff tears compared to patients with impingement and controls. We found additional subacromial narrowing during isometric abduction and, to a lesser amount, during adduction in all subjects and more adductor co-activation in patients with cuff tears. We found no association between subacromial space and activation of the deltoid and main adductors.
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Luque-Suarez A, Navarro-Ledesma S, Petocz P, Hancock M, Hush J. Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: A randomised controlled trial. ACTA ACUST UNITED AC 2013; 18:573-7. [DOI: 10.1016/j.math.2013.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 06/03/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
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Imaging-guided subacromial therapeutic injections: prospective study comparing abnormalities on conventional radiography with patient outcomes. AJR Am J Roentgenol 2013; 201:865-71. [PMID: 24059377 DOI: 10.2214/ajr.12.10094] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare abnormalities detected on conventional shoulder radiography with improvement in pain and shoulder function after subacromial injections. SUBJECTS AND METHODS We conducted a prospective outcomes study including 98 consecutive patients after fluoroscopy-guided subacromial injections who returned outcome questionnaires and who underwent routine shoulder radiography. Numeric pain rating scale (NRS) data were collected before and, along with patient global impression of change (PGIC) data, at 1 week and 1 month after injection. Outcome differences were assessed using the Student t test and Mann-Whitney U test. Logistic regression analysis was done, including radiographic variables compared with the outcome improvement. The odds ratios with 95% CIs were identified for the significant predictors. RESULTS A significant difference in overall improvement was found depending on the posterior acromial slope. Patients with a slope of more than 36° had significantly lower NRS and PGIC scores at 1 week and 1 month (p < 0.025) compared with those with a slope of 36° or less, with 86.4% of patients with a slope of more than 36° reporting significant improvement at 1 month. This was the only variable linked with improvement in the logistic regression analysis, with an odds ratio of 2.16 (95% CI, 1.11-4.22). Patients with calcific tendinitis had significantly lower NRS scores at both 1 week and 1 month (p = 0.03 and 0.05, respectively) and PGIC scores at 1 week (p = 0.05). CONCLUSION A posterior acromial slope of more than 36° and the presence of calcific tendinitis on conventional shoulder radiography are associated with better outcomes. Patients with a slope of more than 36° showed the best improvement.
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McCreesh KM, Crotty JM, Lewis JS. Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review. Br J Sports Med 2013; 49:298-305. [DOI: 10.1136/bjsports-2012-092063] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD. Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elbow Surg 2012; 21:1289-98. [PMID: 22217644 PMCID: PMC3725773 DOI: 10.1016/j.jse.2011.09.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 09/16/2011] [Accepted: 09/24/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many studies have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Therefore, the purpose of this study was to determine the relationship between rotator cuff disease and the development of symptoms with different radiographic acromial characteristics, including shape, index, and presence of a spur. MATERIALS AND METHODS The records of 216 patients enrolled in an ongoing prospective, longitudinal study investigating asymptomatic rotator cuff tears were reviewed. All patients underwent standardized radiographic evaluation, clinical evaluation, and shoulder ultrasonography at regularly scheduled surveillance visits. Three blinded observers reviewed all radiographs to determine the acromial morphology, presence, and size of an acromial spur, as well as the acromial index. These findings were analyzed to determine an association with the presence of a full-thickness rotator cuff tear. RESULTS The 3 observers demonstrated poor agreement for acromial morphology (κ = 0.41), substantial agreement for the presence of an acromial spur (κ = 0.65), and excellent agreement for the acromial index (κ = 0.86). The presence of an acromial spur was highly associated with the presence of a full-thickness rotator cuff tear (P = .003), even after adjusting for age. No association was found between the acromial index and rotator cuff disease (P = .92). CONCLUSION The presence of an acromial spur is highly associated with the presence of a full-thickness rotator cuff tear in symptomatic and asymptomatic patients. The acromial morphology classification system is an unreliable method to assess the acromion. The acromial index shows no association with the presence of rotator cuff disease.
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Affiliation(s)
- Nady Hamid
- Shoulder and Elbow Center - OrthoCarolina, Charlotte, NC, USA
| | - Reza Omid
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ken Yamaguchi
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, St.Louis, MO, USA
| | - Georgia Stobbs
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
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McGinley JC, Agrawal S, Biswal S. Rotator cuff tears: association with acromion angulation on MRI. Clin Imaging 2012; 36:791-6. [PMID: 23154011 DOI: 10.1016/j.clinimag.2012.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 03/29/2012] [Accepted: 04/04/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Using magnetic resonance imaging (MRI), evaluate the correlation of acromion angulation with thickening of the coracoacromial ligament (CAL) and narrowing of the subacromial space resulting in impingement upon the rotator cuff tendons. MATERIALS AND METHODS Eighty-nine shoulder MRI studies performed on a 3T scanner were retrospectively analyzed by two blinded independent reviewers. Measurements of the acromion angle (delta angle), CAL thickness and distance between the CAL and humeral head were obtained. The data were categorized into two groups, delta angle less that and greater than 7.5°. The presence or absence of full thickness (FT) or near full thickness (NFT) rotator cuff tears was noted. RESULTS In group 1, the acromion angle varied from -6.8 to 6.8° (1.7±3.5°) with a CAL thickness of 0.91±0.20 mm and a subacromial distance of 6.47±0.88 mm. Group 2 acromion angle varied from 7.6° to 46.8° (18.0°±8.1°) with a CAL of 1.77±0.51 mm and a subacromial distance of 4.52±0.82 mm. The difference in CAL thickness and subacromial distance were significantly different between the two groups (P<.001). In Group 1, 3 out of 51 patients had a FT or NFT tear of the rotator cuff compared to 20 out of 38 in Group 2 (P<.001). There was no significant interobserver variability. CONCLUSION Steep acromion angulation is associated with CAL thickening and narrowing of the subacromial space. Patients with a steep acromion angle had a statistically increased incidence of rotator cuff tears.
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Tuite MJ. Magnetic resonance imaging of rotator cuff disease and external impingement. Magn Reson Imaging Clin N Am 2012; 20:187-200, ix. [PMID: 22469399 DOI: 10.1016/j.mric.2012.01.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Magnetic resonance (MR) imaging plays a major role in helping to identify rotator cuff disease and in demonstrating the pathology associated with external impingement. Many surgeons rely on MR imaging to assist in decision making and presurgical planning for patients with rotator cuff pain. This article reviews the etiology of external impingement and rotator cuff tears, and describes the MR imaging appearance of the normal and the pathologic rotator cuffs. It focuses on the supraspinatus tendon because this is the tendon involved in 95% of rotator cuff tears.
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Affiliation(s)
- Michael J Tuite
- Division of Musculoskeletal Imaging and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Bernhardt GA, Glehr M, Zacherl M, Wurnig C, Gruber G. Observer variability in the assessment of the acromiohumeral interval using anteroposterior shoulder radiographs. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:185-90. [PMID: 23412450 DOI: 10.1007/s00590-012-0942-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 01/07/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND An acromiohumeral interval narrower than 6 mm measured on AP shoulder radiographs has been considered pathological and suggestive of rotator cuff tears. This prospective study was conducted to assess inter- and intraobserver variation in the radiographic assessment of the acromiohumeral interval and its critical value on routinely taken AP shoulder radiographs off-study use to evaluate the accuracy of this measurement method. METHODS The acromiohumeral distance from the inferior anterior acromial aspect to the humeral head was measured in millimeters. Thirty blinded, anteroposterior shoulder radiographs were independently reviewed by five board-certified orthopedic shoulder surgeons at two time points in random order. RESULTS The results of three investigators showed significant intraobserver variation. Five investigator pairs showed significant interobserver variation at both examination time points. The maximum interobserver difference for the same radiograph was 8 mm (range 0 to 8 mm). CONCLUSION Our results indicate that the assessment of the acromiohumeral interval using non-standardized anteroposterior radiographs off-study use cannot be seen as a reproducible and reliable method of measurement.
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Affiliation(s)
- G A Bernhardt
- Division of General Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
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de Witte PB, Nagels J, van Arkel ERA, Visser CPJ, Nelissen RGHH, de Groot JH. Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM). BMC Musculoskelet Disord 2011; 12:282. [PMID: 22168667 PMCID: PMC3296676 DOI: 10.1186/1471-2474-12-282] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The subacromial impingement syndrome (SIS) is the most common diagnosed disorder of the shoulder in primary health care, but its aetiology is unclear. Conservative treatment regimes focus at reduction of subacromial inflammatory reactions or pathologic scapulohumeral motion patterns (intrinsic aetiology). Long-lasting symptoms are often treated with surgery, which is focused at enlarging the subacromial space by resection of the anterior part of the acromion (based on extrinsic aetiology). Despite that acromionplasty is in the top-10 of orthopaedic surgical procedures, there is no consensus on its indications and reported results are variable (successful in 48-90%). We hypothesize that the aetiology of SIS, i.e. an increase in subacromial pressure or decrease of subacromial space, is multi-factorial. SIS can be the consequence of pathologic scapulohumeral motion patterns leading to humerus cranialisation, anatomical variations of the scapula and the humerus (e.g. hooked acromion), a subacromial inflammatory reaction (e.g. due to overuse or micro-trauma), or adjoining pathology (e.g. osteoarthritis in the acromion-clavicular-joint with subacromial osteophytes).We believe patients should be treated according to their predominant etiological mechanism(s). Therefore, the objective of our study is to identify and discriminate etiological mechanisms occurring in SIS patients, in order to develop tailored diagnostic and therapeutic strategies. METHODS In this cross-sectional descriptive study, applied clinical and experimental methods to identify intrinsic and extrinsic etiologic mechanisms comprise: MRI-arthrography (eligibility criteria, cuff status, 3D-segmented bony contours); 3D-motion tracking (scapulohumeral rhythm, arm range of motion, dynamic subacromial volume assessment by combining the 3D bony contours and 3D-kinematics); EMG (adductor co-activation) and dynamometry instrumented shoulder radiographs during arm tasks (force and muscle activation controlled acromiohumeral translation assessments); Clinical phenotyping (Constant Score, DASH, WORC, and SF-36 scores). DISCUSSION By relating anatomic properties, kinematics and muscle dynamics to subacromial volume, we expect to identify one or more predominant pathophysiological mechanisms in every SIS patient. These differences in underlying mechanisms are a reflection of the variations in symptoms, clinical scores and outcomes reported in literature. More insight in these mechanisms is necessary in order to optimize future diagnostic and treatment strategies for patients with SIS symptoms. TRIAL REGISTRATION Dutch Trial Registry (Nederlands Trial Register) NTR2283.
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Affiliation(s)
- Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Centre (LUMC), Postzone J11R, Postbus 9600, 2300 RC Leiden, The Netherlands
- Laboratory for Kinematics and Neuromechanics, Departments of Rehabilitation and Orthopaedics, Leiden University Medical Centre, Postzone B0-Q, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Centre (LUMC), Postzone J11R, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Ewoud RA van Arkel
- Department of Orthopaedics, Medical Centre Haaglanden (MCH), Postbus 432, 2501 CK Den Haag, The Netherlands
| | - Cornelis PJ Visser
- Department of Orthopaedics, Rijnland Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
| | - Rob GHH Nelissen
- Department of Orthopaedics, Leiden University Medical Centre (LUMC), Postzone J11R, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Jurriaan H de Groot
- Laboratory for Kinematics and Neuromechanics, Departments of Rehabilitation and Orthopaedics, Leiden University Medical Centre, Postzone B0-Q, Postbus 9600, 2300 RC Leiden, The Netherlands
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Abstract
Subacromial impingement syndrome (SIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. Both extrinsic compression and intrinsic degeneration may play a role. Management includes physical therapy, injections, and, for some patients, surgery. There remains a need for high-quality studies of the pathology, etiology, and management of SIS.
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Leão Almeida GP, De Souza VL, Barbosa G, Santos MB, Saccol MF, Cohen M. Swimmer’s shoulder in young athlete: Rehabilitation with emphasis on manual therapy and stabilization of shoulder complex. ACTA ACUST UNITED AC 2011; 16:510-5. [DOI: 10.1016/j.math.2010.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 12/21/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
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Supervised exercises compared with radial extracorporeal shock-wave therapy for subacromial shoulder pain: 1-year results of a single-blind randomized controlled trial. Phys Ther 2011; 91:37-47. [PMID: 21088117 DOI: 10.2522/ptj.20090338] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence from a recent randomized controlled trial indicated that supervised exercises (SE) were more effective than radial extracorporeal shock-wave therapy (rESWT) for the treatment of subacromial shoulder pain in the short to medium term. Little knowledge exists about the long-term results of rESWT for subacromial pain. OBJECTIVE The aim of this study was to evaluate the results of rESWT and SE provided to patients with subacromial shoulder pain after 1 year. DESIGN This was a single-blind randomized controlled trial. SETTING The study was conducted in the outpatient clinic of the Physical Medicine and Rehabilitation Department at Oslo University Hospital, Ullevaal, Norway. PATIENTS One hundred four patients with subacromial shoulder pain lasting at least 3 months participated. Patients were randomly assigned to either an rESWT group (n=52) or an SE group (n=52). INTERVENTION The rESWT intervention consisted of one session weekly for 4 to 6 weeks. The SE intervention consisted of two 45-minute sessions per week for up to 12 weeks. MEASUREMENTS The primary outcome measure was the Shoulder Pain and Disability Index. Secondary outcome measures were questions regarding pain and function and work status. RESULTS After 1 year, an intention-to-treat analysis showed no significant differences between the 2 groups for the primary outcome measure (-7.6 points, 95% confidence interval=-16.6 to 0.5) and pain, function, and medication use. Twenty-nine participants (60%) in the SE group versus 24 participants (52%) in the rESWT group were categorized as clinically improved. Thirty-eight participants in the SE group were at work compared with 30 participants in the rESWT group (odds ratio=1.1, 95% confidence interval=1.0 to 1.2). Fewer patients in the SE group had received additional treatments between 18 weeks and 1 year. LIMITATIONS The lack of a placebo control group, the lack of a cost-benefit analysis, and the small sample size were limitations of the study. CONCLUSION No significant difference was found between the SE and rESWT groups at the 1-year follow-up. More participants in the SE group had returned to work.
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Pijls BG, Kok FP, Penning LIF, Guldemond NA, Arens HJ. Reliability study of the sonographic measurement of the acromiohumeral distance in symptomatic patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:128-134. [PMID: 20127966 DOI: 10.1002/jcu.20674] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the inter- and intra-observer reliability and accuracy of sonographic (US) acromiohumeral distance (AHD) measurement for both experienced and novice operators in US in patients suffering from subacromial impingement syndrome. METHOD A total of 43 patients (50 shoulders) diagnosed with subacromial impingement syndrome were recruited from an orthopedic outpatient clinic. The US measurement of AHD was obtained consecutively in a neutral position and in a 60 degrees abduction position. A total of 300 blinded measurements were taken. RESULT In the neutral abduction group the intra- observer interclass correlation coefficient (ICC) was 0.94 for the experienced operator and 0.92 for the novice operator. The inter-observer ICC was 0.70 and the accuracy was 1.1 mm. In the 60 degrees abduction group, the intra-observer ICC was 0.90 for the experienced operator and 0.87 for the novice operator. The inter-observer ICC was 0.64 and the accuracy was 1.4 mm. All ICCs were significant at a level of p < 0.0001. CONCLUSION The inaccuracy of the method was 1 mm regardless of the experience of the observer. US AHD measurement in patients with shoulder complaints is not as accurate as reported in healthy subjects. This may have important implications for the clinical use of this parameter.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedic Surgery and Traumatology, Elkerliek Hospital, Helmond, The Netherlands
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Gille J, Suehwold J, Schulz AP, Kienast B, Unger A, Jürgens C. Deltoid muscular flap transfer for the treatment of irreparable rotator cuff tears. Orthop Rev (Pavia) 2009; 1:e15. [PMID: 21808677 PMCID: PMC3143977 DOI: 10.4081/or.2009.e15] [Citation(s) in RCA: 5] [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: 06/23/2009] [Revised: 07/17/2009] [Accepted: 07/20/2009] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to evaluate the outcome of deltoid muscle flap transfer for the treatment of irreparable rotator cuff tears. In a retrospective study 20 consecutive patients were evaluated. The index procedure took place between 2000 and 2003. Fifteen patients were male, mean age was 62 years. Inclusion criterion was a rotator cuff defect Bateman grade IV. Exclusion criteria were smaller defects, shoulder instability and fractures of the injured shoulder. An open reconstruction with acromioplasty and a pedicled delta flap was performed. Follow up period was mean 42 months. Follow-up included clinical examination, Magnetic Resonance Imaging (MRI) and the Constant and Simple (CS) shoulder tests. According to the Constant shoulder test the results were good in 13 patients, fair in 5 and unsatisfactory in 2. The pre-operative Constant Score improved from mean 25.7 points (±5.3) to 72.3 (±7.8) at follow-up. The mean values for the subcategories of CS increased significantly from 3.9 to 14.4 points for pain and from 4.2 to 15.9 points for activities daily routine (p<0.05). The change in range of motion and strength were not significant (p>0.05). Results of the Simple Shoulder Test showed a significant increase of the mean values from pre-operative 4.3 to 14.7 points post-operatively. MRI showed a subacromial covering of the defect in all cases, all flaps where intact on MRI but always the flap showed marked fatty degeneration. In conclusion, the delta flap is a simple method for the repair of large defects of the rotator cuff leading to satisfying medium results.
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Affiliation(s)
- Justus Gille
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Germany
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