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Kim JH, Kwon OY, Hwang UJ, Jung SH, Gwak GT. Prediction model of subacromial pain syndrome in assembly workers using shoulder range of motion and muscle strength based on support vector machine. ERGONOMICS 2024; 67:1237-1246. [PMID: 38039103 DOI: 10.1080/00140139.2023.2290983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023]
Abstract
Subacromial pain syndrome (SAPS) is the most common upper-extremity musculoskeletal problem among workers. In this study, a machine learning model was built to predict and classify the presence or absence of SAPS in assembly workers with shoulder joint range of motion (ROM) and muscle strength data using support vector machine (SVM). Permutation importance was used to determine important variables for predicting workers with or without SAPS. The accuracy of the support vector classifier (SVC) polynomial model for classifying workers with SAPS was 82.4%. The important variables in model construction were internal rotation and abduction of shoulder ROM and internal rotation of shoulder muscle strength. It is possible to accurately perform SAPS classification of workers with relatively easy-to-obtain shoulder ROM and muscle strength data using this model. In addition, preventing SAPS in workers is possible by adjusting the factors affecting model building using exercise or rehabilitation programs.Practitioner summary: This study aimed to create a machine learning model that can predict and classify SAPS using shoulder ROM and muscle strength and identify the variables that are of high importance in model construction. This model could be used to predict or classify workers' SAPS and manage or prevent SAPS.
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Affiliation(s)
- Jun-Hee Kim
- Laboratory of KEMA AI Research (KAIR), Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Oh-Yun Kwon
- Laboratory of Kinetic Ergocise Based on Movement Analysis, Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Ui-Jae Hwang
- Laboratory of KEMA AI Research (KAIR), Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
| | - Sung-Hoon Jung
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, South Korea
| | - Gyeong-Tae Gwak
- Laboratory of KEMA AI Research (KAIR), Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea
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Alzubaidi L, Al-Dulaimi K, Salhi A, Alammar Z, Fadhel MA, Albahri AS, Alamoodi AH, Albahri OS, Hasan AF, Bai J, Gilliland L, Peng J, Branni M, Shuker T, Cutbush K, Santamaría J, Moreira C, Ouyang C, Duan Y, Manoufali M, Jomaa M, Gupta A, Abbosh A, Gu Y. Comprehensive review of deep learning in orthopaedics: Applications, challenges, trustworthiness, and fusion. Artif Intell Med 2024; 155:102935. [PMID: 39079201 DOI: 10.1016/j.artmed.2024.102935] [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: 06/01/2023] [Revised: 03/18/2024] [Accepted: 07/22/2024] [Indexed: 08/24/2024]
Abstract
Deep learning (DL) in orthopaedics has gained significant attention in recent years. Previous studies have shown that DL can be applied to a wide variety of orthopaedic tasks, including fracture detection, bone tumour diagnosis, implant recognition, and evaluation of osteoarthritis severity. The utilisation of DL is expected to increase, owing to its ability to present accurate diagnoses more efficiently than traditional methods in many scenarios. This reduces the time and cost of diagnosis for patients and orthopaedic surgeons. To our knowledge, no exclusive study has comprehensively reviewed all aspects of DL currently used in orthopaedic practice. This review addresses this knowledge gap using articles from Science Direct, Scopus, IEEE Xplore, and Web of Science between 2017 and 2023. The authors begin with the motivation for using DL in orthopaedics, including its ability to enhance diagnosis and treatment planning. The review then covers various applications of DL in orthopaedics, including fracture detection, detection of supraspinatus tears using MRI, osteoarthritis, prediction of types of arthroplasty implants, bone age assessment, and detection of joint-specific soft tissue disease. We also examine the challenges for implementing DL in orthopaedics, including the scarcity of data to train DL and the lack of interpretability, as well as possible solutions to these common pitfalls. Our work highlights the requirements to achieve trustworthiness in the outcomes generated by DL, including the need for accuracy, explainability, and fairness in the DL models. We pay particular attention to fusion techniques as one of the ways to increase trustworthiness, which have also been used to address the common multimodality in orthopaedics. Finally, we have reviewed the approval requirements set forth by the US Food and Drug Administration to enable the use of DL applications. As such, we aim to have this review function as a guide for researchers to develop a reliable DL application for orthopaedic tasks from scratch for use in the market.
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Affiliation(s)
- Laith Alzubaidi
- School of Mechanical, Medical, and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia; Research and Development department, Akunah Med Technology Pty Ltd Co, Brisbane, QLD 4120, Australia.
| | - Khamael Al-Dulaimi
- Computer Science Department, College of Science, Al-Nahrain University, Baghdad, Baghdad 10011, Iraq; School of Electrical Engineering and Robotics, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Asma Salhi
- QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia; Research and Development department, Akunah Med Technology Pty Ltd Co, Brisbane, QLD 4120, Australia
| | - Zaenab Alammar
- School of Computer Science, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Mohammed A Fadhel
- Research and Development department, Akunah Med Technology Pty Ltd Co, Brisbane, QLD 4120, Australia
| | - A S Albahri
- Technical College, Imam Ja'afar Al-Sadiq University, Baghdad, Iraq
| | - A H Alamoodi
- Institute of Informatics and Computing in Energy, Universiti Tenaga Nasional, Kajang 43000, Malaysia
| | - O S Albahri
- Australian Technical and Management College, Melbourne, Australia
| | - Amjad F Hasan
- Faculty of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA
| | - Jinshuai Bai
- School of Mechanical, Medical, and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Luke Gilliland
- QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia; Research and Development department, Akunah Med Technology Pty Ltd Co, Brisbane, QLD 4120, Australia
| | - Jing Peng
- Research and Development department, Akunah Med Technology Pty Ltd Co, Brisbane, QLD 4120, Australia
| | - Marco Branni
- QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia; Research and Development department, Akunah Med Technology Pty Ltd Co, Brisbane, QLD 4120, Australia
| | - Tristan Shuker
- QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD 4000, Australia
| | - Kenneth Cutbush
- QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD 4000, Australia
| | - Jose Santamaría
- Department of Computer Science, University of Jaén, Jaén 23071, Spain
| | - Catarina Moreira
- Data Science Institute, University of Technology Sydney, Australia
| | - Chun Ouyang
- School of Information Systems, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Ye Duan
- School of Computing, Clemson University, Clemson, 29631, SC, USA
| | - Mohamed Manoufali
- CSIRO, Kensington, WA 6151, Australia; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Mohammad Jomaa
- QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD 4000, Australia
| | - Ashish Gupta
- School of Mechanical, Medical, and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia; Research and Development department, Akunah Med Technology Pty Ltd Co, Brisbane, QLD 4120, Australia
| | - Amin Abbosh
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Yuantong Gu
- School of Mechanical, Medical, and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; QUASR/ARC Industrial Transformation Training Centre-Joint Biomechanics, Queensland University of Technology, Brisbane, QLD 4000, Australia
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Manoso-Hernando D, Bailón-Cerezo J, Angulo-Díaz-Parreño S, Reina-Varona Á, Elizagaray-García I, Gil-Martínez A. Shoulder mobility and strength impairments in patients with rotator cuff related shoulder pain: a systematic review and meta analysis. PeerJ 2024; 12:e17604. [PMID: 38948223 PMCID: PMC11214432 DOI: 10.7717/peerj.17604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Background The methods previously proposed in the literature to assess patients with rotator cuff related shoulder pain, based on special orthopedic tests to precisely identify the structure causing the shoulder symptoms have been recently challenged. This opens the possibility of a different way of physical examination. Objective To analyze the differences in shoulder range of motion, strength and thoracic kyphosis between rotator cuff related shoulder pain patients and an asymptomatic group. Method The protocol of the present research was registered in the International Prospective Register of Systematic Review (PROSPERO) (registration number CRD42021258924). Database search of observational studies was conducted in MEDLINE, EMBASE, WOS and CINHAL until July 2023, which assessed shoulder or neck neuro-musculoskeletal non-invasive physical examination compared to an asymptomatic group. Two investigators assessed eligibility and study quality. The Newcastle Ottawa Scale was used to evaluate the methodology quality. Results Eight studies (N = 604) were selected for the quantitative analysis. Meta-analysis showed statistical differences with large effect for shoulder flexion (I2 = 91.7%, p < 0.01, HG = -1.30), external rotation (I2 = 83.2%, p < 0.01, HG = -1.16) and internal rotation range of motion (I2 = 0%, p < 0.01, HG = -1.32). Regarding to shoulder strength; only internal rotation strength showed statistical differences with small effect (I2 = 42.8%, p < 0.05, HG = -0.3). Conclusions There is moderate to strong evidence that patients with rotator cuff related shoulder pain present less shoulder flexion, internal and external rotation range of motion and less internal rotation strength than asymptomatic individuals.
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Affiliation(s)
- Daniel Manoso-Hernando
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | - Javier Bailón-Cerezo
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - Álvaro Reina-Varona
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
| | | | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain
- Unidad de Fisioterapia, Hospital Universitario La Paz-Carlos III (IdiPAZ), Madrid, Spain
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Özlü A, Üstündağ S, Bulut Özkaya D, Menekşeoğlu AK. Effect of Exergame on Pain, Function, and Quality of Life in Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study. Games Health J 2024; 13:109-119. [PMID: 38394299 DOI: 10.1089/g4h.2023.0108] [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] [Indexed: 02/25/2024] Open
Abstract
Objective: This study aimed to investigate the effect of a virtual reality (VR)-mediated gamified rehabilitation program added to a home exercise program on pain, functionality, and quality of life in shoulder impingement syndrome. Methods: Forty-eight participants with shoulder impingement syndrome were included in this prospective, randomized, single-blind study between January and July 2022. The participants were randomized into two groups: the VR group (n = 24) and the control group (n = 24). All participants were given a home exercise program for 3 weeks, with five sessions per week. The participants in the VR group received 15 sessions (45 minutes each session) of a gamified shoulder exercise program with an immersive VR headset, while those in the control group received 15 sessions (45 minutes each session) of supervised therapeutic exercises. The participants were evaluated and compared before and after treatment using the 36-item Short Form Survey (SF-36), range-of-motion (ROM) measurements, the Visual Analog Scale (VAS), and the Shoulder Pain and Disability Scale (SPADI). Results: At the baseline assessment, the two groups were homogenous regarding demographic and clinical parameters. The post-treatment shoulder extension and adduction ROM was significantly greater in the VR group and the post-treatment pain subscales for SPADI and SF-36 were significantly lower in the VR group. Conclusion: In individuals with shoulder impingement syndrome, a VR-mediated gamified exercise program added to a home exercise program increased shoulder ROM and reduced pain scores. Further clinical studies are needed to prove the long-term efficacy of the addition of VR-mediated gamified exercises to the treatment of this condition in clinical settings.
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Affiliation(s)
- Aysun Özlü
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Sema Üstündağ
- Department of Internal Medicine, Faculty of Nursing, Kutahya Health Sciences University, Kutahya, Turkey
| | - Dilan Bulut Özkaya
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ahmet Kıvanç Menekşeoğlu
- Department of Physical Medicine and Rehabilitation, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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Moeda F, Melo X, Hatia M, Pinho S, Calado D, de Andrade MR, Tomás N, Barbosa J. Clinical and ultrasound findings of 'swimmer's shoulder' and its association with training history in elite Portuguese swimmers: a cross-sectional study. PHYSICIAN SPORTSMED 2024; 52:187-199. [PMID: 37183885 DOI: 10.1080/00913847.2023.2211994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To assess the prevalence of shoulder injuries and ultrasound findings in elite Portuguese swimmers and their association with symptoms and personal or training-related factors. METHODS This cross-sectional study was conducted at the Portuguese Open and Youth Swimming National Championships between 27 and 30th July 2022. Each athlete entered details regarding personal and training history into a questionnaire and underwent a physical and ultrasound shoulder examination. RESULTS A total of 102 swimmers out of 662 Portuguese athletes were included in the study. Shoulder pain experienced during the previous season was reported by 42% of the athletes. A high prevalence of shoulder structural abnormalities was noted, specifically supraspinatus tendinosis (91%), tears (29%), and subacromial bursitis (29%). Specific training for injury prevention was associated with higher rates of infraspinatus tendinosis (p = 0.047), and supraspinatus tears were linked to greater swimming distances per week (p < 0.001) and practice (p < 0.001), more years of practice (p = 0.018), shoulder pain at the time of evaluation (p = 0.023), a higher number of missed competitions (p = 0.041), and shoulder injections (p = 0.009). Subacromial bursitis was associated with shoulder pain at the time of evaluation (p = 0.002) and during the previous season (p < 0.001), missed competitions (p < 0.001), and requirement for physical therapy (p = 0.006). CONCLUSIONS A high prevalence of shoulder morphological changes was found in surveyed swimmers and there were several associations with training load, regardless of individual characteristics of each athlete. It is essential to understand the true impact of current injury prevention programs and to develop effective measures to protect swimmers' health.
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Affiliation(s)
- Frederico Moeda
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Xavier Melo
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Madjer Hatia
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Sérgio Pinho
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Duarte Calado
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | | | - Nuno Tomás
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Jorge Barbosa
- Physical Medicine and Rehabilitation, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
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Gowda CS, Mirza K, Galagali DA. Rotator Cuff Tears: Correlation Between Clinical Examination, Magnetic Resonance Imaging and Arthroscopy. Cureus 2024; 16:e56065. [PMID: 38618461 PMCID: PMC11009554 DOI: 10.7759/cureus.56065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Background Arthroscopy in diagnosing a rotator cuff injury has surgical and anaesthesia-related risks. Magnetic resonance imaging (MRI), a non-invasive procedure, is expensive, and lacks dynamic components making it less favourable. Clinical examination narrows the diagnosis, but lacks diagnostic accuracy due to overlap of clinical signs and symptoms. We aimed to determine the diagnostic accuracy of clinical examination and MRI in rotator cuff tears by correlating it with arthroscopy. Methods This prospective, cross-sectional validation study included patients (N=28) with shoulder pain with clinical characteristics suggestive of rotator cuff tears. Clinical diagnoses and MRI were done preoperatively, following which each patient underwent arthroscopic surgery. Shoulder arthroscopy findings were correlated with those of clinical examination and MRI. Results The mean age of patients was 50.21±9.66 years, with 60.71% being males. Clinical examination was 100% sensitive and 73.8% specific for detecting rotator cuff tears. MRI was 92.85% sensitive and 98.8% specific in detecting rotator cuff tears. Shoulder MRI demonstrated a higher agreement with arthroscopy than clinical results for subscapularis, supraspinatus, infraspinatus, teres, and biceps tendon appearance. Conclusion MRI results in identifying rotator cuff pathologies are comparable with arthroscopy. Clinical examination findings are variable due to an examiner's bias and therefore its diagnostic scope is limited. However, clinical examination with MRI together might accurately identify the rotator cuff injury.
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Affiliation(s)
| | - Kiyana Mirza
- Trauma and Orthopaedics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, GBR
| | - Dev A Galagali
- Foot and Ankle Surgery, Indian Foot and Ankle Society, Bangalore, IND
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Zhong Z, Zang W, Tang Z, Pan Q, Yang Z, Chen B. Effect of scapular stabilization exercises on subacromial pain (impingement) syndrome: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1357763. [PMID: 38497039 PMCID: PMC10940535 DOI: 10.3389/fneur.2024.1357763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Objective To evaluate the effectiveness of scapular stabilization exercises (SSE) in the treatment of subacromial pain syndrome (SAPS). Methods Clinical randomized controlled trials (RCTs) on SSE in the treatment of SAPS were searched electronically in PubMed, Science Direct, Cochrane Central Register of Controlled Trials (CENTRAL), EBSCOhost, Physiotherapy Evidence Database (PEDro), Web of Science, and other databases from 2000 to 2022, supplemented by manual search. Final RCTs were selected based on inclusion and exclusion criteria, and the Physiotherapy Evidence Database scale was used to evaluate the methodological quality of the study. A meta-analysis was conducted on data using the RevMan5.4 software. Results Eight RCTs involving 387 participants were included. The meta-analysis showed that the experimental group (SSE) had greater improvements in the Visual Analog Scale score [Weighted Mean Difference (WMD) = -0.94, 95% CI (-1.23, -0.65), p < 0.001] and the Shoulder Pain and Disability Index score [WMD = -10.10, 95% CI (-18.87, -1.33), p = 0.02] than the control group (conventional physical therapy). However, range of motion (ROM) was not found to be greater in the experimental group than in the control group. Conclusion Existing evidence moderately supports the efficacy of SSE for reducing pain and improving function in SAPS, without significant improvement in ROM. Future research should focus on larger, high-quality, standardized protocols to better understand SSE's effects across diverse SAPS populations, treatment, and outcome measures. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=307437, CRD42022307437.
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Affiliation(s)
- Ziyi Zhong
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Wanli Zang
- Postgraduate School, Harbin Sport University, Harbin, China
| | - Ziyue Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiaodan Pan
- School of Medicine, Tongji University, Shanghai, China
| | - Zhen Yang
- Department of Movement Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Bin Chen
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
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Clarke CJ, Torrance E, Gibson J, Brownson P, Funk L. Diagnosing the direction of shoulder instability in rugby players. Shoulder Elbow 2024; 16:33-37. [PMID: 38435041 PMCID: PMC10902408 DOI: 10.1177/17585732221092025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/18/2022] [Indexed: 03/05/2024]
Abstract
The muscular characteristics of rugby players may make diagnosing the direction of shoulder instability and labral pathology challenging. This study aimed to assess the accuracy of clinical examination and specifically instability tests, in diagnosing the direction of shoulder instability in rugby players. One-hundred-and-forty rugby players, who had undergone a shoulder stabilization procedure, over a 55-month period, were included in this study. The mean age was 21.5 years with 137 males. Data collected included clinical examination and intraoperative findings. The two were compared to calculate the diagnostic accuracy of special tests for instability. The Anterior Apprehension Test had good sensitivity (82.7%), specificity (100%) and PPV (100%) but poor NPV (55.8%). All posterior instability tests demonstrated a sensitivity of over 85%, but all had a specificity of 25% or less. In 83.6% of cases the direction of instability was correctly identified from history and examination. Anterior instability was correctly diagnosed in 78.9% of cases and posterior in 100.0%. The poor NPV of the anterior apprehension test suggests that clinicians should be suspicious of anterior instability in rugby shoulders even in the light of negative examination findings. Positive posterior instability tests are highly suggestive of posterior instability in rugby players.
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Affiliation(s)
| | | | - Jo Gibson
- Liverpool Shoulder Clinic, Liverpool, UK
| | | | - Lennard Funk
- Wrightington Hospital, Appley Bridge, Lancashire, UK
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Marjanovič B, Ušaj T, Mirnik N, Todorov R, Nabergoj M. SLAP lesion type IX: case series and a review of literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3337-3346. [PMID: 37076632 DOI: 10.1007/s00590-023-03547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE A type IX SLAP (superior labrum anterior to posterior) lesion involves 360° of the glenohumeral labrum. Only rare reports have been published analyzing the risk factors of this lesion and the success of its arthroscopic management. The aim of our study is to evaluate predisposing factors that lead to SLAP IX and to assess the clinical outcome after arthroscopic treatment. Our treatment algorithm is also presented. METHODS We report on a series of six patients treated in our institution between January 2014 and January 2019 who underwent shoulder arthroscopy and were intraoperatively found to have a SLAP lesion type IX. Arthroscopic labral repair and biceps tenodesis were indicated in all patients. American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Rowe Score and Constant Murley Shoulder Score (CS) were used for clinical evaluation. Patients were evaluated preoperatively and at 12 weeks, 1 year and 2 years postoperatively. RESULTS We analyzed six patients of which 83% were males (5/6 patients). The average age at the time of surgery was 37.16 (range 30-42 years). The dominant arm was affected in 50% of patients (3/6 patients). A significant postoperative improvement was seen in all six patients. 83% (5/6) of patients returned to their pre-injury activity level. Average values of all three measured scores show a significant increase comparing preoperative to postoperative period (P-value < 0.05). All patients were able to return to work. CONCLUSIONS The final diagnosis was established intraoperatively as 83% (5/6) of radiology reports differed from subsequent arthroscopic findings. The mechanism of injury in all our cases was high energy trauma with traction, arm in abduction or anteflexion. We observed great success with arthroscopic treatment as high percentage of our patients returned back to work and sports.
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Affiliation(s)
- Benjamin Marjanovič
- Orthopaedic Hospital Valdoltra, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia.
| | - Tina Ušaj
- Orthopaedic Hospital Valdoltra, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia
| | - Nino Mirnik
- Orthopaedic Hospital Valdoltra, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia
| | - Risto Todorov
- University Clinic for Surgical Diseases "St. Naum Ohridski", Bul. 11th October No. 53, 1000, Skopje, North Macedonia
| | - Marko Nabergoj
- Orthopaedic Hospital Valdoltra, Valdoltra Orthopaedic Hospital, Jadranska Cesta 31, 6280, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
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Schiltz M, Goudman L, Moens M, Nijs J, Hatem SM. The diagnostic value of physical examination tests in adhesive capsulitis: a systematic review. Eur J Phys Rehabil Med 2023; 59:724-730. [PMID: 37737049 PMCID: PMC10792672 DOI: 10.23736/s1973-9087.23.07940-6] [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: 02/23/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Adhesive capsulitis, a condition marked by pain and stiffness of the shoulder, can have a frustrating clinical course for patients and health care professionals. Despite huge research interest, a universally accepted and used definition of clinical criteria for the diagnosis of adhesive capsulitis is currently still lacking. This systematic review aimed to identify diagnostic values for clinical examinations tests used in the diagnosis of adhesive capsulitis. EVIDENCE ACQUISITION A total of 5 electronic databases (PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials [CENTRAL] and PEDro) were searched for relevant studies from 2002 until October 2022 using the terms: "adhesive capsulitis AND diagnosis" and "frozen shoulder AND diagnosis." The Downs and Black Checklist (modified) was used to assess the risk of bias. The study protocol was prospectively registered at the International prospective register of systematic reviews (PROSPERO, CRD42022365993). EVIDENCE SYNTHESIS The initial database search identified 1799 studies, of which 9 (0.50%) were eventually included in the systematic review. Non-intrusive shoulder range of motion measurements in patients with adhesive capsulitis using the Kinect for Windows (Microsoft, Redmond, WA, USA) showed high correlation with clinical range of motion measurement. Two specific clinical tests, the affected-unaffected shoulder approach of the Coracoid Pain Test and the Distension Test in Passive External Rotation, were identified and presented excellent sensibility and specificity in the diagnosis of adhesive capsulitis, in their original study. Comparison between clinical tests was not possible due to the heterogeneity in clinical tools. CONCLUSIONS This systematic review identified several physical examination tests developed for the diagnosis of adhesive capsulitis but could not compare them nor advance a set of clinical diagnostic tests that are scientifically validated. Further research is warranted to obtain validation of clinical diagnosis tools for adhesive capsulitis.
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Affiliation(s)
- Marc Schiltz
- Department of Physical and Rehabilitation Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium -
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium -
- STIMULUS Consortium, Vrije Universiteit Brussel, Brussels, Belgium -
| | - Lisa Goudman
- STIMULUS Consortium, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Jette, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Jette, Belgium
- Research Foundation-Flanders, Brussels, Belgium
| | - Maarten Moens
- STIMULUS Consortium, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Jette, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Jette, Belgium
| | - Jo Nijs
- Department of Physical and Rehabilitation Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Jette, Belgium
| | - Samar M Hatem
- Department of Physical and Rehabilitation Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- STIMULUS Consortium, Vrije Universiteit Brussel, Brussels, Belgium
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Moretti L, Bizzoca D, Farì G, Caricato A, Angiulli F, Cassano GD, Solarino G, Moretti B. Bari Shoulder Telemedicine Examination Protocol (B-STEP): A Standard Protocol for Personalized Remote Shoulder Examination. J Pers Med 2023; 13:1159. [PMID: 37511772 PMCID: PMC10381873 DOI: 10.3390/jpm13071159] [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: 04/17/2023] [Revised: 06/25/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic drastically changed many aspects of the traditional functioning of health systems all around the world. In Italy, as reported by the CIO, compared to the previous year, there was a significant reduction in 2020 in overall outpatient activities by up to 75%. These data support the need for telemedicine, which represents a current challenge and can no longer be postponed in the future. This study aims to elaborate on a possible model for remote shoulder examination based on traditional tests to improve the quality of telemedicine in orthopedic and rehabilitation. Between May 2020 and November 2020, ten orthopedic surgeons individually examined six patients with a known shoulder disorder, both in hospital and via webcam according to the previously shared protocol (B-STEP). According to the 10 observers, completing 100% of the ASES score and at least 87.5% of the Constant score is possible. Shoulder ROM and many specific tests are also reproducible via webcam, but with less sensitivity, according to the subjective opinion of observers. The B-STEP is a useful protocol for the standardization of the objective examination of the shoulder via webcam. Further studies are necessary to determine if the B-STEP protocol is useful for diagnosing pathology in unknown patients and evaluating its sensitivity and specificity for each pathology.
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Affiliation(s)
- Lorenzo Moretti
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Davide Bizzoca
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giacomo Farì
- Physical Medicine and Rehabilitation Unit, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessandro Caricato
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesco Angiulli
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Danilo Cassano
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Solarino
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Biagio Moretti
- Orthopaedic and Trauma Unit, AOUC Policlinico di Bari, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
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Murphy RJ, Bintcliffe F. Ask the expert: assessment of shoulder pain in primary care. BMJ 2023; 382:1255. [PMID: 37419617 DOI: 10.1136/bmj.p1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
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13
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Gomes E, Andrade R, Valente C, Santos JV, Nunes J, Carvalho Ó, Correlo VM, Silva FS, Oliveira JM, Reis RL, Espregueira-Mendes J. Inconsistency in Shoulder Arthrometers for Measuring Glenohumeral Joint Laxity: A Systematic Review. Bioengineering (Basel) 2023; 10:799. [PMID: 37508826 PMCID: PMC10376824 DOI: 10.3390/bioengineering10070799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
There is no consensus on how to measure shoulder joint laxity and results reported in the literature are not well systematized for the available shoulder arthrometer devices. This systematic review aims to summarize the results of currently available shoulder arthrometers for measuring glenohumeral laxity in individuals with healthy or injured shoulders. Searches were conducted on the PubMed, EMBASE, and Web of Science databases to identify studies that measure glenohumeral laxity with arthrometer-assisted assessment. The mean and standard deviations of the laxity measurement from each study were compared based on the type of population and arthrometer used. Data were organized according to the testing characteristics. A total of 23 studies were included and comprised 1162 shoulders. Populations were divided into 401 healthy individuals, 278 athletes with asymptomatic shoulder, and 134 individuals with symptomatic shoulder. Sensors were the most used method for measuring glenohumeral laxity and stiffness. Most arthrometers applied an external force to the humeral head or superior humerus by a manual-assisted mechanism. Glenohumeral laxity and stiffness were mostly assessed in the sagittal plane. There is substantial heterogeneity in glenohumeral laxity values that is mostly related to the arthrometer used and the testing conditions. This variability can lead to inconsistent results and influence the diagnosis and treatment decision-making.
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Affiliation(s)
- Eluana Gomes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, 4200-450 Porto, Portugal
| | - Cristina Valente
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
| | - J Victor Santos
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
| | - Jóni Nunes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Serviço de Ortopedia e Traumatologia do Hospital de Santa Maria Maior, 4750-333 Barcelos, Portugal
- School of Medicine, University of Minho, 4710-057 Braga, Portugal
| | - Óscar Carvalho
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
| | - Vitor M Correlo
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- Pro2B, Consultoria e Gestão de Projetos, AvePark-Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - Filipe S Silva
- Centre for Microelectromechanical Systems (CMEMS-UMINHO), Campus Azurém, University of Minho, 4800-058 Guimarães, Portugal
- LABBELS Associate Laboratory, University of Minho, 4800-058 Guimarães, Portugal
| | - J Miguel Oliveira
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - Rui L Reis
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
| | - João Espregueira-Mendes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415 Porto, Portugal
- Dom Henrique Research Centre, 4350-415 Porto, Portugal
- School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência E Tecnologia, University of Minho, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
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Kijkunasathian C, Niyomkha S, Woratanarat P, Vijittrakarnrung C. The preferable shoulder position can isolate supraspinatus activity superior to the classic empty can test: an electromyographic study. BMC Musculoskelet Disord 2023; 24:255. [PMID: 37013546 PMCID: PMC10069100 DOI: 10.1186/s12891-023-06372-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Supraspinatus (SSP) strength tests are an important shoulder examination tool for clinical evaluations of patients with a suspected SSP tear. While the empty can (EC) test is widely used to diagnose SSP dysfunction, the test cannot selectively activate SSP activity. The aim of this study was to access the electromyographic (EMG) activity within SSP, deltoid, and surrounding periscapular muscles after resisted abduction force to determine which shoulder position helps best isolate SSP from deltoid activity. METHODS A controlled laboratory EMG study was conducted. Specifically, we conducted an EMG analysis of the seven periscapular muscles (i.e., the middle deltoid, anterior deltoid, SSP, upper trapezius, posterior deltoid, infraspinatus, and pectoralis major) in 21 healthy participants, without any history of shoulder disorder, aged 29 ± 0.9 years old with a dominant-right arm. EMG activities were measured during resisted abduction force according to comprehensive shoulder positions in abduction, horizontal flexion, and humeral rotation. The supraspinatus to middle deltoid (S:D) ratio was calculated using the standardized weighted EMG and the maximum voluntary isometric contraction of the SSP and middle deltoid muscles, for each shoulder position to determine the best isolated SSP muscle strength test position. Results were analyzed with the Kruskal-Wallis test for non-normally distributed data. RESULTS Shoulder abduction, horizontal flexion, and humeral rotation significantly affected the activity of the middle deltoid, SSP, and S:D ratio (P < 0.05). The S:D ratio increased significantly in lower degrees of shoulder abduction, lower degrees of horizontal flexion, and external humeral rotation over internal rotation. The greatest S:D ratio (3.4 (0.5-9.1)) occurred at the shoulder position of 30° shoulder abduction combined with 30° horizontal flexion and external humeral rotation. Conversely, the classic EC position manifested nearly the smallest S:D ratio (0.8 (0.2-1.2)). CONCLUSION Application of the SSP strength test in the shoulder position of 30 degrees abduction, 30 degrees horizontal flexion, and external humeral rotation offers the best position to isolate the abducting activity of the SSP from that of the deltoid, which could help with diagnosis among patients with chronic shoulder pain with a suspected SSP tear condition.
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Affiliation(s)
- Chusak Kijkunasathian
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Supajed Niyomkha
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Patarawan Woratanarat
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Chaiyanun Vijittrakarnrung
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand.
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15
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Diplock B, Hing W, Marks D. The long head of biceps at the shoulder: a scoping review. BMC Musculoskelet Disord 2023; 24:232. [PMID: 36978047 PMCID: PMC10044783 DOI: 10.1186/s12891-023-06346-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. METHODS PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. RESULTS 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep's role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy's limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. CONCLUSIONS The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. PRE-REGISTRATION OSF: https://osf.io/erh9m.
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Affiliation(s)
- Brendan Diplock
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
| | - Wayne Hing
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Darryn Marks
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
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Sudah SY, Menendez ME, Garrigues GE. Nonoperative Treatment of the Biceps-Labral Complex. Phys Med Rehabil Clin N Am 2023; 34:365-375. [PMID: 37003658 DOI: 10.1016/j.pmr.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
The long head of the biceps and superior labrum should be evaluated as an interdependent functional unit. A focused patient history and physical examination including multiple provocative tests should be performed alongside advanced imaging studies to obtain an accurate diagnosis. Nonoperative treatment modalities including nonsteroidal anti-inflammatory drugs, glucocorticoid injections, and a standardized physical therapy regimen should be exhausted before operative intervention. Significant improvements in pain, functional outcomes, and quality of life are achieved in patients treated nonoperatively. Although these outcomes are less consistent for overhead athletes, return to play and performance metrics seem comparable to those who undergo surgery.
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Affiliation(s)
- Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740, USA
| | - Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, 2780 East Barnett Road, 200, Medford, OR 97504, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison Street, Orthopedic Building, Suite 400, Chicago, IL 60612, USA.
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17
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Roldán-Jiménez C, Cuadros-Romero M, Bennett P, Cuesta-Vargas AI. Differences in Tridimensional Shoulder Kinematics between Asymptomatic Subjects and Subjects Suffering from Rotator Cuff Tears by Means of Inertial Sensors: A Cross-Sectional Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:1012. [PMID: 36679809 PMCID: PMC9864778 DOI: 10.3390/s23021012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Background: The aim of this study was to analyze differences in three-dimensional shoulder kinematics between asymptomatic subjects and patients who were diagnosed with rotator cuff tears. Methods: This cross-sectional study recruited 13 symptomatic subjects and 14 asymptomatic subjects. Data were obtained from three inertial sensors placed on the humerus, scapula and sternum. Kinematic data from the glenohumeral, scapulothoracic and thoracohumeral joints were also calculated. The participants performed shoulder abductions and flexions. The principal angles of movements and resultant vectors in each axis were studied. Results: The glenohumeral joint showed differences in abduction (p = 0.001) and flexion (p = 0.000), while differences in the scapulothoracic joint were only significant during flexion (p = 0.001). The asymptomatic group showed higher velocity values in all sensors for both movements, with the differences being significant (p < 0.007). Acceleration differences were found in the scapula during abduction (p = 0.001) and flexion (p = 0.014), as well as in the sternum only during shoulder abduction (p = 0.022). Conclusion: The results showed kinematic differences between the patients and asymptomatic subjects in terms of the mobility, velocity and acceleration variables, with lower values for the patients.
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Affiliation(s)
- Cristina Roldán-Jiménez
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, 29016 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Miguel Cuadros-Romero
- Unit of Upper Limb Orthopedic Surgery of Hospital, University of Malaga, 29010 Málaga, Spain
| | - Paul Bennett
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane City, QLD 4059, Australia
| | - Antonio I. Cuesta-Vargas
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, 29016 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane City, QLD 4059, Australia
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Rhee SM, Youn SM, Park JH, Chang GW, Rhee YG. The scissors sign: a provocative test for detecting the leading-edge tear of subscapularis tendon: a diagnostic study. BMC Musculoskelet Disord 2022; 23:679. [PMID: 35842588 PMCID: PMC9288008 DOI: 10.1186/s12891-022-05621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several physical examination tests and signs have been described to aid in the diagnosis of subscapularis (SSC) tear, but have limitations and variable sensitivity. This study aimed to introduce a novel test for detecting a leading-edge tear of the subscapularis (LETS), the most important tendinous portion of SSC. METHODS A total of 233 patients who underwent arthroscopic repair for anterior and superior cuff tears between January 2018 to September 2019 were retrospectively reviewed. The provocative test we have coined as the "scissors sign" and the other related clinical tests (i.e., belly press, belly off, Napoleon, lift off, internal rotation lag, bear hug tests) were performed preoperatively. Whether the patient has a LETS or the complete tear of the SSC (CTS) was confirmed by arthroscopic findings. Sensitivity, specificity, and areas under the receiver operating characteristic curve were calculated for each test. RESULTS In patients who had LETS with or without supraspinatus tear, the scissors sign showed the highest sensitivity (91.4%) with a specificity of 81.6%, positive predictive value (PPV) of 80.2%, and negative predictive value (NPV) of 92.1%. In patients with isolated LETS, the scissors sign also showed the highest sensitivity (90.3%) with a specificity of 81.6%, PPV of 57.1%, and NPV of 96.8%. The scissors sign for the complete tear of the subscapularis (CTS) with or without supraspinatus tear and the isolated CTS had a sensitivity of 73.1 and 75%, respectively. CONCLUSIONS The scissors sign is a novel provocative test that can be helpful in the diagnosis of subscapularis tears, especially LETS, with its high sensitivity and diagnostic accuracy. In combination with other tests, the scissors sign will be a good screening tool.
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Affiliation(s)
- Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Seung-Min Youn
- The Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, 4029, Australia
| | - Joon Hong Park
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Geun Wu Chang
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Gyeonggi-do, Goyang-si, South Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Gyeonggi-do, Goyang-si, South Korea.
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Liu J, Hui SSC, Yang Y, Rong X, Zhang R. Effectiveness of home-based exercise for non-specific shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:2036-2050. [DOI: 10.1016/j.apmr.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
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Nigues A, Salentiny Y, Nabergoj M, Lädermann A, Neyton L. The Digitation Sign Facilitates Diagnosis of Shoulder Subscapularis Lesions on Preoperative Magnetic Resonance Imaging. Arthrosc Sports Med Rehabil 2022; 4:e883-e889. [PMID: 35747646 PMCID: PMC9210382 DOI: 10.1016/j.asmr.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The purposes of this study were to investigate a radiographic sign found on coronal magnetic resonance imaging (MRI) sequences in subscapularis (SSC) pathology, reporting interobserver reliability data and sensitivity and specificity; and to correlate the preoperative assessment of SSC pathology with intraoperative assessment of the SSc during shoulder arthroscopy. Methods A consecutive series of patients undergoing arthroscopic rotator cuff repair from January 2020 to December 2020 were examined. The positive diagnosis of a subscapularis tendon tear was prospectively determined and confirmed by arthroscopy. The “digitation sign” was assessed by 3 independent shoulder-trained fellows when evaluating the SSC in the coronal plane on T2-weighted images. Results Of the 132 patients included, 74 (56%) had SSC tendon tears confirmed during arthroscopy. Interobserver agreement for digitation sign was substantial (k= 0.640). Sensitivity for digitation sign only was 74.3%; for criteria of Adams et al. (Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy; Arthroscopy 2010;26:1427-1433) only, 83.8%; and for the combination of the 2 methods, 89.2%. Specificity was 84.5% for digitation sign only, 77.6% for Adams et al. criteria only, and 67.2% for the combination of the 2 methods. Sensitivity is statistically better when the digitation sign is added to the Adams et al. criteria for detection of SSC lesions. As expected, specificity is statistically lower. SSC tears are significantly associated with biceps lesions. Conclusion Preoperative systematic MRI evaluation by shoulder surgeons can diagnose subscapularis lesions by using the digitation sign in the coronal plane along with Adams et al. criteria, leading to good sensitivity. This easy-to-apply sign can be helpful in the initial MRI evaluation in the coronal plane, with improved sensitivity when combined with a systematic approach. Level of Evidence II, study of diagnostic test.
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21
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Baek CH, Kim JG, Baek GR. Restoration of active internal rotation following reverse shoulder arthroplasty: anterior latissimus dorsi and teres major combined transfer. J Shoulder Elbow Surg 2022; 31:1154-1165. [PMID: 34968688 DOI: 10.1016/j.jse.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty (RSA) for irreparable massive rotator cuff tear (mRCT) and cuff tear arthropathy (CTA) demonstrates satisfactory clinical outcomes. However, many studies have reported no significant improvements in internal and external rotation. To our knowledge, there have been no studies on new attempts to restore active internal rotation following RSA. The purpose of this study was to compare RSA alone and RSA with anterior latissimus dorsi and teres major (aLDTM) tendon transfer in patients with CTA and mRCT with combined loss of active elevation and internal rotation (CLEIR). METHODS This retrospective cohort study included patients who underwent RSA with a lateralized design and had CLEIR between October 2014 and January 2019. Two groups were classified: patients who underwent RSA alone (group R, n = 36) and patients who underwent RSA with aLDTM tendon transfer (group T, n = 24). Clinical outcomes, including the visual analog scale score, Constant score, American Shoulder and Elbow Surgeons score, active range of motion, score for activities of daily living requiring active internal rotation (ADLIR), and ability to perform toileting activity, were compared. Moreover, radiologic outcomes and complications were compared. RESULTS The mean follow-up period was 36.8 ± 11.6 months (range, 24-67 months). Both group R and group T showed significant improvements in clinical scores and active range of motion preoperatively and postoperatively. In group T, the Constant score (65.2 ± 7.5 vs. 58.1 ± 12.3, P = .008), ADLIR score (26.1 ± 3.1 vs. 20.3 ± 5.0, P < .001), internal rotation level with the arm behind the back (P < .001), and subscapularis-specific physical examination findings (P < .001) were significantly better than in group R. However, no significant difference in the American Shoulder and Elbow Surgeons score, forward flexion, and external rotation at 0° and 90° of abduction were found at final follow-up. Transient axillary nerve palsy was found in 2 patients in group T. However, there were no significant differences in complication rates between 2 groups. CONCLUSION Lateralized RSA with aLDTM tendon transfer for patients with CTA and mRCT with CLEIR restored shoulder function and improved clinical outcomes, especially the ability to perform ADLIR and toileting activity.
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Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea.
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Gyu Rim Baek
- Department of Mathematics, Dongguk University, Seoul, Republic of Korea
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22
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Fieseler G, Laudner K, Sendler J, Cornelius J, Schulze S, Lehmann W, Hermassi S, Delank KS, Schwesig R. The internal rotation and shift-test for the detection of superior lesions of the rotator cuff: reliability and clinical performance. JSES Int 2022; 6:495-499. [PMID: 35572448 PMCID: PMC9091795 DOI: 10.1016/j.jseint.2022.01.011] [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] [Indexed: 11/13/2022] Open
Abstract
Background Using reliable and valid clinical tests are essential for proper diagnosis and clinical outcomes among injuries involving the rotator cuff. The addition of a new clinical examination test could improve the clinical diagnosis and informative value of the sensitivity and specificity of pathology. This study of diagnostic accuracy evaluated the use of a new rotator cuff test, called the internal rotation and shift-test (IRO/shift-test), to determine its reliability and clinical performance (sensitivity, specificity, positive (PPV)/negative predictive value (NPV)). Clinical diagnostic outcomes were confirmed with radiological findings (MRI). Methods 100 patients from a specialized shoulder unit participated (64 male, 36 female, mean age: 55 ± 13.5 years). A single-blinded (no knowledge of prior clinical or technical diagnostics) study design was used with two experienced physicians performing the IRO/shift-test. For clinical performance, all clinical testing was compared with MRI. Results The intra-rater (ICC = 0.73, 95% CI: 60-82) and inter-rater (ICC = 0.89, 95% CI: 81-94) coefficients for the IRO/shift-test showed good-to-excellent reliability. 75% of the patients showed a positive IRO/shift-test, while 65% had a radiologically diagnosed superior rotator cuff tear. 60% of these patients had both a positive IRO/shift-test and objective rotator cuff tear via MRI. The sensitivity of the IRO/shift-test to detect superior rotator cuff lesions based on MRI diagnosis was calculated at 92% (95% CI: 86-99%), while specificity was 67% (95% CI: 50-84%). Predictive values were also found to be high with 86% PPV (95% CI: 78-94%) and 80% NPV (95% CI: 64-96%). Conclusion Our results demonstrate that the IRO/shift-test is a reliable and valid tool for assessing superior rotator cuff pathology. With good-to-excellent intrarater and inter-rater reliability and strong sensitivity and specificity this test should be considered a valuable addition to clinicians' cadre of clinical evaluation tools.
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Affiliation(s)
- Georg Fieseler
- Clinic of Orthopedic and Trauma Surgery, Sports Medicine, Klinikum Hann, Münden, Germany
| | - Kevin Laudner
- Department of Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO
| | - Julia Sendler
- Clinic of Orthopedic and Trauma Surgery, Sports Medicine, Klinikum Hann, Münden, Germany
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jakob Cornelius
- Clinic of Orthopedic and Trauma Surgery, Sports Medicine, Klinikum Hann, Münden, Germany
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephan Schulze
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Wolfgang Lehmann
- Clinic of Orthopedic, Trauma and Reconstructive Surgery, Georg August University Göttingen, Göttingen, Germany
| | - Souhail Hermassi
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
| | - Karl-Stefan Delank
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - René Schwesig
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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23
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Shibayama Y, Hirose T, Sugi A, Mizushima E, Watanabe Y, Tomii R, Iba K, Yamashita T. Diagnostic accuracy of magnetic resonance imaging for partial tears of the long head of the biceps tendon in patients with rotator cuff tears. JSES Int 2022; 6:638-642. [PMID: 35813151 PMCID: PMC9264005 DOI: 10.1016/j.jseint.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is useful for diagnosing shoulder diseases preoperatively. However, detection of partial tears of the long head of the biceps tendon (LHBT) using current clinical tests and imaging modalities is difficult. We aimed to evaluate the accuracy of radial-slice MRI for diagnosing partial tears of the LHBT. We hypothesized that radial-slice MRI may be a valuable diagnostic tool for assessing diagnosing tears of the LHBT. Methods We retrospectively investigated 118 patients who underwent shoulder arthroscopy for rotator cuff tears. Intraoperative LHBT findings were compared with the identification of partial tears of the LHBT on conventional-slice MRI and radial-slice MRI, using a 3.0-T system. We calculated sensitivity, specificity, accuracy, and positive and negative predictive values for the detection of LHBT tears. Inter- and intraobserver reliability for radial-slice MRI was calculated using kappa statistics. Results We diagnosed 69 patients (58%) without any LHBT tears and 49 with partial tears (42%), arthroscopically. Sensitivity, specificity, accuracy, and positive and negative predictive values of conventional-slice MRI for detection of partial tears of the LHBT were 52%, 94%, 78%, 92%, and 58%, respectively. Radial-slice MRI had 84% sensitivity, 90% specificity, 86% accuracy, and 92% positive and 80% negative predictive values for partial tears of the LHBT. Inter- and intraobserver reliability for radial-slice MRI was 0.69 and 0.74, respectively, corresponding to high reproducibility and defined as good. Conclusion Radial-slice MRI demonstrated significantly higher sensitivity than conventional-slice MRI. These results indicate that radial-slice MRI is useful for diagnosing LHBT partial tears.
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Affiliation(s)
- Yuji Shibayama
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
- Corresponding author: Yuji Shibayama, MD, PhD, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | | | - Akira Sugi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Emi Mizushima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuto Watanabe
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Rira Tomii
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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24
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Wang Y, Xu Y, Peng Y, Liao S, Dai G, Li T. Acupuncture for Atraumatic Shoulder Conditions: Protocol for a Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:720551. [PMID: 35330586 PMCID: PMC8940297 DOI: 10.3389/fmed.2022.720551] [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: 06/04/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Shoulder pain is one of the most common musculoskeletal disorders among adults and is caused by a variety of shoulder conditions. The popularity of different acupuncture methods in the nonsurgical treatment of shoulder pain has recently increased. However, evidence regarding the efficacy of acupuncture for shoulder pain is inconsistent, and there is a lack of supporting evidence regarding the overall efficacy of different acupuncture methods for shoulder pain. Methods and Analysis A systematic review will be conducted to assess the effectiveness of a wide range of acupuncture techniques for atraumatic shoulder conditions. The PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Ovid MEDLINE, Chinese Biomedical Literature, Chinese National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases will be searched to identify eligible studies. Studies will be selected according to preset inclusion and exclusion criteria and relevant data will be extracted from the final included studies. The heterogeneity, risk of bias, publication bias and evidence quality of the studies will be assessed, and a subgroup analysis and sensitivity analysis will be performed. Systematic Review Registration PROSPERO registration number CRD42021249625.
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Affiliation(s)
- Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Yan Xu
- Experiment Teaching Center for Preclinical Medicine, Chengdu Medical College, Chengdu, China
| | - Yu Peng
- School of Sports Medicine and Health, Postgraduate School, Chengdu Sport Institute, Chengdu, China
| | - Shichuan Liao
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Tao Li
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, Chengdu, China
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25
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Gallo R, Applewhite AI, Silvis ML, Yenior AL, Ton AN, Ortiguera CJ, Pujalte G. Shoulder Evaluation by Telephone and Video Visit: A Narrative Review. Cureus 2022; 14:e22461. [PMID: 35371710 PMCID: PMC8942451 DOI: 10.7759/cureus.22461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 11/08/2022] Open
Abstract
Telemedicine has a very important role in today’s healthcare system, which has been accentuated during the SARS-CoV-2 pandemic. Virtual medical evaluations offer a myriad of benefits for both patients and providers. Evaluations of the musculoskeletal system, however, present unique challenges because diagnosis significantly relies on a physical examination, something not easily accomplished by virtual means. The shoulder, a complex region with four separate articulations, is no exception. Nevertheless, a properly planned and executed telemedicine visit may yield successful results even with challenging shoulder pathologies. This narrative review aims to offer clinicians who are novices in the practice of telemedicine a basic framework with instructions, questions, and some examples of interpretation of patient answers to guide them through encounters for the evaluation of shoulder complaints via telephone and video consultation.
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26
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Maselli F, Storari L, Lorusso M, Mourad F, Pennella D, Barbari V, Salomon M, Brindisino F. Osteoid Osteoma in an Adult Wheelchair Basketball Player Mimicking Musculoskeletal Shoulder Pain: Red Flag or a Red Herring? Tomography 2022; 8:389-401. [PMID: 35202197 PMCID: PMC8877604 DOI: 10.3390/tomography8010032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 12/01/2022] Open
Abstract
Osteoid osteoma (OO) is a relatively common, benign bone-forming tumour, which mainly occurs on the long tubular bones of the limbs in adolescents. Usually, the OO is classified based on its localisation. Night-time pain is the major symptom of OO, which is commonly relieved using non-steroidal anti-inflammatory drugs, while surgery is required only for those patients with severe pain or in case of failure of previous conservative treatments. Our case report describes a 56-year-old male basketball player who self-referred to our outpatient physical therapy with a shoulder pain complaint. Considering the anamnesis and the physical examination, the physical therapist referred the patient to an orthopaedic surgeon, who suggested a detailed imaging investigation. The peculiarity of this clinical case is the overlapping of two clinical presentations: the symptomatology of the OO and the concurrent mechanical disorder due to a rotator cuff tendinopathy.
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Affiliation(s)
- Filippo Maselli
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy;
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 17100 Savona, Italy;
| | - Lorenzo Storari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 17100 Savona, Italy;
- Correspondence:
| | - Mariangela Lorusso
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (M.L.); (D.P.); (M.S.); (F.B.)
| | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg;
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Denis Pennella
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (M.L.); (D.P.); (M.S.); (F.B.)
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
| | - Valerio Barbari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 17100 Savona, Italy;
| | - Mattia Salomon
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (M.L.); (D.P.); (M.S.); (F.B.)
| | - Fabrizio Brindisino
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (M.L.); (D.P.); (M.S.); (F.B.)
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise C/da Tappino c/o Cardarelli Hospital, 86100 Campobasso, Italy
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Anauate Nicolao F, Yazigi Junior JA, Matsunaga FT, Archetti Netto N, Belloti JC, Tamaoki MJS. Comparing shoulder maneuvers to magnetic resonance imaging and arthroscopic findings in patients with supraspinatus tears. World J Orthop 2022; 13:102-111. [PMID: 35096540 PMCID: PMC8771410 DOI: 10.5312/wjo.v13.i1.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/09/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shoulder maneuvers and magnetic resonance imaging (MRI) are performed to diagnose supraspinatus tendon tears regardless of arthroscopy exam. Although there are many studies on this subject, there is a lack of studies comparing the sensitivity (Se) and specificity (Sp) of shoulder maneuvers and MRI to arthroscopic findings (intact, partial, or full thickness supraspinatus tendon tear).
AIM To compare the diagnostic values of shoulder maneuvers with MRI for supraspinatus tendon tears in patients undergoing shoulder arthroscopy.
METHODS A total of 199 consecutive patients from four orthopedic centers met the eligibility criteria of shoulder pain persisting for at least four weeks. They were prospectively enrolled in this study from April 2017 to April 2019. Seven clinical tests (full can, empty can, drop arm, Hawkins’, painful arc, Neer’s sign and resisted external rotation) and MRI were performed, and all were compared with surgical findings. Full can, empty can and resisted external rotation tests were interpreted as positive in the case of pain and/or weakness. We assessed the Se, Sp, accuracy, positive predictive value (PPV) and negative predictive value (NPV), positive and negative likelihood ratio and diagnostic odds ratio for overall, partial and full-thickness supraspinatus tears.
RESULTS MRI had the highest Se for overall (0.97), partial (0.91) and full-thickness (0.99) tears; moreover, MRI had the highest NPV: 0.90, 0.88 and 0.98 for overall, partial and full-thickness tears, respectively. For overall supraspinatus tears, the Se and PPV were: Painful arc (Se = 0.85/PPV = 0.91), empty can (pain) (Se = 0.80/PPV = 0.89), full can (pain) (Se = 0.78/PPV = 0.90), resisted external rotation (pain) (Se = 0.48/PPV = 0.87), drop arm (Se = 0.19/PPV = 0.97), Neer’s sign (Se = 0.78/PPV = 0.93) and Hawkins’ (Se = 0.80/PPV = 0.88). MRI had the highest PPV (0.99). The Hawkin’s test had the highest false positive rate in patients with intact tendons (0.36). The Sp of the empty can and full can (both tests positive for pain and weakness), drop arm and MRI were: 0.93, 0.91, 0.98 and 0.96, respectively. For partial and full-thickness tears, the empty can test (positive for pain and weakness) had a Sp of 0.93, and the drop arm and MRI had the same Sp (0.98).
CONCLUSION Physical examination demonstrated good diagnostic value, the drop arm test had a Sp as good as MRI for supraspinatus tears; however, MRI was more accurate in ruling out tears. The Hawkins’ test had high false-positive findings in patients with intact tendons.
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Affiliation(s)
- Fabio Anauate Nicolao
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
- Orthopedics and Traumatology Discipline, Universidade de Santo Amaro – UNISA, Sao Paulo 04829-300, Brazil
| | - Joao Alberto Yazigi Junior
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
- Orthopedics and Traumatology Discipline, Universidade de Santo Amaro – UNISA, Sao Paulo 04829-300, Brazil
| | - Fabio Teruo Matsunaga
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
| | - Nicola Archetti Netto
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
| | - Joao Carlos Belloti
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
| | - Marcel Jun Sugawara Tamaoki
- Orthopedics and Traumatology Department, Escola Paulista de Medicina – Universidade Federal de São Paulo – UNIFESP, Sao Paulo 04038-001, Brazil
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Schydlowsky P, Szkudlarek M, Madsen OR. Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial. BMC Musculoskelet Disord 2022; 23:52. [PMID: 35033043 PMCID: PMC8760780 DOI: 10.1186/s12891-021-04969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/17/2021] [Indexed: 12/05/2022] Open
Abstract
Background There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested. The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR. Methods Randomised control trial with blinded assessor. 126 consecutive patients with SIS were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430. Results CS improved by 22.7 points for the STR group and by 23,7 points for the HTR (p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference. Conclusion We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.
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Affiliation(s)
| | - Marcin Szkudlarek
- Reumatologiklinikken i Værløse, Bymidten 11,1, 3500, Værløse, Denmark.,Department of Rheumatology, Zealand University Hospital at Køge, Køge, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Rintek Madsen
- Department of Rheumatology and Spine Diseases, Gentofte University Hospital and Rigshospitalet, DK-2900, Hellerup, Denmark
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Thiagarajan A, Nagaraj R, Marathe K. Correlation Between Clinical Diagnosis, MRI, and Arthroscopy in Diagnosing Shoulder Pathology. Cureus 2021; 13:e20654. [PMID: 35106207 PMCID: PMC8786586 DOI: 10.7759/cureus.20654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction Shoulder disorders are frequently encountered by clinicians and are a common cause of musculoskeletal pain in the general population. Clinical tests specific to each shoulder pathology, MRI, and arthroscopy are the most relied upon modalities of diagnosis used by many clinicians. The aim of this study was to correlate clinical tests and MRI with arthroscopy as the gold standard and whether a negative MRI with a positive clinical test could justify an arthroscopy. Materials and methods A total of 120 consecutive patients who had a history of shoulder pain or instability were evaluated by clinical tests and MRI, and underwent arthroscopy. Based on the confirmatory findings of arthroscopy, they were classified as True Positive (TP), True Negative (TN), False Positive (FP) and False Negative (FN) for each modality i.e., clinical tests and MRI. Results Clinical assessment of rotator cuff tears in comparison to arthroscopy yielded a sensitivity of 96.88%, specificity of 92.86% and diagnostic accuracy of 95%, whilst MRI had a sensitivity of 90.62%, specificity of 92.86% and diagnostic accuracy of 91.67%. In anterior labral lesions, clinical assessment had a sensitivity of 94.44%, specificity of 97.62 % and diagnostic accuracy of 96.67%, whilst MRI had a sensitivity of 83.33%, specificity of 92.86%, with diagnostic accuracy of 90%. Interestingly, in the clinical assessment of superior labral tear from anterior to posterior (SLAP) lesions, a sensitivity of 90%, specificity of 95%, and diagnostic accuracy of 93.33% were observed while MRI had a sensitivity of 60%, specificity of 92.50%, and diagnostic accuracy of 81.67%. Conclusion On the basis of these results, clinical assessment appears to be an effective tool in diagnosing shoulder pathologies, whereas MRI, though reliable in the identification of rotator cuff tears and instability, does not identify patients with SLAP lesions effectively. This study reinforces the importance of a good clinical examination of the shoulder, especially in chronic pain and an uncertain MRI, therefore improving patient management.
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30
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Philp F, Faux-Nightingale A, Woolley S, de Quincey E, Pandyan A. Evaluating the clinical decision making of physiotherapists in the assessment and management of paediatric shoulder instability. Physiotherapy 2021; 115:46-57. [DOI: 10.1016/j.physio.2021.12.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/21/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
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Der IRO-/Shift-Test zur klinischen Diagnostik superiorer Rotatorenmanschettendefekte. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Othman R, Swain N, Tumilty S, Jayakaran P, Mani R. Pro-nociceptive pain modulation profile in patients with acute and chronic shoulder pain: a hypothesis-generating topical review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1973776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rani Othman
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
| | - Steve Tumilty
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
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Storari L, Signorini M, Barbari V, Mourad F, Bisconti M, Salomon M, Rossettini G, Maselli F. A Thoracic Outlet Syndrome That Concealed a Glioblastoma. Findings from a Case Report. ACTA ACUST UNITED AC 2021; 57:medicina57090908. [PMID: 34577831 PMCID: PMC8468880 DOI: 10.3390/medicina57090908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
Background: Glioblastoma is the most frequent and aggressive malignant brain tumor among adults. Unfortunately, its symptoms can vary considerably depending on the size, location and the anatomic structures of the involved brain. Case report: A 58-year-old male amateur cyclist who suffered from sharp arm pain was examined for a thoracic outlet syndrome due to a previous clavicle fracture. Because of ambiguous results of the neck and nerve plexus imaging, he was referred to a neurosurgeon who properly suspected a brain tumor. The neuroimaging of the brain shown a 3 cm disploriferative mass with a blood enhancement within the left parietal lobe. The mass was urgently removed, and its histologic analysis stated a grade 4 glioblastoma. Conclusion: This case report highlights the differential diagnosis process and the teamwork approach needed to diagnose a rare presentation of a brain glioblastoma, which started its symptoms mimicking a thoracic outlet syndrome caused by a previous bone fracture.
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Affiliation(s)
- Lorenzo Storari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DI-NOGMI), Campus of Savona—University of Genova, Via Magliotto 2, 17100 Savona, Italy; (L.S.); (V.B.)
| | - Manuel Signorini
- Department of Radiology, ULSS 9 Scaligera, Mater Salutis Hospital, 37045 Legnago, Italy;
| | - Valerio Barbari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DI-NOGMI), Campus of Savona—University of Genova, Via Magliotto 2, 17100 Savona, Italy; (L.S.); (V.B.)
| | - Firas Mourad
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy; (F.M.); (M.S.)
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, L-4671 Differdange, Luxembourg
| | - Mattia Bisconti
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, c/o Cardarelli Hospital, C/da Tappino, 86100 Campobasso, Italy;
| | - Mattia Salomon
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy; (F.M.); (M.S.)
| | | | - Filippo Maselli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DI-NOGMI), Campus of Savona—University of Genova, Via Magliotto 2, 17100 Savona, Italy; (L.S.); (V.B.)
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy
- Correspondence:
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Eliason A, Harringe M, Engström B, Sunding K, Werner S. Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome. Physiother Theory Pract 2021; 38:2568-2579. [PMID: 34402715 DOI: 10.1080/09593985.2021.1962462] [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: 10/20/2022]
Abstract
Background: Subacromial pain syndrome is a common musculoskeletal shoulder problem. The accuracy of clinical tests is low and techniques such as ultrasound and magnetic resonance imaging have been added to set up a diagnosis. Previous researchers have usually only examined the symptomatic shoulder. However, there might be similar findings in the asymptomatic shoulder. Objective:The aim of the present study was to investigate the prevalence of structural abnormalities of both shoulders in patients with clinically diagnosed unilateral subacromial pain syndrome using diagnostic ultrasound. Methods: Bilateral ultrasound examinations were performed in 115 consecutive patients, 54 men and 61 women. The patients were recruited from primary care centers in the area of Stockholm, Sweden. Results: Abnormal ultrasound findings were found in both shoulders and increased with age (p = .0004). Bursitis was the most common ultrasound finding and significantly more prevalent in the symptomatic shoulder compared to the asymptomatic shoulder (90%:74%; p = .0021), though 73% of the bursitis were bilateral. Supraspinatus is the most vulnerable tendon of the rotator cuff in both shoulders. In terms of partial-thickness tears and tendinosis, the tendon was affected more commonly in the symptomatic shoulder compared to the asymptomatic shoulder (30%:14%: 14%; p = .0026) and (24%:10%; p = .0054), respectively, but for calcification no significant difference between the shoulders was found (18%:12%; 0.1988). Conclusion: Ultrasound detected shoulder abnormalities were present in both symptomatic and asymptomatic shoulders. Bursitis and partial-thickness tears were more common in the affected shoulder when compared to the unaffected shoulder. Ultrasound as well as clinical examination findings and patient´s history should be taken into consideration when diagnosing patients with subacromial pain syndrome.
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Affiliation(s)
- Anna Eliason
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Health Care Services Stockholm County (SLSO), Region Stockholm
| | - Marita Harringe
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Aleris Sports Medicine & Ortopedi Sabbatsberg Hospital, Stockholm, Sweden
| | - Björn Engström
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Capio Artro Clinic, Stockholm, Sweden
| | - Kerstin Sunding
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Aleris Sports Medicine & Ortopedi Sabbatsberg Hospital, Stockholm, Sweden
| | - Suzanne Werner
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Khil EK, Choi JA, Lee E, Oh JH. Subscapularis (SSC) tendon tears: diagnostic performance and reliability of magnetic resonance arthrography (MRA) with arthroscopic correlation and comparison with clinical tests. Skeletal Radiol 2021; 50:1647-1655. [PMID: 33483772 DOI: 10.1007/s00256-020-03697-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/22/2020] [Accepted: 12/13/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance and reliability of magnetic resonance of arthrography (MRA) in diagnosis of subscapularis (SSC) tendon tears between two reviewers with varying levels of experience, and compare the results with clinical tests. MATERIALS AND METHODS SSC tendons were retrospectively evaluated in a total of 272 patients with arthroscopic confirmations. A total of 548 shoulder MRAs were evaluated by two musculoskeletal radiologists, and SSC tendon pathologies were classified into three groups: intact tendon (n = 149), partial-thickness tear (n = 92), or full-thickness tear (n = 31). Diagnostic performance was determined using arthroscopy as gold standard and compared with results of four clinical tests. Intra- and inter-observer reliabilities of two reviewers were evaluated using kappa statistics. RESULTS For full-thickness tears, mean values of sensitivity, specificity, and accuracy of reviewer 1/reviewer 2 were 71.0%/87.1%, 97.3%/98.3%, and 94.4%/95.5%, respectively. For partial-thickness tears, mean values of sensitivity, specificity, and accuracy were 72.8%/73.4%, 78.3%/81.2%, and 76.5%/78.5%, respectively. Intra- and inter-observer reliabilities for both reviewers were good to very good (k = 0.85/0.93, p < 0.001; k = 0.74-0.89, p < 0.001). For all clinical tests, while specificity was very high, sensitivity was very low and the overall accuracy was also low. CONCLUSION MRA showed high diagnostic performance for the diagnosis of SSC tendon tears, especially full-thickness tears, with good inter- and intra-observer reliabilities, regardless of the level of experience of the reviewer.
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Affiliation(s)
- Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, South Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, South Korea.
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 445-907, South Korea.
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, 13620, South Korea
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Lädermann A, Meynard T, Denard PJ, Ibrahim M, Saffarini M, Collin P. Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests. Knee Surg Sports Traumatol Arthrosc 2021; 29:2118-2133. [PMID: 32725446 DOI: 10.1007/s00167-020-06136-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/26/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Clinical diagnosis of posterosuperior rotator cuff tears remains uncertain due to a lack of evidence-based consensus. This review aimed to compare the diagnostic accuracy of commonly used clinical tests for posterosuperior rotator cuff tears. METHODS The authors conducted an electronic literature search using Medline, Embase and the Cochrane library/Central, to identify original clinical studies reporting diagnostic accuracy of clinical tests to diagnose the presence of posterosuperior rotator cuff tears involving the infraspinatus, supraspinatus and/or teres minor. RESULTS The electronic literature search returned 1981 records, of which 14 articles were eligible. Among 17 tests included in the systematic review, 6 tests were eligible for meta-analysis: drop arm sign, Jobe test, external rotation lag sign, Hawkins-Kennedy test, Neer test and painful arc abduction test. According to QUADAS-2 criteria, risk of bias was low in 1 study, moderate in 2 and high in 4. The highest pooled sensitivity was 0.77 (CI 0.67-0.85), for the Jobe test, while the lowest pooled sensitivity was 0.38 (CI 0.01-0.98), for the drop arm sign. CONCLUSIONS The Jobe test had the best pooled sensitivity, while the drop arm sign had the best pooled specificity. As no single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option. More reliable clinical diagnosis of posterosuperior rotator cuff tears could reduce the reliance on magnetic resonance imaging or arthrography and their associated costs and waiting times. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland. .,Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland.
| | - Timon Meynard
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA.,Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA
| | - Mohamed Ibrahim
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Fayoum, Fayoum, Egypt
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland
| | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
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Meder A, Stefanescu MC, Ateschrang A, Froehlich S, Obertacke U, Schulz AP, Meyerhoff HS, Oswald EJ, Sterz J, Ruesseler M. Evidence-Based Examination Techniques for the Shoulder Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 159:332-335. [PMID: 34111895 DOI: 10.1055/a-1440-2242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Digitalisation now almost covers all areas of medical student teaching. Teaching videos are a good way to help students learn practical skills. The existing evidence is a recognised aid for the classification of the respective technology. METHOD This video presents the usual examination techniques of the shoulder joint on a patient with an unstable shoulder. The respective techniques, if available, were backed up with appropriate evidence. CONCLUSION The examination techniques presented allow students to view them in a standardized manner on a patient. The evidence for the examination techniques can help with the classification of the respective technique.
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Affiliation(s)
- Adrian Meder
- Trauma and Reconstructive Surgery, Professional Association Trauma Clinic Tübingen, Germany
| | - Maria-Christina Stefanescu
- Trauma, Hand and Reconstructive Surgery Clinic, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Atesch Ateschrang
- Orthopaedic and Trauma Surgery, Community Clinics Koblenz Mayen, Koblenz, Germany
| | - Susanne Froehlich
- Orthopaedic Clinic and Polyclinic, University Clinics Rostock, Rostock, Germany
| | - Udo Obertacke
- Orthopaedic and Trauma Surgery Centre, University Clinics Mannheim, Germany
| | - Arndt Peter Schulz
- Clinic for Surgery of the Musculoskeletal and Locomotor System of Lübeck University, Lübeck, Germany.,Trauma Surgery and Orthopaedics, Professional Association Trauma Hospital Hamburg, Germany
| | | | - Eva J Oswald
- Media Competence Centre, Eberhard Karl University of Tübingen, Tübingen, Germany
| | - Jasmina Sterz
- Trauma, Hand and Reconstructive Surgery Clinic, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Miriam Ruesseler
- Trauma, Hand and Reconstructive Surgery Clinic, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Short- and Long-Term Effects of a Scapular-Focused Exercise Protocol for Patients with Shoulder Dysfunctions-A Prospective Cohort. SENSORS 2021; 21:s21082888. [PMID: 33924207 PMCID: PMC8074594 DOI: 10.3390/s21082888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/22/2022]
Abstract
Current clinical practice lacks consistent evidence in the management of scapular dyskinesis. This study aims to determine the short- and long-term effects of a scapular-focused exercise protocol facilitated by real-time electromyographic biofeedback (EMGBF) on pain and function, in individuals with rotator cuff related pain syndrome (RCS) and anterior shoulder instability (ASI). One-hundred and eighty-three patients were divided into two groups (n = 117 RCS and n = 66 ASI) and guided through a structured exercise protocol, focusing on scapular dynamic control. Values of pain and function (shoulder pain and disability index (SPADI) questionnaire, complemented by the numeric pain rating scale (NPRS) and disabilities of the arm, shoulder, and hand (DASH) questionnaire) were assessed at the initial, 4-week, and 2-year follow-up and compared within and between. There were significant differences in pain and function improvement between the initial and 4-week assessments. There were no differences in the values of DASH 1st part and SPADI between the 4-week and 2-year follow-up. There were no differences between groups at the baseline and long-term, except for DASH 1st part and SPADI (p < 0.05). Only 29 patients (15.8%) had a recurrence episode at follow-up. These results provide valuable information on the positive results of the protocol in the short- and long-term.
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Dominguez-Romero JG, Jiménez-Rejano JJ, Ridao-Fernández C, Chamorro-Moriana G. Exercise-Based Muscle Development Programmes and Their Effectiveness in the Functional Recovery of Rotator Cuff Tendinopathy: A Systematic Review. Diagnostics (Basel) 2021; 11:529. [PMID: 33809604 PMCID: PMC8002167 DOI: 10.3390/diagnostics11030529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/10/2021] [Accepted: 03/13/2021] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Rotator cuff (RC) tendinopathy causes pain and functional limitation of the shoulder. Physical exercises are effective therapies but there is no consensus on which exercise programme is the most appropriate. Objective: To analyze and compare the effectiveness of different intervention modalities-based exclusively on physical exercise muscle-development programs to improve shoulder pain and function in RC tendinopathy. (2) Methods: Systematic review (PRISMA) through a search in PubMed, WOS, PEDro, Cinahl, Scopus and Dialnet. The PEDro Scale and the Cochrane Risk of Bias analyzed the methodological quality. A pre-established table collected data on: patients, interventions, outcome measures and results. A narrative synthesis of the results was conducted. (3) Results: eight articles were selected (Cochrane: low risk of bias; PEDro: good quality). All assessed programs were effective. Only one study found statistically and clinically significant differences in favour of eccentric training. The exercises used were: eccentric/concentric/conventional, open/closed kinetic chain, with/without co-activation of glenohumeral muscle, with/without pain, and in clinic/at home. (4) Conclusions: All exercise programs were effective in RC tendinopathy, improving pain and shoulder function. No solid results were obtained when the interventions were compared due to their heterogeneity. Patients perception assessment tools were the most widely used. Amount of load applied should be considered.
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Affiliation(s)
| | | | | | - Gema Chamorro-Moriana
- Research Group “Area of Physiotherapy” CTS-305, University of Seville, 41009 Seville, Spain; (J.G.D.-R.); (J.J.J.-R.); (C.R.-F.)
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Implications for the design of a Diagnostic Decision Support System (DDSS) to reduce time and cost to diagnosis in paediatric shoulder instability. BMC Med Inform Decis Mak 2021; 21:78. [PMID: 33639920 PMCID: PMC7912970 DOI: 10.1186/s12911-021-01446-5] [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] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background Currently the diagnosis of shoulder instability, particularly in children, is difficult and can take time. These diagnostic delays can lead to poorer outcome and long-term complications. A Diagnostic Decision Support System (DDSS) has the potential to reduce time to diagnosis and improve outcomes for patients. The aim of this study was to develop a concept map for a future DDSS in shoulder instability. Methods A modified nominal focus group technique, involving three clinical vignettes, was used to elicit physiotherapists decision-making processes. Results Twenty-five physiotherapists, (18F:7 M) from four separate clinical sites participated. The themes identified related to ‘Variability in diagnostic processes and lack of standardised practice’ and ‘Knowledge and attitudes towards novel technologies for facilitating assessment and clinical decision making’. Conclusion No common structured approach towards assessment and diagnosis was identified. Lack of knowledge, perceived usefulness, access and cost were identified as barriers to adoption of new technology. Based on the information elicited a conceptual design of a future DDSS has been proposed. Work to develop a systematic approach to assessment, classification and diagnosis is now proposed. Trial Registraty This was not a clinical trial and so no clinical trial registry is needed.
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Storari L, Barbari V, Brindisino F, Testa M, Filippo M. An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report. Arch Physiother 2021; 11:5. [PMID: 33583432 PMCID: PMC7883431 DOI: 10.1186/s40945-021-00099-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Shoulder pain (SP) may originate from both musculoskeletal and visceral conditions. Physiotherapists (PT) may encounter patients with life-threatening pathologies that mimic musculoskeletal pain such as Acute Myocardial Infarction (AMI). A trained PT should be able to distinguish between signs and symptoms of musculoskeletal or visceral origin aimed at performing proper medical referral. CASE PRESENTATION A 46-y-old male with acute SP lasting from a week was diagnosed with right painful musculoskeletal shoulder syndrome, in two successive examinations by the emergency department physicians. However, after having experienced a shift of the pain on the left side, the patient presented to a PT. The PT recognized the signs and symptoms of visceral pain and referred him to the general practitioner, which identified a cardiac disease. The final diagnosis was acute myocardial infarction. CONCLUSION This case report highlights the importance of a thorough patient screening examination, especially for patients treated in an outpatient setting, which allow distinguishing between signs and symptoms of musculoskeletal from visceral diseases.
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Affiliation(s)
- Lorenzo Storari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Valerio Barbari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Maselli Filippo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy.
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Hansen LM, Garg A, Khanna R, Thayer M, Saltzman MD, Marra G, Seitz AL. Clinical Y-view versus 3-dimensional assessments of intramuscular fat in patients with full-thickness rotator cuff tears. Clin Imaging 2021; 77:13-16. [PMID: 33621862 DOI: 10.1016/j.clinimag.2021.01.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/10/2020] [Accepted: 01/27/2021] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES Recent evidence suggests an inhomogeneous distribution of intramuscular rotator cuff fat infiltration (FI) in a small sample of individuals with rotator cuff tears, yet clinically just a few slices at the scapular Y-view are used to evaluate FI in patients with rotator cuff tears. The purpose of this study was to determine if assessment of FI using the scapular Y-view is representative of the entire muscle in patients with full-thickness rotator cuff tears, and whether this varies by tear size. MATERIALS AND METHODS Patients (N = 25) diagnosed with full-thickness rotator cuff tear and confirmed with magnetic resonance imaging (MRI) were included. Fat-water sequences were used to objectively quantify mean FI (%) in the entire 3D muscle and the mean from 3 slices at the Y-view. Mixed-model 2 × 2 ANOVAs were used to assess for differences between methods, and if results vary by tear-size. RESULTS There were no statistically significant differences between mean amount of FI of the entire 3D muscle and mean Y-view in the supraspinatus or infraspinatus muscles (p > 0.05). Additionally, this did not differ across tear size groups (p > 0.05). CONCLUSION Results of this study suggest FI assessed in the Y-view is not different (mean difference < 1.0%) from FI of the entire 3D muscle in patients with full-thickness rotator cuff tears. Therefore, the clinical utility of evaluating rotator cuff intramuscular fat infiltration with the Y-view is further supported in patients with full-thickness rotator cuff tears across tear sizes.
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Affiliation(s)
- Logan M Hansen
- Northwestern University, Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Ankur Garg
- Northwestern University, Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA; Northwestern Memorial Hospital, Department of Radiology, 676 N St Clair St, Chicago, IL 60611, USA.
| | - Rajan Khanna
- Loyola University Chicago, Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, USA.
| | - Michael Thayer
- Northwestern University, Feinberg School of Medicine, 645 N Michigan Ave, Suite 1100, Chicago, IL, 60611, USA.
| | - Matthew D Saltzman
- Northwestern University, Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA; Northwestern Memorial Hospital, Department of Orthopedic Surgery, 259 E Erie St, Chicago, IL 60611, USA.
| | - Guido Marra
- Northwestern University, Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA; Northwestern Memorial Hospital, Department of Orthopedic Surgery, 259 E Erie St, Chicago, IL 60611, USA.
| | - Amee L Seitz
- Northwestern University, Feinberg School of Medicine, 645 N Michigan Ave, Suite 1100, Chicago, IL, 60611, USA.
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Pinnamaneni S, Lamplot JD, Rodeo SA, Swensen-Buza S, Lawton CD, Dines JS, Young WK, Taylor SA. The Virtual Shoulder Physical Exam. HSS J 2021; 17:59-64. [PMID: 33967643 PMCID: PMC8077973 DOI: 10.1177/1556331620975033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 01/25/2023]
Affiliation(s)
| | - Joseph D. Lamplot
- Sports Medicine Division, Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Scott A. Rodeo
- Sports Medicine Institute, Hospital for Special Surgery, New York City, NY, USA
| | | | - Cort D. Lawton
- Sports Medicine Division, Ortho Illinois, Algonquin, IL, USA
| | - Joshua S. Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Warren K. Young
- Sports Medicine Institute, Hospital for Special Surgery, New York City, NY, USA
| | - Samuel A. Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York City, NY, USA
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Diagnostic ultrasound in patients with shoulder pain: An inter-examiner agreement and reliability study among Dutch physical therapists. Musculoskelet Sci Pract 2021; 51:102283. [PMID: 33348286 DOI: 10.1016/j.msksp.2020.102283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/07/2020] [Accepted: 10/27/2020] [Indexed: 01/16/2023]
Abstract
STUDY DESIGN A cross-sectional inter-examiner agreement and reliability study among physical therapists in primary care. BACKGROUND musculoskeletal ultrasound (MSU) is frequently used by physical therapists to improve specific diagnosis in patients with shoulder pain, especially for the diagnosis rotator cuff tendinopathy (RCT) including tears. OBJECTIVES To estimate the inter-examiner agreement and reliability in physical therapists using MSU for patients with shoulder pain. METHODS Physical therapists performed diagnostic MSU in 62 patients with shoulder pain. Both physical therapists were blinded to each other's results and patients were not informed about the test results. We calculated the overall inter-examiner agreement, specific positive and negative inter-examiner agreement, and inter-examiner reliability (Cohen's Kappa's). RESULTS Overall agreement for detecting RC ruptures ranged from 61.7% to 85.5% and from 43.9% to 91.4% for specific positive agreement. The specific negative agreement was lower with values ranging from 44.4% to 79.1% for RC ruptures. Overall agreement for other pathology than ruptures related to SAPS, ranged from 72.6% to 93.6% and from 77.3% to 96% for specific positive agreement. The specific negative agreement was lower with values ranging from 44.4% to 79.1% for RC ruptures and 52.5%-83.3% for other pathology than ruptures related to SAPS. Reliability values varied from substantial for any thickness ruptures to moderate for partial thickness ruptures and fair for full thickness tears. Moreover, reliability was fair for cuff tendinopathy. The reliability for AC arthritis and no pathology found was fair and moderate. There was substantial agreement for the calcifying tendinopathy. CONCLUSIONS Physical therapists using MSU agree on the diagnosis of cuff tendinopathy and on the presence of RCT in primary care, but agree less on the absence of pathology.
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Roldán-Jiménez C, Cuesta-Vargas AI, Martín JM. Discriminating the precision of inertial sensors between healthy and damaged shoulders during scaption movement: A cross-sectional study. Clin Biomech (Bristol, Avon) 2021; 82:105257. [PMID: 33406457 DOI: 10.1016/j.clinbiomech.2020.105257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Shoulder assessment in rehabilitation is focused on kinematic properties due to the variability of symptomatology and clinical expression of shoulder injuries. AIM To perform a receiver operating characteristic analysis of the kinematic variables involved in the functional mobility of the shoulder that allow the identification of discriminating variables between healthy and diseased shoulders during scaption motion. METHOD Analytical cross-sectional study of diagnostic effectiveness was performed in 27 subjects suffering from shoulder damage and 14 asymptomatic controls. Scaption kinematics were evaluated using four inertial sensors placed on the humerus, scapula, forearm and sternum. Three variables (mobility, velocity and acceleration) were obtained from each sensor and the norm of the resultant vector was calculated from each axis. A discriminatory receiver operating characteristic analysis was performed, obtaining the area under the curve, sensitivity and specificity. FINDINGS Significant differences from both the resultant vectors and the axis depended on the body segment analysed were observed. Greater movement velocity and acceleration were observed in the asymptomatic group. Receiver operating characteristic analysis, scapular protraction-retraction mobility distinguished with a diagnostic sensitivity of 83.3% and specificity of 90.9% between asymptomatic and shoulder-damaged patients. These diagnosis values were 83.3% and 72.7% for scapular anterior-posterior velocity. Scapular kinematics, in terms of mobility and velocity, are the key variables in shoulder assessment. INTERPRETATION This study discriminated between patients suffering from shoulder damage and asymptomatic subjects based on shoulder kinematics during scaption motion. Scapular mobility and velocity were found to be key variables in shoulder assessment, along with the humerus.
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Affiliation(s)
- Cristina Roldán-Jiménez
- Department of Physiotherapy, University of Málaga, 29071 Málaga, Spain; Biomedical Research Institute of Málaga (IBIMA), (F-14), Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Málaga, 29071 Málaga, Spain; Biomedical Research Institute of Málaga (IBIMA), (F-14), Spain; School of Clinical Science, Faculty of Health Science, Queensland University Technology, Australia.
| | - Jaime Martín Martín
- Biomedical Research Institute of Málaga (IBIMA), (F-14), Spain; University of Medicine, Department of Human Anatomy, Legal Medicine and History of Science; Area of Legal Medicine, Spain
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CORRELATION BETWEEN THE KERLAN-JOBE ORTHOPEDIC CLINIC SCREEN AND SUBACROMIAL IMPINGEMENT TEST-ITEM CLUSTER IN COLLEGIATE BASEBALL PITCHERS: A PILOT STUDY. Int J Sports Phys Ther 2020; 15:1080-1089. [PMID: 33344025 DOI: 10.26603/ijspt20201080] [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: 11/18/2022] Open
Abstract
Background Shoulder injuries in baseball related to throwing account for 60% of all baseball injuries and 75% of those throwing injuries occur in pitchers. Impingement is the beginning of a continuum of rotator cuff pathology that can result in pain and disability in pitchers. Identification of self-reported measures and clinical tests that can indicate early pathology of shoulder impingement is needed for overhead athletes. Early identification of shoulder impingement is important to the long-term health and function of these athletes. Hypothesis/Purpose The purpose of this study was to determine if a correlation exists between self-reported pain and disability using the Kerlan-Jobe Orthopedic Clinic (KJOC) score and the Park Test-Item Cluster (TIC) for subacromial impingement in college baseball pitchers. The research hypotheses are that there will be a correlation 1) between the KJOC score and the TIC by Park and 2) between the KJOC and the Hawkins-Kennedy impingement, the painful arc, and the infraspinatus muscle strength tests individually. Design Cross-sectional pilot study. Methods Twenty-one collegiate baseball pitchers completed the KJOC and then were tested using the Park test-item cluster. Data Analysis Kruskal-Wallis was used to test the relationship of individual demographics with KJOC scores. Spearman rho correlation was used to determine if the number of positive clinical tests in the Park TIC or with the individual tests within the TIC correlated with scores on the KJOC. Results No significant relationships between KJOC scores and demographics were found. A significant moderate-to-good relationship was found between the painful arc test and the KJOC (r = -.601, p = 0.00) and a significant fair correlation was found between the number of positive tests within the Park TIC and KJOC (r = -.426, p = 0.05). No significant relationships were found between the Hawkins-Kennedy and KJOC (r = -.348, p = 0.12) or between the infraspinatus strength test and KJOC (r = -.040, p = 0.86). Conclusion The correlations between the painful arc test and the number of positive impingement tests with the composite score on the KJOC suggests a relationship between these two outcome measures, shoulder irritability, and decreased function in collegiate baseball pitchers. Of the three tests included in the Park TIC, the painful arc test was the only one with an independent significant correlation to the KJOC. The combination of impairment-specific cluster testing and an activity-focused self-assessment tool could be utilized to identify potential pathology and alert the medical professional that assessment and intervention are necessary. Level of Evidence Level 2 (Diagnosis).
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Baeske R, Hall T, Silva MF. The inclusion of mobilisation with movement to a standard exercise programme for patients with rotator cuff related pain: a randomised, placebo-controlled protocol trial. BMC Musculoskelet Disord 2020; 21:744. [PMID: 33183274 PMCID: PMC7663889 DOI: 10.1186/s12891-020-03765-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/03/2020] [Indexed: 11/15/2022] Open
Abstract
Background Rotator cuff related pain (RCRP) is one of the most common sources of musculoskeletal shoulder pain affecting the general population. Conservative treatment, in the form of exercise, is considered the first line approach, nonetheless, improvements seem to be modest. One therapeutic modality that might be an adjunct to the treatment of this condition is mobilisation with movement (MWM). MWM is a pain-free manual procedure that targets restricted and painful movements, commonly seen in patients with RCRP. The purpose of clinical trial is to determine whether MWM with exercise has benefits over sham MWM with exercise in RCRP. Methods A randomised, sham-controlled trial of 70 adults complaining of RCRP will compare the effects of MWM combined with exercise over sham MWM with exercise. Participants will be allocated to one of two groups: exercise and MWM (EG) or exercise and sham MWM (CG). Two weekly individual treatment sessions will be conducted over five weeks. All assessments will be performed by a blinded assessor. Primary outcome measures will be the shoulder pain and disability index (SPADI) and the numeric pain rating scale (NPRS), assessed at baseline, discharge and one-month follow-up. Secondary outcome measures will be active range of motion, self-efficacy and the global rating of change scale. The analyses will be conducted considering a statistically significant p-value ≤0.05. Normality will be assessed with the Kolmogorov-Smirnov test and homogeneity with the Levene’s test. For the primary outcome measures (SPADI and NPRS) and self-efficacy, a 2 × 3 ANOVA with treatment group (EG versus CG) and time (baseline, end of the treatment and follow-up) factors will be performed. Separate 2 × 2 ANOVA will be used for range of motion (baseline and end of the treatment). Global rating scale of change analysis will be conducted using descriptive statistics. Intention-to-treat analysis will be adopted. Discussion As there is a paucity of longitudinal studies investigating the use of MWM in patients with RCRP, this study will help to better understand its role together with a structured exercise programme. Trial registration Clinical Trials Registry number NCT04175184. November, 2019.
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Affiliation(s)
- Rafael Baeske
- Science of Rehabilitation programme at Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, CEP 90050-170, Brazil. .,, São Leopoldo, Brazil.
| | - Toby Hall
- School of Physiotherapy & Exercise Science, Curtin University, Kent Street, Bentley, Western Australia, 6102
| | - Marcelo Faria Silva
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, Rio Grande do Sul, CEP 90050-170, Brazil
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Abraham PF, Nazal MR, Varady NH, Gillinov SM, Quinlan NJ, Alpaugh K, Martin SD. The new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears. J Shoulder Elbow Surg 2020; 29:2213-2220. [PMID: 32650076 DOI: 10.1016/j.jse.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/13/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Traditional shoulder physical examination (PE) tests have suboptimal sensitivity for detection of supraspinatus full-thickness tears (FTTs). Therefore, clinicians may continue to suspect FTTs in some patients with negative rotator cuff PE tests and turn to magnetic resonance imaging (MRI) for definitive diagnosis. Consequently, there is a need for a secondary screening test that can accurately rule out FTTs in these patients to better inform clinicians which patients should undergo MRI. The purpose of this study was to assess the ability of 2 new dynamic PE tests to detect supraspinatus pathology in patients for whom traditional static PE tests failed to detect pathology. METHODS We prospectively enrolled 171 patients with suspected rotator cuff pathology with negative findings on traditional rotator cuff PE, who underwent 2 new dynamic PE tests: first, measurement of angle at which the patient first reports pain on unopposed active abduction and, second, the dynamic isotonic manipulation examination (DIME). Patients then underwent shoulder magnetic resonance arthrogram. Data from the new PE maneuvers were compared with outcomes collected from magnetic resonance arthrogram reports. RESULTS Pain during DIME testing had a sensitivity of 96.3% and 92.6% and a negative predictive value of 96.2% and 94.9% in the coronal and scapular planes, respectively. DIME strength ≤86.0 N had a sensitivity of 100% and 96.3% and a negative predictive value of 100% and 95.7% in the coronal and scapular planes, respectively. Pain at ≤90° on unopposed active abduction in the coronal plane had a specificity of 100% and a positive predictive value of 100% for supraspinatus pathology of any kind (ie, tendinopathy, "fraying," or tearing). CONCLUSION DIME is highly sensitive for supraspinatus FTTs in patients with negative traditional rotator cuff PE tests for whom there is still high clinical suspicion of FTTs. Thus, this test is an excellent secondary screening tool for supraspinatus FTTs in patients for whom clinicians suspect rotator cuff pathology despite negative traditional static PE tests. Given its high sensitivity, a negative DIME test rules out supraspinatus FTT well in these patients, and can therefore better inform clinicians which patients should undergo MRI. In addition, the angle at which patients first report pain on unopposed active shoulder abduction is highly specific for supraspinatus pathology.
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Affiliation(s)
- Paul F Abraham
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA.
| | - Mark R Nazal
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen M Gillinov
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
| | - Noah J Quinlan
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kyle Alpaugh
- Department of Orthopaedic Surgery, University of Massachusetts, Worcester, MA, USA
| | - Scott D Martin
- Department of Orthopaedic Surgery, Sports Medicine Center, Massachusetts General Hospital, Boston, MA, USA
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Lamplot JD, Pinnamaneni S, Swensen-Buza S, Lawton CD, Dines JS, Nawabi DH, Young W, Rodeo SA, Taylor SA. The Virtual Shoulder and Knee Physical Examination. Orthop J Sports Med 2020; 8:2325967120962869. [PMID: 33614791 PMCID: PMC7871077 DOI: 10.1177/2325967120962869] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/03/2020] [Indexed: 01/25/2023] Open
Abstract
The COVID-19 crisis has forced a sudden and dramatic shift in the way that clinicians interact with their patients, from outpatient encounters to telehealth visits utilizing a variety of internet-based videoconferencing applications. Although many aspects of pre–COVID-19 outpatient sports medicine care will ultimately resume, it is likely that telehealth will persist because of its practicality and because of patient demand for access to efficient and convenient health care. Physical examination is widely considered a critical obstacle to a thorough evaluation of sports medicine patients during telehealth visits. However, a closer reflection suggests that a majority of the examination maneuvers are possible virtually with limited, if any, modifications. Thus, we provide a comprehensive shoulder and knee physical examination for sports medicine telehealth visits, including (1) verbal instructions in layman’s terms that can be provided to the patient before or read verbatim during the visit, (2) multimedia options (narrated videos and annotated presentations) of the shoulder and knee examination that can be provided to patients via screen-share options, and (3) a corresponding checklist to aid in documentation.
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Affiliation(s)
- Joseph D Lamplot
- Department of Orthopaedics, Emory University, Atlanta, Georgia, USA
| | | | | | | | - Joshua S Dines
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Warren Young
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Samuel A Taylor
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Brindisino F, Giovannico G, Maselli F. Conservative management in a patient with massive rotator cuff tear and rheumatoid arthritis. J Back Musculoskelet Rehabil 2020; 33:329-337. [PMID: 31356189 DOI: 10.3233/bmr-171069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shoulder pain is one of the most common problems affecting people older than 60 years. Among the shoulder pathologies, the disorders of the periarticular soft tissue (e.g. rotator cuff) are considered to be the most common; moreover, these disorders are found in approximately 75% of patients with seropositive rheumatoid arthritis. The incidence of structural rotator cuff tendon pathology, including full-thickness rotator cuff tendon tears, increases with age. Recent researchers suggested that non-operative treatment of full-thickness rotator cuff tears could be successful in some patients; furthermore, in rheumatoid arthritis patients, there was a greater possibility of developing surgical complications compared with non-rheumatoid arthritis patients. MATERIALS AND METHODS A case report of a woman, 72 years old, with rheumatoid arthritis, shoulder pain and pseudo-paralytic arm presented with a massive tear of Supraspinatus and Infraspinatus tendon. In accordance with evidence, the case was managed using pain education and exercise therapy for 2.5 months. The shoulder pain, the function and the range of motion improved following a physiotherapy program. CONCLUSION Pain education in combination with exercise therapy was effective for improving pain and function in a full-thickness tear of Supraspinatus and Infraspinatus tendon in a patient also suffering from rheumatoid arthritis.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Physiotherapy and Manual Therapy, Physiotherapy Department, Lecce, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.,Physiotherapy and Manual Therapy, Physiotherapy Department, Lecce, Italy
| | - Filippo Maselli
- Dinogmi Department, Genova University, Genova, Italy.,Sovrintendenza Sanitaria Regionale Puglia INAIL Bari, Italy
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