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Abstract
In 1972, American orthopaedic surgeon Charles Neer published his seminal paper, "Anterior Acromioplasty for the Chronic Impingement Syndrome in the Shoulder: A Preliminary Report." It wasn't a robust scientific paper; however, it changed the direction of orthopaedic practice for the next half century. Neer argued that a primary cause of shoulder pain was attrition of the supraspinatus tendon and related structures from the overlying acromion, especially when the arm was elevated. Neer recommended surgical removal to stop the impingement, and over the last half century, it could be argued that millions of people around the globe would have undergone acromioplasty surgery to stop this portion of the bone impinging onto the soft tissues located in the subacromial space. More recently, against the tide of subacromial decompression surgery there has been dissent, and the relationship between the acromion and symptoms has been challenged. J Orthop Sports Phys Ther 2018;48(3):127-129. doi:10.2519/jospt.2018.0102.
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Comparison of acromiohumeral distance in symptomatic and asymptomatic patient shoulders and those of healthy controls. Clin Biomech (Bristol, Avon) 2018; 53:101-106. [PMID: 29494815 DOI: 10.1016/j.clinbiomech.2018.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/08/2018] [Accepted: 02/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The reduction of the subacromial space has traditionally been linked to rotator cuff pathology. The contribution of this narrowing, both in the development and maintenance of rotator cuff tendinopathy, is still under debate. The objective of the present study was compare the acromiohumeral distance at 0 and 60 degrees of active shoulder abduction in scapular plane, static position, in both symptomatic and contralateral shoulders, between participants with unilateral rotator cuff related shoulder pain, and in asymptomatic participants. METHOD This was a cross-sectional observational study. Seventy-six participants with chronic shoulder pain were assessed. Forty participants without shoulder pain were also recruited to compare the acromiohumeral distance with symptomatic participants. The acromiohumeral distance was measured at 0 and 60 degrees of active shoulder abduction in all the groups by ultrasound imaging. Mean differences between symptomatic versus contralateral shoulders, and versus healthy controls, were calculated. FINDINGS There were no statistical significant differences (p > .05) in the acromiohumeral distance at 0 degrees of shoulder elevation between the groups. However, significant differences were found at 60° between symptomatic and contralateral shoulder groups (0,51 mm; 95% CI: -0.90 to -0.12). INTERPRETATIONS Differences in shoulder pain perception at 0° are not attributable to acromiohumeral distance differences. However, treatments focused on increasing AHD at 60° could be prescribed, as a significantly reduced AHD was found in symptomatic shoulders when compared with contralateral shoulders. Further research is needed to determine, not only static differences in AHD, but also dynamic differences.
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Navarro-Ledesma S, Struyf F, Labajos-Manzanares MT, Fernandez-Sanchez M, Luque-Suarez A. Is coracohumeral distance associated with pain-function, and shoulder range of movement, in chronic anterior shoulder pain? BMC Musculoskelet Disord 2017; 18:136. [PMID: 28376749 PMCID: PMC5379620 DOI: 10.1186/s12891-017-1498-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was twofold: (i) to assess the intrarater reliability of coracohumeral distance; (ii) to investigate the level of association between coracohumeral distance measured by ultrasonography, and pain-disability and shoulder range of movement, in patients suffering from chronic anterior shoulder pain. METHODS An observational, cross sectional study was carried out. A convenience sample comprised of 87 patients with chronic anterior shoulder pain was assessed from 3 primary care centres. Main outcomes as pain and function were measured through the shoulder pain and disability index. Furthermore, shoulder range of movement-free of pain in shoulder elevation, as well as coracohumeral distance at both 0 and 60 degrees, were collected. RESULTS Absence of any correlation was found between coracohumeral distance and shoulder pain and disability index at both 0 and 60 degrees of shoulder elevation. Furthermore, absence of any correlation was found between coracohumeral distance measurements and active shoulder range of movement -free of pain. CONCLUSIONS There was poor association between coracohumeral distance and shoulder pain and function, as well as with shoulder range of movement, in patients with chronic anterior shoulder pain. Hence, clinicians should consider, not only increasing this space, but also other possibilities in their therapies, when patients with anterior shoulder pain are treated. TRIAL REGISTRATION ACTRN12614000144617 . Registered: 1st March 2014.
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Affiliation(s)
- S Navarro-Ledesma
- Department of Physiotherapy, University of Malaga, Malaga, Spain.,Departament of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | - F Struyf
- Departament of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerpen, Belgium
| | | | - M Fernandez-Sanchez
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
| | - A Luque-Suarez
- Department of Physiotherapy, University of Malaga, Malaga, Spain.
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Lewis J, Sim J, Barlas P. Acupuncture and electro-acupuncture for people diagnosed with subacromial pain syndrome: A multicentre randomized trial. Eur J Pain 2017; 21:1007-1019. [DOI: 10.1002/ejp.1001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/10/2022]
Affiliation(s)
- J. Lewis
- Department of Clinical Therapies; University of Limerick; Ireland
- School of Health and Social Work; University of Hertfordshire; Hatfield United Kingdom
- Central London Community Healthcare NHS Trust; London United Kingdom
| | - J. Sim
- Institute for Primary Care and Health Sciences; Keele University; Staffordshire United Kingdom
| | - P. Barlas
- School of Health and Rehabilitation; Keele University; Staffordshire United Kingdom
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Haik MN, Alburquerque-Sendín F, Moreira RFC, Pires ED, Camargo PR. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med 2016; 50:1124-34. [DOI: 10.1136/bjsports-2015-095771] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2016] [Indexed: 12/13/2022]
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Dal Maso F, Blache Y, Raison M, Arndt A, Begon M. Distance between rotator cuff footprints and the acromion, coracoacromial ligament, and coracoid process during dynamic arm elevations: Preliminary observations. ACTA ACUST UNITED AC 2016; 25:94-9. [PMID: 27039161 DOI: 10.1016/j.math.2016.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/28/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this study was to provide preliminary measures of the distance between the supraspinatus, infraspinatus, and subscapularis footprints and the acromion, coracoacromial ligament, and coracoid process, during dynamic arm elevations through the entire range-of-motion. METHODS Two healthy men performed maximum adduction, flexion, abduction, and extension with the arm internally, neutrally, and externally rotated. The distance between each rotator cuff footprint and the acromion, coracoacromial ligament, and coracoid process was measured from glenohumeral kinematics obtained from markers fitted to intracortical pins combined with the scapular and humeral 3D geometry obtained from CT-scan. RESULTS All footprints moved to be less than 10 mm to the acromion, coracoacromial ligament and coracoid process. They got closer to the acromion than to the other parts of the coracoacromial arch. The acromion-supraspinatus and acromion-infraspinatus distances were minimal during abduction and flexion. The acromion-subscapularis distance was minimal when the arm was in external and neutral rotation during both adduction and flexion. CONCLUSIONS The present study provides benchmark results of the distance between the rotator cuff footprints and the coracoacromial arch that may guide future clinical research. Pressure transducers should be positioned throughout the coracoacromial arch to provide comprehensive assessment of the compression undergone by the rotator cuff tendons. Common shoulder examination tests, that require flexion and internal rotation movements, may be refined since the supraspinatus footprint was the closest to the coracoacromial arch during abduction. Larger scale investigations may be needed to identify more accurate shoulder examination tests.
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Affiliation(s)
- Fabien Dal Maso
- Département de kinésiologie, Université de Montréal, 2100, boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; Centre de recherché du CHU Ste Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C4, Canada.
| | - Yoann Blache
- Département de kinésiologie, Université de Montréal, 2100, boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; Centre de recherché du CHU Ste Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C4, Canada
| | - Maxime Raison
- Centre de recherché du CHU Ste Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C4, Canada; Ecole Polytechnique de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada
| | - Anton Arndt
- Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden; The Swedish School of Sport and Health Sciences, Lidingövägen 1, 114 33 Stockholm, Sweden
| | - Mickaël Begon
- Département de kinésiologie, Université de Montréal, 2100, boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; Centre de recherché du CHU Ste Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C4, Canada
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Abstract
Synopsis The hallmark characteristics of rotator cuff (RC) tendinopathy are pain and weakness, experienced most commonly during shoulder external rotation and elevation. Assessment is complicated by nonspecific clinical tests and the poor correlation between structural failure and symptoms. As such, diagnosis is best reached by exclusion of other potential sources of symptoms. Symptomatic incidence and prevalence data currently cannot be determined with confidence, primarily as a consequence of a lack of diagnostic accuracy, as well as the uncertainty as to the location of symptoms. People with symptoms of RC tendinopathy should derive considerable comfort from research that consistently demonstrates improvement in symptoms with a well-structured and graduated exercise program. This improvement is equivalent to outcomes reported in surgical trials, with the additional generalized benefits of exercise, less sick leave, a faster return to work, and reduced costs to the health care system. This evidence covers the spectrum of conditions that include symptomatic RC tendinopathy and atraumatic partial- and full-thickness RC tears. The principles guiding exercise treatment for RC tendinopathy include relative rest, modification of painful activities, an exercise strategy that initially does not exacerbate pain, controlled reloading, and gradual progression from simple to complex shoulder movements. Evidence also exists for a specific exercise program being beneficial for people with massive inoperable tears of the RC. Education is an essential component of rehabilitation, and attention to lifestyle factors (smoking cessation, nutrition, stress, and sleep management) may enhance outcomes. Outcomes may also be enhanced by subgrouping RC tendinopathy presentations and directing treatment strategies according to the clinical presentation and the patient's response to shoulder symptom modification procedures outlined herein. There are substantial deficits in our knowledge regarding RC tendinopathy that need to be addressed to further improve clinical outcomes. J Orthop Sports Phys Ther 2015;45(11):923-937. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5941.
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