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Kim YT, Kim TY, Lee JB, Hwang JT. Glenohumeral versus subacromial steroid injections for impingement syndrome with mild stiffness: a randomized controlled trial. Clin Shoulder Elb 2023; 26:390-396. [PMID: 37798841 DOI: 10.5397/cise.2023.00346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The subacromial (SA) space is a commonly used injection site for treatment of impingement syndrome. For shoulder stiffness, glenohumeral (GH) injections are commonly performed. However, in cases of impingement syndrome with mild shoulder stiffness, the optimal site of steroid injection has yet to be identified. METHODS This prospective, randomized study compared the short-term outcomes of ultrasound-guided GH and SA steroid injections in patients who were diagnosed with impingement syndrome and mild stiffness. Each group comprised 24 patients who received either a GH or SA injection of 40 mg of triamcinolone. Range of motion and clinical scores were assessed before and 3, 7, and 13 weeks after the injection. RESULTS GH and SA injections significantly improved the range of motion and clinical scores after 13 weeks of follow-up. Notably, targeting the GH joint resulted in an earlier gain of forward elevation, external rotation, and internal rotation in 3 weeks (P<0.001, P=0.012, and P=0.002, respectively) and of internal rotation and a Constant-Murley score in 7 weeks (P<0.001 and P=0.046). Subsequent measurements were similar between the groups and showed a steady improvement in all ranges of motion and clinical scores. CONCLUSIONS GH injections may be more favorable than SA injections for treatment of impingement syndrome with mild stiffness, especially in improving the range of motion in the early period. However, the procedures showed similar outcomes after 3 months. Level of evidence: I.
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Affiliation(s)
- Yong-Tae Kim
- Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Tae-Yeong Kim
- Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jun-Beom Lee
- Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
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Exel J, Deimel D, Koller W, Werle C, Baca A, Maffiodo D, Sesana R, Colombo A, Kainz H. Neuromechanics of finger hangs with arm lock-offs: analyzing joint moments and muscle activations to improve practice guidelines for climbing. Front Sports Act Living 2023; 5:1251089. [PMID: 37927449 PMCID: PMC10623130 DOI: 10.3389/fspor.2023.1251089] [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: 07/31/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Climbing imposes substantial demands on the upper limbs and understanding the mechanical loads experienced by the joints during climbing movements is crucial for injury prevention and optimizing training protocols. This study aimed to quantify and compare upper limb joint loads and muscle activations during isometric finger hanging exercises with different arm lock-off positions. Methods Seventeen recreational climbers performed six finger dead hangs with arm lock-offs at 90° and 135° of elbow flexion, as well as arms fully extended. Upper limb joint moments were calculated using personalized models in OpenSim, based on three-dimensional motion capture data and forces measured on an instrumented hang board. Muscle activations of upper limb muscles were recorded with surface electromyography electrodes. Results Results revealed that the shoulder exhibited higher flexion moments during arm lock-offs at 90° compared to full extension (p = 0.006). The adduction moment was higher at 135° and 90° compared to full extension (p < 0.001), as well as the rotation moments (p < 0.001). The elbows exhibited increasing flexion moments with the increase in the arm lock-off angle (p < 0.001). Muscle activations varied across conditions for biceps brachii (p < 0.001), trapezius (p < 0.001), and latissimus dorsi, except for the finger flexors (p = 0.15). Discussion Our findings indicate that isometric finger dead hangs with arms fully extended are effective for training forearm force capacities while minimizing stress on the elbow and shoulder joints. These findings have important implications for injury prevention and optimizing training strategies in climbing.
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Affiliation(s)
- Juliana Exel
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - David Deimel
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Willi Koller
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Vienna Doctoral School of Pharmaceutical, Nutritional and Sport Sciences, University of Vienna, Vienna, Austria
| | - Cäcilia Werle
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Arnold Baca
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Daniela Maffiodo
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Raffaella Sesana
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Alessandro Colombo
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Hans Kainz
- Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
- Neuromechanics Research Group, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
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McFarland EG, Brand JC, Ring D. Clinical Faceoff: Is Preventative Surgery a Good Idea for Patients With Rotator Cuff Tendinopathy? Clin Orthop Relat Res 2023; 481:1486-1490. [PMID: 37404134 PMCID: PMC10344515 DOI: 10.1097/corr.0000000000002752] [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] [Received: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Edward G. McFarland
- Department of Orthopaedic Surgery, Division of Shoulder Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jefferson C. Brand
- Heartland Orthopedic Specialists, 111 17th Ave E, Ste. 101, Alexandria, MN, USA
| | - David Ring
- Associate Dean for Comprehensive Care, Dell Medical School, Department of Surgery and Perioperative Care, Austin, TX, USA
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Horowitz EH, Aibinder WR. Shoulder Impingement Syndrome. Phys Med Rehabil Clin N Am 2023; 34:311-334. [PMID: 37003655 DOI: 10.1016/j.pmr.2022.12.001] [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: 02/27/2023]
Abstract
Shoulder impingement is the most common diagnosis for shoulder pain. Shoulder impingement syndrome has been scrutinized as a misleading "umbrella" term, due to its vague and nonspecific context. It is better subcategorized into subacromial, internal, and subcoracoid impingement. The evaluation and treatment algorithm for each is grossly similar. A thorough history, focused physical examination, and standard radiographs are the first steps. Advanced imaging with MRI or ultrasound may be useful. The mainstay of treatment includes physical therapy, anti-inflammatory medications, and injections. Surgical treatment is reserved for refractory cases, and includes decompression, debridement, and/or repair of injured structures.
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Affiliation(s)
- Evan H Horowitz
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC 30, Brooklyn, NY 11203, USA. https://twitter.com/EvanHorowitzMD
| | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106, USA.
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Hadjisavvas S, Efstathiou MA, Malliou V, Giannaki CD, Stefanakis M. Risk factors for shoulder injuries in handball: systematic review. BMC Sports Sci Med Rehabil 2022; 14:204. [PMID: 36461053 PMCID: PMC9717475 DOI: 10.1186/s13102-022-00588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Handball is a sport with a high number of severe injuries. The shoulder is one of the most commonly injured joints, with an average prevalence of 17-41%. OBJECTIVE The primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies. METHODS Systematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. RESULTS 1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50-85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player's position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1). CONCLUSION Overall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies. PROTOCOL REGISTRATION PROSPERO ID: CRD42020138233.
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Affiliation(s)
- Stelios Hadjisavvas
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Michalis A. Efstathiou
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Vivian Malliou
- grid.12284.3d0000 0001 2170 8022Department of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Christoforos D. Giannaki
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Manos Stefanakis
- grid.413056.50000 0004 0383 4764Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Longo D, Branchi E, Matucci-Cerinic P, Bagni MA, Matucci-Cerinic M, Melchiorre D. Shoulder impingement syndrome in water polo players: muscle shortening manoeuvre controls pain intensity, recovers function and normalizes sonographic parameters. J Ultrasound 2022; 25:667-673. [PMID: 35060097 PMCID: PMC9402839 DOI: 10.1007/s40477-021-00645-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the effects of muscle shortening manoeuvre (MSM) by sonography (US) in professional water polo players with shoulder impingement syndrome (SIS). METHODS Twenty-four professional water polo players (mean age: 22.13 ± 3.34) with SIS were assigned to one of 2 different treatment interventions: Group (1) MSM: a series of fast accelerations in the upward direction was applied to the upper limb that's connected to a spring through a metal plate with a ring. The ring was linked to a pulley system that was submitted to forces acting in the opposite direction (added mass). Group (2) Simple traction: the series of fast accelerations were performed without the springs. Pain intensity, Yocum and Hawkins tests for SIS, Neer's impingement sign, range of motion, muscle strength and shoulder US were assessed. The examination was performed before, immediately after and 30 days after each treatment to study the US width of subacromial-subdeltoid bursa (SSB), thickness of supraspinatus (ST), long biceps tendons (LBT); hypoechoic halo of surrounding the long biceps (LBH) and subscapular tendons (STH); width of acromio-clavicular joint capsule (ACJ) and the distance between bone heads (ACD). Impingement sign (IS) was evaluated by dynamic examination. RESULTS Immediately after treatment with MSM, pain was much reduced (p = 0.002); Yocum and Hawkins tests were decreased (p = 0.008, p = 0.031); Neer's impingement sign was negative; range of motion and muscle strength were increased. US showed that the following parameters were significantly reduced: SSB (p = 0.001), LBT (p = 0.014), LBH (p = 0.014), SSH (p = 0.002), ACJ (p = 0.004), ACD (p = 0.001). IS was no more detected. After 30 days, the improvement of clinical and US findings was maintained. In the control group, after simple traction, no clinical amelioration of US parameters was found immediately after the procedure. CONCLUSION These data show that MSM could be significantly and rapidly effective against pain and the loss of function due to shoulder impingement in water polo players.
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Affiliation(s)
- Diego Longo
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Sezione di Scienze Fisiologiche, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Viale Morgagni 63, 50100, Florence, Italy.
| | - Enrico Branchi
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pietro Matucci-Cerinic
- Department of Surgery and Transplantation, Academic Hospital of Santa Maria della Misericordia Udine, University of Udine, Udine, Italy
| | - Maria Angela Bagni
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
- Division of Rheumatology AOUC, Florence, Italy
| | - Daniela Melchiorre
- Department Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Division of Rheumatology AOUC, Florence, Italy
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The Effect of Acromioplasty or Bursectomy on the Results of Arthroscopic Repair of Full Thickness Rotator Cuff Tears: Does the Acromion Type Affect These Results? SISLI ETFAL HASTANESI TIP BULTENI 2022; 55:486-494. [PMID: 35317384 PMCID: PMC8907701 DOI: 10.14744/semb.2021.12354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022]
Abstract
Objectives: The aim of this study was to investigate the effect of subacromial decompression on the results of full thickness rotator cuff repair applied arthroscopically. Examination was also made of the effect of acromion type on the subacromial decompression procedure in patients applied with arthroscopic rotator cuff repair. Methods: The study included a total of 150 patients, comprising 102 (68%) females and 48 (32%) males with a full thickness rotator cuff tear repaired arthroscopically. The patients were separated into three groups of 50. Group A comprised those with acromioplasty and bursectomy applied additional to the repair. In Group B, only bursectomy was performed additional to the repair and in Group C, only rotator cuff repair was applied. Evaluation was made of the post-operative long-term pain and functional results. Results: The mean age of the cases was 65.63±9.22 years (range, 46–86 years). The affected side was right side in 95 (63.3%) cases and left side in 55 (36.7%). No statistically significant difference was determined between the groups according to the post-operative Constant Murley and ASES scores (p>0.05). In the paired comparisons, the post-operative VAS scores of Group C were higher than those of Groups A and B (p=0.018, p=0.029, p<0.05). No statistically significant difference was determined between Group A and Group B in respect of the post-operative VAS scores (p>0.05). Conclusion: In the arthroscopic repair of full thickness rotator cuff tears, neither acromioplasty, coracoacromial ligament loosening nor bursectomy were determined to have any positive effect on the results. Whatever the acromion type, there is no need for an additional subacromial decompression procedure after rotator cuff repair, in respect of pain and functional outcomes. Only acromial spurs should be gently removed paying attention to the coraco-acromial ligament.
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Bodin J, Garlantézec R, Descatha A, Evanoff B, Thomas T, Roquelaure Y. Risk factors for shoulder disorders among French workers: prospective cohort study. Int Arch Occup Environ Health 2022; 95:1511-1519. [PMID: 35294628 PMCID: PMC9424162 DOI: 10.1007/s00420-022-01853-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
Objectives Shoulder disorders are common in the working population. This longitudinal study aimed to explore the relationships between personal factors and occupational organisational, psychosocial, and biomechanical factors and the incidence of shoulder disorders. Methods A total of 3710 workers in the Pays de la Loire region (Loire Valley area, France) were randomly included by their occupational physician in the Cosali cohort between 2002 and 2005. All workers completed a self-administered questionnaire about personal factors and work exposure, and using a standardised physical examination, occupational physicians diagnosed shoulder disorders. Between 2007 and 2010, 1611 workers were re-examined by their occupational physician. The 1,320 workers free of shoulder disorders at baseline were studied. A conceptual model was developed in which relationships between organisational, psychosocial, biomechanical, and personal factors at baseline and the incidence of shoulder disorders were assumed. Structural equation modelling was used to test the model. Results Shoulder disorders were directly associated with biomechanical factors and age but not with psychosocial factors. However, skill discretion and psychological demand influenced shoulder disorders indirectly through biomechanical factors. Exposure to a work pace dependent on an automatic rate and to a work pace dependent on customers’ demands were associated with biomechanical and psychosocial factors, but not directly to shoulder disorders. Conclusions This study identified the complex direct and indirect relationships between occupational factors and shoulder disorders. Our data confirmed our conceptual causation model: organisational and psychosocial factors were associated with biomechanical factors, while biomechanical factors were associated with the incidence of shoulder disorders. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-022-01853-9.
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Affiliation(s)
- Julie Bodin
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, SFR ICAT, F-49000, Angers, France.
| | - Ronan Garlantézec
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Alexis Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, SFR ICAT, F-49000, Angers, France.,Inserm, UMS 011, Unité Cohortes Epidémiologiques en Population, Villejuif, France
| | - Bradley Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, St. Louis, MO, 13 63310, USA
| | - Thierry Thomas
- Department of Rheumatology, CHU Saint-Etienne, Saint-Etienne, France.,INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - Yves Roquelaure
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, SFR ICAT, F-49000, Angers, France
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Ishigaki T, Yoshino K, Hirokawa M, Sugawara M, Yamanaka M. Supraspinatus tendon thickness and subacromial impingement characteristics in younger and older adults. BMC Musculoskelet Disord 2022; 23:234. [PMID: 35277147 PMCID: PMC8915467 DOI: 10.1186/s12891-022-05179-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Subacromial impingement (SAI) may be a cause of age-related rotator cuff abnormalities; therefore, the purpose of this study was to compare SAI characteristics between younger and older adults. In addition to the fact that thickened supraspinatus tendon (SST) indicates tendon abnormalities, SAI characteristics have been recognized as follows: greater SST thickness, reduced acromiohumeral distance (AHD), greater reduction of AHD (∆AHD) with arm elevation, and a higher percentage of SST within AHD (i.e., occupation ratio: OcAHD). Furthermore, we investigated the relationships between SST thickness and AHD, as well as SST thickness and ∆AHD to clarify the effect of SAI on rotator cuff abnormalities.
Methods
Healthy younger (n = 18, 21–24-year-old) and older (n = 27, 45–80-year-old) adults without any shoulder symptoms participated in this study. We measured their SST thickness and AHD at rest and at arm elevation (30° and 60°) in the scapular plane using ultrasound, and calculated ∆AHD as the relative change expressed as a percentage of the baseline. OcAHD was expressed as the ratio of SST thickness at rest to AHD at rest and in elevated positions.
Results
The older subjects had approximately one mm thicker SST (P = 0.003, 95% Confidence interval [CI] = 0.410 to 1.895) and approximately 1.0 to 1.3 mm greater AHD than the younger subjects (P = 0.011, 95%CI = 0.284 to 2.068 at rest; P = 0.037, 95%CI = 0.082 to 2.609 for 30° of arm elevation; P = 0.032, 95%CI = 0.120 to 2.458 for 60° of arm elevation). However, there were no differences in ΔAHD and OcAHD between the groups.
Conclusion
This study demonstrated that, compared with the younger subjects, the older subjects showed thicker supraspinatus tendon but no other SAI characteristics including decreases in AHD and increases in OcAHD. Thus, this study suggests that older subjects showed age-related SST abnormalities without SAI, although the magnitude of the differences in SST thickness is notably small and the clinical significance of this difference is unclear.
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Ge M, Zhang Y, Li Y, Feng C, Tian J, Huang Y, Zhao T. Publication Trends and Hot Spots in Subacromial Impingement Syndrome Research: A Bibliometric Analysis of the Web of Science Core Collection. J Pain Res 2022; 15:837-856. [PMID: 35370418 PMCID: PMC8974249 DOI: 10.2147/jpr.s348528] [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] [Received: 11/09/2021] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background In recent years, the research on subacromial impingement syndrome (SIS) has gradually increased. Although the research directions are diverse, the overall research status and trend are not clear. Objective The aim of our study was to use bibliometric analysis to identify the trends in SIS-related research and to analyze the most highly cited scientific publications on SIS. Methods All data were retrieved from the Web of Science Core Collection database, and the year of publications, countries, journals, institutions and total number of citations were extracted and analyzed. The results related to countries, institutions and keywords were then analyzed using VOSviewer software and bibliometrics online analysis platform. And, we also identified the 100 most cited articles on SIS. Results A total of 548 articles related to AIS were identified. The frequency of publication on SIS has increased substantially over time. Among all countries, Turkey has contributed the most publications on SIS (n=118). The institution with the most articles was Istanbul University (n=17). Journal of Shoulder and Elbow Surgery topped the list of journals and has published 19 SIS-related publications. The hotspot of research changed from the former arthroscopic surgery to physical therapy and rehabilitation. Conclusion The scientific research on SIS has rapidly expanded in recent years. This study represents the first bibliometric analysis of SIS, gives us a systematic and comprehensive summary into the development of SIS.
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Affiliation(s)
- Meng Ge
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Yuan Zhang
- Bengbu Medical College, Bengbu, People's Republic of China
- Center for General Practice Medicine, Department of Rheumatology and Immunology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
| | - Yanlei Li
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Chenchen Feng
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Jinlong Tian
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Yazeng Huang
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
- Bengbu Medical College, Bengbu, People's Republic of China
| | - Tingxiao Zhao
- Center for Plastic & Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People's Republic of China
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Requejo-Salinas N, Lewis J, Michener LA, La Touche R, Fernández-Matías R, Tercero-Lucas J, Camargo PR, Bateman M, Struyf F, Roy JS, Jaggi A, Uhl T, Bisset L, Wassinger CA, Donatelli R, Haik MN, Lluch-Girbés E. International physical therapists consensus on clinical descriptors for diagnosing rotator cuff related shoulder pain: A Delphi study. Braz J Phys Ther 2022; 26:100395. [PMID: 35366589 DOI: 10.1016/j.bjpt.2022.100395] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 01/12/2022] [Accepted: 02/08/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is a lack of standardized criteria for diagnosing rotator cuff related shoulder pain (RCRSP). OBJECTIVE To identify the most relevant clinical descriptors for diagnosing RCRSP. METHODS A Delphi study was conducted through use of an international physical therapists expert panel. A 3-round Delphi survey involving an international panel of physical therapists experts with extensive clinical, teaching, and research experience was conducted. A search query was performed in Web of Science, along with a manual search, to find the experts. The first round was composed of items obtained from a previous pilot Delphi study along with new items proposed by the experts. Participants were asked to rate items across six clinical domains using a five-point Likert scale. An Aiken's Validity Index ≥ 0.7 was considered indicative of group consensus. RESULTS Fifteen experts participated in the Delphi survey. After the three rounds, consensus was reached on 18 clinical descriptors: 10 items were included in the "subjective examination" domain, 1 item was included in the "patient-reported outcome measures" domain, 3 items in the "diagnostic examination" domain, 2 items in the "physical examination" domain", and 2 items in the "functional tests" domain. No items reached consensus within the "special tests" domain. The reproduction of symptoms in relation to the application of load, the performance of overhead activities, and the need of active and resisted movement assessment were some of the results with greatest consensus. CONCLUSION In this Delphi study, a total of 18 clinical descriptors across six clinical domains were agreed upon for diagnosing RCRSP.
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Affiliation(s)
- Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, United States
| | - Roy La Touche
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain; Neuroscience and Craniofacial Pain Institute (INDCRAN), Madrid, Spain
| | - Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain; Research Institute of Physical Therapy and Pain, University of Alcala, Alcala de Henares, Madrid, Spain.
| | | | - Paula Rezende Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Marcus Bateman
- Derby Shoulder Unit, Orthopaedic Outpatient Department, Royal Derby Hospital, Derby, United Kingdom
| | - Filip Struyf
- Department Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jean-Sébastien Roy
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada
| | - Anju Jaggi
- Royal National Orthopaedic Hospital NHS Trust, London Borough of Harrow, London, United Kingdom
| | - Timothy Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, United States
| | - Leanne Bisset
- School of Allied Health Sciences, Griffith University, South East Queensland, Australia
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee, United States
| | | | - Melina Nevoeiro Haik
- Department of Physical Therapy, Center of Health and Sport Science, Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Enrique Lluch-Girbés
- Department of Physical Therapy, University of Valencia, Valencia, Spain; Pain in Motion Research Group, University of Valencia, Valencia, Spain
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12
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Thangarajah T, Lo IK. Optimal Management of Partial Thickness Rotator Cuff Tears: Clinical Considerations and Practical Management. Orthop Res Rev 2022; 14:59-70. [PMID: 35250316 PMCID: PMC8893150 DOI: 10.2147/orr.s348726] [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] [Received: 12/07/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
Partial thickness rotator cuff tears have been diagnosed with increased frequency due to heightened awareness and an improvement in diagnostic modalities. When >50% of the tendon thickness has ruptured, intra-tendinous strain of the residual tendon increases. Surgery is generally confined to patients who have failed non-operative measures and have persistent symptoms. The rationale for repairing partial thickness tears lies in their limited self-healing capacity, and propensity to enlarge over time and progress to a full thickness defect. Although tear debridement and acromioplasty can improve pain and function, tear progression can occur, in addition to worse results being noted in bursal-sided defects. Several surgical strategies have been recommended but there is a lack of evidence to advocate one form of treatment over another. The aim of this narrative review is to discuss the treatment options for partial thickness tears of the rotator cuff.
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Affiliation(s)
- Tanujan Thangarajah
- Department of Trauma and Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
- Correspondence: Tanujan Thangarajah, Department of Trauma and Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada, Email
| | - Ian K Lo
- Department of Trauma and Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
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13
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Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice. Dis Mon 2022; 68:101314. [PMID: 34996610 DOI: 10.1016/j.disamonth.2021.101314] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.
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14
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Croen BJ, Carballo CB, Wada S, Zhang X, Patel S, Deng XH, Rodeo SA. Chronic subacromial impingement leads to supraspinatus muscle functional and morphological changes: Evaluation in a murine model. J Orthop Res 2021; 39:2243-2251. [PMID: 33336819 DOI: 10.1002/jor.24964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 02/04/2023]
Abstract
Muscle atrophy and fatty infiltration have been directly correlated with higher rates of incomplete or failed healing following surgical repair of the rotator cuff. The purpose of this study was to evaluate clinically relevant functional and morphological changes in the supraspinatus muscle at various time points in this model of rotator cuff tendinopathy. Subacromial impingement was induced in 47, male C57BL/6 mice (total 94 limbs) by implantation of a metal clip in the subacromial space. Specimens were evaluated at 4, 6, and 12 weeks postoperatively. Gait analysis was used to measure various kinematic parameters. Supraspinatus muscle wet weight, histology, and quantitative reverse-transcription polymerase chain reaction analysis of genes related to muscle atrophy and adipogenesis were performed to characterize the structural, cellular, and molecular changes. Muscle atrophy and fatty infiltration was evident beginning at 6 weeks, with progression out to 12 weeks. Gait analysis identified significant functional changes in many aspects of gait and abnormal stance tracing as early as 4 weeks, verifying alterations in upper extremity function. We have demonstrated that clinically relevant changes to the supraspinatus muscle are seen starting 6 weeks after induction of subacromial impingement. Furthermore, the gait analysis provides key functional outcome measurements that may be useful for future evaluation of new therapeutic strategies.
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Affiliation(s)
- Brett J Croen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Camila B Carballo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Susumu Wada
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Xueying Zhang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Saral Patel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Xiang-Hua Deng
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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15
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Verdonk DL, Spigt M, Lima Passos V, Klemann-Harings SEJM, Ottenheijm RPG. Phenotyping the shoulder patient based on ultrasound-detected pathologies: a cross-sectional study in general practice. Fam Pract 2021; 38:313-320. [PMID: 33313809 DOI: 10.1093/fampra/cmaa129] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Shoulder complaints arise from a single pathology or a combination of different underlying pathologies that are hard to differentiate in general practice. Subgroups of pathologies have been identified on the basis of ultrasound imaging that might affect treatment outcomes. OBJECTIVE Our aim was to validate the existence of different subgroups of patients with shoulder complaints, based on ultrasound-detected pathology, and compare clinical features among them. Profiling shoulder patients into distinct shoulder pathology phenotypes could help designing tailored treatment trials. METHODS This was a cross-sectional study in general practice. Data were extracted from 840 first visit patient records at a single diagnostic centre in the Netherlands. Exclusion criteria were age <18 years and previous shoulder surgery. Latent class analysis was used to uncover cross-combinations of ultrasound detected pathologies, yielding subgroups of shoulder patients. The uncovered subgroups were compared for demographic and clinical characteristics. RESULTS We uncovered four distinct subgroups of patients with shoulder complaints: (i) Frozen shoulder group (11%), (ii) Limited pathology group (44%), (iii) Degenerative pathology group (31%) and (iv) Calcifying tendinopathy group (15%). Group comparisons showed significant differences in demographic and clinical characteristics among subgroups, consistent with the literature. CONCLUSION In a general practice population, we uncovered four different phenotypes of shoulder patients on the basis of ultrasound detected pathology. These phenotypes can be used designing tailored treatment trials in patients with shoulder complaints.
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Affiliation(s)
- Debra L Verdonk
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mark Spigt
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
| | - Valéria Lima Passos
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht,The Netherlands
| | | | - Ramon P G Ottenheijm
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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16
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Bolia IK, Collon K, Bogdanov J, Lan R, Petrigliano FA. Management Options for Shoulder Impingement Syndrome in Athletes: Insights and Future Directions. Open Access J Sports Med 2021; 12:43-53. [PMID: 33880071 PMCID: PMC8053512 DOI: 10.2147/oajsm.s281100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/13/2021] [Indexed: 01/02/2023] Open
Abstract
Athletes participating in overhead sports are at particularly high risk of shoulder impingement syndrome. Subcoracoid impingement is defined as impingement of the anterior soft tissues of the shoulder between the coracoid process and the lesser tuberosity. Subacromial impingement syndrome (SIS) occurs due to extrinsic compression of the rotator cuff between the humeral head and coracoacromial structures or intrinsic degeneration of the supraspinatus tendon and subsequent superior migration of the humerus. Internal impingement is a major cause of shoulder pain in overhead athletes, and it occurs due to repetitive impingement of the articular surface of the rotator cuff with the glenoid during maximum abduction and external rotation of the arm. When examining athletes with suspected impingement of the shoulder, it is important to discuss the sport-specific motion that regenerates the symptoms and perform a combination of physical examination tests to improve the diagnostic accuracy. Radiographic evaluation is recommended, and the extent of soft tissue abnormalities can be assessed on ultrasound or magnetic resonance imaging of the shoulder. Management of shoulder impingement syndrome can be conservative or operative, based on the severity and chronicity of symptoms and the associated structural abnormalities. This review provides an update on the management of SIS, subcoracoid impingement, and internal impingement in the athletic population.
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Affiliation(s)
- Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Kevin Collon
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Jacob Bogdanov
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Rae Lan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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17
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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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18
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Zeng YM, Xu C, Zhang K, Yu DG, Zhang J. Prediction of Rotator Cuff Injury Associated with Acromial Morphology: A Three-Dimensional Measurement Study. Orthop Surg 2020; 12:1394-1404. [PMID: 33200577 PMCID: PMC7670155 DOI: 10.1111/os.12774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the relationship between the acromial morphology and the related rotator cuff injury using a three‐dimensional (3D) measurement technology. Methods For the present study, 226 patients (113 men and 113 women) who underwent shoulder Coarthroscopy from June 2015 to December 2019 at the Department of Orthopedics at our hospital were selected retrospectively. A total of 113 shoulder joints of age‐matched healthy people were selected as the control group. A 3D model coordinate system of the shoulder was established based on CT scan images. Patients were grouped according to the condition of the rotator cuff injury during surgery. The patients whose rotator cuff tear site corresponded to the 3D osseous proliferative structure of the acromion were classified into the impingement injury group (II group). The other patients were classified into the non‐impingement injury group (NII group). The acromiohumeral interval (AHI), the acromial anterior protrusion (AAP), the acromial inferior protrusion (AIP), the acromioclavicular angle (AC angle), the distance from the most medial edge of the acromial anterolateral protrusion (AALP) to the most lateral point of acromion (MLPA) (a), the distance from the most posteromedial edge of the AALP to the MLPA (b), the anteroposterior diameters of the AALP (c), and the proportion of anteroposterior diameters of AALP to the anteroposterior diameters of acromion, (c/c + d) × 100(%), were measured using the 3D shoulder model. Results The results of the intraobserver (<5%) and interobserver variability (>87%) analysis found the parameters to have high intraobserver and interobserver concordance. There were no significant differences in age among the control group, the NII group, and the II group (P = 0.8416). There were significant differences in AAP among the three groups (P = 0.0374). The results were the same for men and women, respectively. The AAP in the control group and the NII group did not show a difference, while the AAP in the II group was increased by 26.9% (P = 0.015) and 25% (P = 0.023), respectively, compared with the NII group and the control group. AHI, AIP, and AC angles did not show significant differences among the three groups (P > 0.05). The (a) and (b) of the II group were significantly larger than those of the NII group; P‐values were 0.0119 and 0.0003, respectively. The (a) and (b) in patients with rotator cuff injuries were larger than in the normal population (P < 0.05). The above results were the same for men and women. This suggested that the larger width of the AALP might cause the related rotator cuff injury. The (c/c + d) in the II group was significantly larger than those in the control and the NII groups, with P‐values of 0.0005 and 0.0021, respectively. The risk of rotator cuff injury due to subacromial impingement was increased when the maximum width of the medial–lateral edge of the AALP exceeded 16.8 mm (17.4 mm in men, 15.1 mm in women), the maximum width of the posterior edge of the AALP exceeded 12.9 mm (13.8 mm in men,12.7 mm in women), or the anteroposterior diameters of the AALP exceeded the anteroposterior diameters of the acromion by 33.5%. Conclusion We could predict the occurrence and development of the related rotator cuff injury in symptomatic patients with specific 3D changes in their acromion and intervene in the acromion of such patients as early as possible to prevent possible rotator cuff injuries in the future.
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Affiliation(s)
- Yi-Ming Zeng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Xu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - De-Gang Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth's People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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19
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Eraghi AS. Acromioplasty in the surgical operations of partial-thickness rotator cuff tears: A comprehensive review. J Family Med Prim Care 2020; 9:520-525. [PMID: 32318375 PMCID: PMC7114056 DOI: 10.4103/jfmpc.jfmpc_870_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/31/2019] [Accepted: 01/08/2020] [Indexed: 01/12/2023] Open
Abstract
The partial-thickness rotator cuff tears (PTRCTs) are known as a prevalent pathology, which cause inability mostly in athletes. So far, a number of treatments have been suggested depending on patient characteristics and size and location of the tears. Surgical repair in rotator cuff tears that include 50% or more of the tendon thickness is the accepted practice in the following failure of nonoperative treatment. In the surgical procedure, acromioplasty is known as a long-established component and used to modify the detrimental acromion morphology, which accounts for rotator cuff tearing. A range of trials has been reported that compare the results of surgical procedure with and without acromioplasty in patients undergoing rotator cuff repairs. According to the findings of 15 studies including ~1,500 patients, with mean age 60 years (range 5-80 years) and mean follow-up of 22 months (range 13-26 months) found by searching on Cochrane Register of Controlled Trials databases, Excerpta Medica/Embase, and Medline/PubMed, we revealed that acromioplasty cannot present an impressive effect on patient outcome scores at intermediate and short-term follow-ups. In fact, despite the theoretic advantages of acromioplasty in the setting of PTRCTs, it has reported little or no efficacy on outcomes of postoperative patients.
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Affiliation(s)
- Amir Sobhani Eraghi
- Department of Orthopedics, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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20
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Rossi LA, Ranalletta M. Subacromial Decompression Is Not Beneficial for the Management of Rotator Cuff Disease. JBJS Rev 2020; 8:e0045. [DOI: 10.2106/jbjs.rvw.19.00045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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21
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Cereceda-Muriel C, Álvarez-Bueno C, Martínez-Vizcaíno V, Cavero-Redondo I. Effect of supervised physiotherapy versus home exercise program in patients with subacromial impingement syndrome: A systematic review and meta-analysis. Phys Ther Sport 2019; 41:34-42. [PMID: 31726386 DOI: 10.1016/j.ptsp.2019.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/14/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether supervised physiotherapy is more effective for functional improvement and pain relief than a home exercise program in subjects with subacromial impingement syndrome. DESIGN Systematic review and meta-analysis of randomized clinical trials. METHODS An electronic search was performed in Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared supervised physiotherapy versus home exercise program, in the shoulder function, pain, and range of motion in subjects older than 18 years of age with a medical diagnosis of subacromial impingement syndrome treated conservatively. RESULTS Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, four studies were included. The standardized mean difference for shoulder function was -0.14 points (95% CI: -1.04 to 0.76; p = 0.760), mean difference 0.21 cm (95% CI: -1.36 to 1.78; p = 0.790) for pain, and mean difference 0.62° (95% CI: -7.15 to 8.38; p = 0.880) for range of motion of flexion. CONCLUSION Supervised physical therapy and home-based progressive shoulder strengthening and stretching exercises for the rotator cuff and scapular muscles are equally effective in patients with subacromial impingement syndrome treated conservatively. TRIAL REGISTRATION NUMBER CRD42018086348.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Faculty of Health, Universidad de Las Americas, Santiago, Chile; Physical Therapy Department, Clinical Hospital San Borja Arriaran, Santiago, Chile
| | - Felipe Araya-Quintanilla
- Faculty of Health, Universidad de Las Americas, Santiago, Chile; Faculty of Health Sciences, Universidad SEK, Santiago, Chile
| | | | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad Autonoma de Chile, Faculty oh Health Sciences, Talca, Chile
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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22
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Dhillon KS. Subacromial Impingement Syndrome of the Shoulder: A Musculoskeletal Disorder or a Medical Myth? Malays Orthop J 2019; 13:1-7. [PMID: 31890103 PMCID: PMC6915323 DOI: 10.5704/moj.1911.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Subacromial impingement syndrome (SAIS) is a commonly diagnosed disorder of the shoulder. Though this disorder has been known for a long time, it remains a poorly understood entity. Over the years several hypotheses have been put forward to describe the pathogenesis of SAIS but no clear explanation has been found. Two mechanisms, the extrinsic and intrinsic mechanism, have been described for the impingement syndrome. The intrinsic mechanism theories which deny the existence of impingement are gaining popularity in recent years. The various shoulder tests used to diagnose SAIS have low specificity with an average of about 50%. Meta-analysis shows that neither the Neer sign nor the Hawkins sign has diagnostic utility for impingement syndrome. Several randomised controlled trials have shown that the outcome of treatment of SAIS by surgery is no better than conservative treatment. Physiotherapy alone can provide good outcome which is comparable to that achieved with surgery without the costs and complications associated with surgery. Since decompression with surgery does not provide any additional benefits as compared to conservative treatment for patients with SAIS, the impingement theory has become antiquated and surgical treatment should have no role in the treatment of such patients. There are calls by some practitioners to abandon the term impingement syndrome and rename it as anterolateral shoulder pain syndrome. It appears that SAIS is a medical myth. There are others who called SAIS as a clinical illusion.
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Affiliation(s)
- K S Dhillon
- Department of Orthopaedics, KPJ Selangor Specialist Hospital, Shah Alam, Malaysia
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Matcuk GR, Moin P, Cen S. Shoulder measurements on MRI: Statistical analysis of patients without and with rotator cuff tears and predictive modeling. Clin Anat 2019; 33:173-186. [PMID: 31177567 DOI: 10.1002/ca.23422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 11/10/2022]
Abstract
This study aims to determine significant differences between various measurements of shoulder structures and relationships in patients with and without rotator cuff tears and identify a subset of these measurements that may merit further investigation. Shoulder MRIs of 120 patients with rotator cuff tears (RCT group) and 80 patients with normal examinations (No RCT group) were retrospectively identified. Numerous measurements of shoulder anatomy and relationships and pathology characterization were performed for each study. The mean and ranges of measurements for each group were identified, and P-values were calculated to assess differences between the two groups. Classification and Regression Tree (CART) identified prediction models for separating the two groups based on these shoulder MRI measurements. Statistically significant differences were observed for 9 of 18 of the shoulder measurements between the two groups (P < 0.05). Using long head of biceps tendon tear, tendinosis, and subacromial-subdeltoid bursal fluid, the prediction model from CART demonstrated 99.5% accuracy in separating the two groups. Subacromial distance, subacromial spur size, and acromioclavicular osteophyte could also separate the two groups with 97.5% accuracy. Other measures less commonly associated with impingement and rotator cuff tears could also be used to separate the two groups with up to 81.5% accuracy. This study introduces new measures and clarifies ranges for existing measurements on shoulder MRI. Abnormalities of some of these measurements may be associated with subacromial impingement, and combinations of these parameters may be useful for separating patients with or without rotator cuff tears. Clin. Anat. 33:173-186, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Paymann Moin
- Department of Radiology, Kaiser Permanente, Panorama City Medical Center, Panorama City, California
| | - Steven Cen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Veen EJD, Stevens M, Koorevaar CT, Diercks RL. Appropriate care for orthopedic patients: effect of implementation of the Clinical Practice Guideline for Diagnosis and Treatment of Subacromial Pain Syndrome in the Netherlands. Acta Orthop 2019; 90:191-195. [PMID: 30931669 PMCID: PMC6534224 DOI: 10.1080/17453674.2019.1593641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and purpose - The multidisciplinary Clinical Practice Guideline for diagnosis and treatment of subacromial pain syndrome (SAPS) was created in 2012 by the Dutch Orthopedic Association. In brief, it stated that SAPS should preferably be treated nonoperatively. We evaluated the effect of the implementation of the guideline on the number of shoulder surgeries for SAPS in the Netherlands (17 million inhabitants). Patients and methods - An observational study was conducted with the use of aggregated data from the national database of the Dutch Health Authority from 2012 to 2016. Information was collected on patients referred to and seen at orthopedic departments. Data from the following Diagnoses Related Groupings were analyzed: 1450 (tendinitis supraspinatus) and 1460 (rotator cuff tear). Results - In 2016 fewer patients were diagnosed with tendinitis supraspinatus than in 2012-a decrease from 49,491 to 44,662 (10%). Of the patients diagnosed with tendinitis, 14% were treated surgically in 2012; this number dropped to 9% by 2016. More patients with a rotator cuff tear were diagnosed in 2016 than in 2012, an increase from 17,793 to 23,389 (32%), fewer were treated surgically: 30% in 2012, compared with 25% in 2016. Interpretation - After introducing the multidisciplinary Clinical Practice Guideline "Diagnosis and treatment of subacromial pain syndrome," a decrease in shoulder surgeries for related diagnoses was observed in the Netherlands. The introduction and dissemination of this guideline seems to have contributed to the implementation of more appropriate health care and prevention of unnecessary surgeries.
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Affiliation(s)
- Egbert J D Veen
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen;; ,Correspondence:
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen;;
| | - Cornelis T Koorevaar
- Department of Orthopedic Surgery and Traumatology, Deventer Hospital, Deventer, the Netherlands
| | - Ron L Diercks
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen;;
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Takeno K, Glaviano NR, Norte GE, Ingersoll CD. Therapeutic Interventions for Scapular Kinematics and Disability in Patients With Subacromial Impingement: A Systematic Review. J Athl Train 2019; 54:283-295. [PMID: 30829536 DOI: 10.4085/1062-6050-309-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Impaired scapular kinematics are commonly reported in patients with subacromial impingement syndrome (SIS). Various therapeutic interventions designed to improve scapular kinematics and minimize pain and disability have been described in the literature. However, the short- and long-term benefits of these interventions are unclear. OBJECTIVE To determine the effects of specific short- and long-term therapeutic interventions on scapular kinematics and disability in patients with SIS. DATA SOURCES We searched PubMed, CINAHL, and SPORTDiscus databases from their origins to January 2018 using a combination of the key words scapular kinematics AND (shoulder dysfunction OR subacromial impingement) and conducted a manual search by reviewing the references of the identified papers. STUDY SELECTION Studies were included if (1) preintervention and postintervention measures were available; (2) patient-reported outcomes were reported; (3) scapular kinematics measures at 90° of ascending limb elevation in the scapular plane were included; (4) SIS was diagnosed in participants or participants self-reported symptoms of SIS; (5) they were original clinical studies published in English; and (6) the sample sizes, means, and measure of variability for each group were reported. DATA EXTRACTION Seven studies were found. Sample sizes, means, and standard deviations of scapular upward rotation, posterior tilt, and internal rotation at 90° of ascending limb elevation on the scapular plane and the Disabilities of the Arm, Shoulder and Hand scores were extracted. DATA SYNTHESIS Standardized mean differences between preintervention and postintervention measures with 95% confidence intervals (CIs) were calculated. We observed that the Disabilities of the Arm, Shoulder and Hand scores improved (mean difference = 0.85; 95% CI = 0.54, 1.16) but did not observe changes in scapular upward rotation (mean difference = -0.04; 95% CI = -0.31, 0.22), posterior tilt (mean difference = -0.09; 95% CI = -0.32, 0.15), or internal rotation (mean difference = 0.06; 95% CI = -0.19, 0.31). CONCLUSIONS The short- and long-term therapeutic interventions for SIS improved patient-reported outcomes but not scapular kinematics. The identified improvements in shoulder pain and function were not likely explained by changes in scapular kinematics.
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Affiliation(s)
- Katsumi Takeno
- College of Health and Human Services, University of Toledo, OH
| | - Neal R Glaviano
- College of Health and Human Services, University of Toledo, OH
| | - Grant E Norte
- College of Health and Human Services, University of Toledo, OH
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The Addition of Glenohumeral Adductor Coactivation to a Rotator Cuff Exercise Program for Rotator Cuff Tendinopathy: A Single-Blind Randomized Controlled Trial. J Orthop Sports Phys Ther 2019; 49:126-135. [PMID: 30501388 DOI: 10.2519/jospt.2019.8240] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatments for rotator cuff tendinopathy include rotator cuff muscle strengthening to promote better muscle recruitment in order to minimize subacromial narrowing during active movement. Glenohumeral adductor recruitment has also been shown to prevent such narrowing in asymptomatic individuals; therefore, adding glenohumeral adductor coactivation during rotator cuff strengthening could enhance the efficacy of rotator cuff strengthening. However, no study has explored its benefits. OBJECTIVES To compare the short-term efficacy of adding glenohumeral adductor coactivation to a rotator cuff-strengthening program to improve function, reduce symptoms, and increase acromiohumeral distance in adults with rotator cuff tendinopathy. METHODS In this single-blind randomized controlled trial, 42 participants with rotator cuff tendinopathy were randomly assigned to 2 groups, one that received strengthening of the scapular and rotator cuff muscles or one that received rotator cuff strengthening plus coactivation with pectoralis major and latissimus dorsi recruitment. The daily programs were performed at home for 6 weeks, with supervised training and follow-up sessions. Functional limitations/symptoms (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire as the primary outcome, and the Western Ontario Rotator Cuff index), pain (visual analog scale), and acromiohumeral distance were measured at baseline, 3 weeks, and 6 weeks. Data were analyzed using a mixed-model analysis of variance. RESULTS No significant group-by-time interaction was observed for the Disabilities of the Arm, Shoulder and Hand questionnaire, Western Ontario Rotator Cuff index, visual analog scale, and acromiohumeral distance (P≥.055). Significant time effects were obtained for the Western Ontario Rotator Cuff index and visual analog scale for pain with movement (P<.001). CONCLUSION The present findings show that adding glenohumeral adductor coactivation to a rotator cuff-strengthening program does not result in improved short-term efficacy in any of the measured outcomes. This study was registered with ClinicalTrials.gov (NCT02837848). LEVEL OF EVIDENCE Therapy, level 1b. J Orthop Sports Phys Ther 2019;49(3):126-135. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8240.
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Ravikanth R, Majumdar P. Magnetic resonance imaging diagnosis of rotator cuff tears in subacromial impingement syndrome: A retrospective analysis of large series of cases from a single center. APOLLO MEDICINE 2019. [DOI: 10.4103/am.am_57_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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Shi GX, Liu BZ, Wang J, Fu QN, Sun SF, Liang RL, Li J, Tu JF, Tan C, Liu CZ. Motion style acupuncture therapy for shoulder pain: a randomized controlled trial. J Pain Res 2018; 11:2039-2050. [PMID: 30310308 PMCID: PMC6165767 DOI: 10.2147/jpr.s161951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Strategies for preventing the persistence of pain and disability beyond the acute phase in shoulder pain patients are critically needed. Conventional acupuncture therapy (CAT) or motion style acupuncture therapy (MSAT) alone results in relative improvements in painful conditions in shoulder pain patients; combined interventions may have more global effects. The aim of this study is to evaluate the efficacy and safety of MSAT vs CAT for shoulder pain. Methods A randomized controlled trial using a factorial design was conducted from January 2014 to December 2015. Patients with a primary complaint of one-sided shoulder pain participated at three study sites. Eligible individuals were randomly assigned to receive MSAT plus minimal CAT (mCAT), CAT plus minimal MSAT (mMSAT), MSAT plus CAT, or mMSAT plus mCAT for 6 weeks in a 1:1:1:1 ratio. The primary outcome was change in shoulder pain intensity (measured using visual analog scale). The secondary outcomes included change in function of the shoulder joint (Constant–Murley score) and the health-related quality of life (Short Form-36 Health Survey). Moreover, perceived credibility of acupuncture was measured using the Treatment Credibility Scale. The outcomes were assessed at baseline and at 6, 10, and 18 weeks after randomization. Analysis of covariance with the baseline score adjustment had been used to determine the primary end point. The between-group differences of MSAT vs mMSAT and CAT vs mCAT were estimated, respectively, after tests of interaction between the two-dimensional interventions. All main analyses followed the intention-to-treat principle. Results A total of 164 patients completed the study. MSAT was superior to mMSAT in alleviating pain intensity at 10 weeks (P=0.024), and it was maintained for 18 weeks (P=0.013). Statistically significant differences were found when comparing MSAT with mMSAT for improvement in shoulder function (6 weeks, P=0.01; 10 weeks, P=0.006; and 18 weeks, P=0.01), physical health (10 weeks, P=0.023 and 18 weeks, P=0.015), and mental health (18 weeks, P=0.05). No significant differences were found in CAT when compared with mCAT. Conclusion After 18 weeks of treatment, pain and joint functions are improved more with MSAT than with minimal motion style acupuncture or conventional acupuncture in patients with shoulder pain.
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Affiliation(s)
- Guang-Xia Shi
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing100010, China
| | - Bao-Zhen Liu
- Acupuncture and Moxibustion Department, Beijing Huairou District Hospital of Traditional Chinese Medicine, Beijing 101400, China
| | - Jun Wang
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing100010, China
| | - Qing-Nan Fu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing100010, China
| | - San-Feng Sun
- Acupuncture and Moxibustion Department, Beijing Huairou District Hospital of Traditional Chinese Medicine, Beijing 101400, China
| | - Rui-Li Liang
- Acupuncture and Moxibustion Department, Beijing Huairou District Hospital of Traditional Chinese Medicine, Beijing 101400, China
| | - Jing Li
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing100010, China
| | - Jian-Feng Tu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing100010, China
| | - Cheng Tan
- Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing100010, China
| | - Cun-Zhi Liu
- Department of Acupuncture and Moxibustion, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing 100078, China,
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30
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Inderhaug E, Kalsvik M, Kollevold KH, Hegna J, Solheim E. Long-term results after surgical treatment of subacromial pain syndrome with or without rotator cuff tear. J Orthop 2018; 15:757-760. [PMID: 29946199 PMCID: PMC6014565 DOI: 10.1016/j.jor.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Some studies suggest a common degenerative path might contribute to a range of shoulder diseases involving subacromial pain syndrome and full-thickness rotator cuff tears. One could therefore theorize arthroscopic subacromial decompression and rotator cuff repair as interventions at different stages of a degenerative shoulder disease. Few studies have compared long-term outcomes after these two procedures. METHOD Matched case-controls undergoing arthroscopic rotator cuff repair combined with subacromial decompression (N = 180) or subacromial decompression only (N = 180) were evaluated pre- and 7.5 years postoperatively using QuickDASH score, VAS of function, VAS of pain and VAS of satisfaction. New surgery and complications were recorded. Baseline characteristics were related to outcomes to investigate predictors of good/poor outcome. RESULTS A general improvement from baseline was seen - from 51 to 14 (QuickDASH) in the combined group and from 53 to 16 in the decompression only group. No differences in outcomes were seen between groups (n.s.). Age above 55 at surgery predicted better VAS of function (P = .04) while acute onset of symptoms predicted better QuickDASH in the combined group (P = 0.03). None in the decompression group had undergone later rotator cuff repair. CONCLUSION Major improvements in pain/function were seen at mid- to long-term after isolated arthroscopic subacromial decompression and combined decompression/rotator cuff repair. Several patient-specific factors predicting worse outcomes were identified.
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Affiliation(s)
- Eivind Inderhaug
- Surgical Department, Haraldsplass Deaconess Hospital, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Maiken Kalsvik
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Kristin H. Kollevold
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | | | - Eirik Solheim
- Surgical Department, Haraldsplass Deaconess Hospital, Norway
- Aleris Nesttun, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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31
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McFarland EG, Matsen FA, Sanchez-Sotelo J. Clinical Faceoff: What is the Role of Acromioplasty in the Treatment of Rotator Cuff Disease? Clin Orthop Relat Res 2018; 476:1707-1712. [PMID: 30001291 PMCID: PMC6259789 DOI: 10.1097/01.blo.0000533630.65994.e2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Edward G McFarland
- E. G. McFarland, The Wayne Lewis Professor of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA. F. A. Matsen, III, Douglas T. Harryman II Endowed Chair in Shoulder and Elbow Research, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA. J. Sanchez-Sotelo, Consultant and Professor, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
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Multimodality imaging of subacromial impingement syndrome. Skeletal Radiol 2018; 47:923-937. [PMID: 29445933 DOI: 10.1007/s00256-018-2875-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/26/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
Subacromial impingement syndrome results from irritation of the tendons of the rotator cuff muscles in the subacromial space and may manifest as a range of pathologies. However, subacromial impingement is a dynamic condition for which imaging reveals predisposing factors but no pathognomonic indicators. Also, the usual imaging features of subacromial impingement may be seen in symptomatic and asymptomatic patients. Therefore, imaging is able to detect tears and describe the risk factors of impingement but cannot confirm subacromial impingement. Radiographs allow assessment of the morphology of the acromion and its lateral extension by means of the acromial index and the critical shoulder angle, which may increase in cases of subacromial impingement. Ultrasound is necessary to evaluate a tendon tear and is the only tool that provides dynamic information, which is essential to assessing dynamic conditions. Magnetic resonance imaging (MRI) allows the assessment of associated intraarticular abnormalities, joint effusion, and bone marrow edema. The objective of this article is to provide an overview of the pathophysiology and clinical manifestations of subacromial impingement and discuss recent advances in the imaging of subacromial impingement and the role of radiography, ultrasound, and MRI in differentiating normal from pathologic findings.
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Abstract
Subacromial lipoma represents a rare cause of subacromial impingement syndrome (SIS). A 49-year-old male patient presented to clinic with progressive right shoulder pain and limited movement, ongoing for approximately 1 month. Magnetic resonance imaging (MRI) revealed a lesion, compatible with lipoma, extending through subacromial space and pressing on supraspinatus muscle. After histopathological verification of lipoma, mass was excised. Postoperatively, patient completed 1 month physical therapy and rehabilitation program. Patient was free of pain at 4-month follow-up. Subacromial lipoma should be included in differential diagnosis of SIS for patients unresponsive to conservative treatment; MRI is very useful to determine precise etiology and inform surgical treatment.
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Affiliation(s)
- Hamza Sucuoglu
- Department of Physical Medicine And Rehabilitation, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.,Deparment of Biochemistry, Fatih Medical Faculty, University of Fatih, Istanbul, Turkey.,Department of Physical Medicine And Rehabilitation, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Kenan Akgun
- Department of Physical Medicine And Rehabilitation, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.,Deparment of Biochemistry, Fatih Medical Faculty, University of Fatih, Istanbul, Turkey.,Department of Physical Medicine And Rehabilitation, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
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Atoun E, Gilat R, van Tongel A, Pradhan R, Cohen O, Rath E, Levy O. Intraobserver and interobserver reliability of the Copeland-Levy classification for arthroscopic evaluation of subacromial impingement. J Shoulder Elbow Surg 2017; 26:2167-2172. [PMID: 28919000 DOI: 10.1016/j.jse.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/08/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Defining a simple and reliable classification for acromial and bursal impingement lesions is necessary to standardize terminology, to improve communication, and to allow better evaluation of the proper treatment of impingement lesions and rotator cuff tears. The purpose of this study was to assess orthopedic surgeons' intraobserver and interobserver reliability of the Copeland-Levy classification. METHODS Six fellowship-trained orthopedic surgeons reviewed shoulder arthroscopy videos of 69 consecutive patients who underwent shoulder arthroscopy for rotator cuff tear repair or subacromial decompression. The surgeons were asked to classify impingement lesions according to the Copeland-Levy classification. One month afterward, the surgeons were requested to repeat the evaluation of the same impingement lesions. Intraobserver reliability was calculated using Cohen's weighted κ. Interobserver reliability was calculated using Kendall's W. RESULTS Overall intraobserver reliability for acromial and bursal lesions was κ = 0.86 (95% confidence interval, 0.82-0.9) and κ = 0.97 (95% confidence interval, 0.95-0.98), respectively. Interobserver reliability for acromial and bursal lesions was W = 0.87 and W = 0.92, respectively. CONCLUSION Intraobserver and interobserver reliability of the Copeland-Levy classification among senior orthopedic surgeons is excellent. Hence, we suggest the Copeland-Levy classification be used to standardize terminology of the subacromial impingement lesion.
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Affiliation(s)
- Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Barzilai Medical Center Campus, Ashkelon, Israel.
| | - Ron Gilat
- Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Be'er Ya'akov, Israel
| | - Alexander van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Riten Pradhan
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ornit Cohen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ehud Rath
- Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
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Lawrence RL, Schlangen DM, Schneider KA, Schoenecker J, Senger AL, Starr WC, Staker JL, Ellermann JM, Braman JP, Ludewig PM. Effect of glenohumeral elevation on subacromial supraspinatus compression risk during simulated reaching. J Orthop Res 2017; 35:2329-2337. [PMID: 28071815 PMCID: PMC5503805 DOI: 10.1002/jor.23515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 12/28/2016] [Indexed: 02/04/2023]
Abstract
Mechanical subacromial rotator cuff compression is one theoretical mechanism in the pathogenesis of rotator cuff disease. However, the relationship between shoulder kinematics and mechanical subacromial rotator cuff compression across the range of humeral elevation motion is not well understood. The purpose of this study was to investigate the effect of humeral elevation on subacromial compression risk of the supraspinatus during a simulated functional reaching task. Three-dimensional anatomical models were reconstructed from shoulder magnetic resonance images acquired from 20 subjects (10 asymptomatic, 10 symptomatic). Standardized glenohumeral kinematics from a simulated reaching task were imposed on the anatomic models and analyzed at 0, 30, 60, and 90° humerothoracic elevation. Five magnitudes of humeral retroversion were also imposed on the models at each angle of humerothoracic elevation to investigate the impact of retroversion on subacromial proximities. The minimum distance between the coracoacromial arch and supraspinatus tendon and footprint were quantified. When contact occurred, the magnitude of the intersecting volume between the supraspinatus tendon and coracoacromial arch was also quantified. The smallest minimum distance from the coracoacromial arch to the supraspinatus footprint occurred between 30 and 90°, while the smallest minimum distance to the supraspinatus tendon occurred between 0 and 60°. The magnitude of humeral retroversion did not significantly affect minimum distance to the supraspinatus tendon except at 60 or 90° humerothoracic elevation. The results of this study provide support for mechanical rotator cuff compression as a potential mechanism for the development of rotator cuff disease. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2329-2337, 2017.
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Ingwersen KG, Jensen SL, Sørensen L, Jørgensen HR, Christensen R, Søgaard K, Juul-Kristensen B. Three Months of Progressive High-Load Versus Traditional Low-Load Strength Training Among Patients With Rotator Cuff Tendinopathy: Primary Results From the Double-Blind Randomized Controlled RoCTEx Trial. Orthop J Sports Med 2017; 5:2325967117723292. [PMID: 28875153 PMCID: PMC5576542 DOI: 10.1177/2325967117723292] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Progressive high-load exercise (PHLE) has led to positive clinical results in patients with patellar and Achilles tendinopathy. However, its effects on rotator cuff tendinopathy still need to be investigated. Purpose: To assess the clinical effects of PHLE versus low-load exercise (LLE) among patients with rotator cuff tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with rotator cuff tendinopathy were recruited and randomized to 12 weeks of PHLE or LLE, stratified for concomitant administration of corticosteroid injection. The primary outcome measure was change from baseline to 12 weeks in the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, assessed in the intention-to-treat population. Results: A total of 100 patients were randomized to PHLE (n = 49) or LLE (n = 51). Mean changes in the DASH questionnaire were 7.11 points (95% CI, 3.07-11.16) and 8.39 points (95% CI, 4.35-12.44) in the PHLE and LLE groups, respectively; this corresponded to a statistically nonsignificant adjusted mean group difference of −1.37 points (95% CI, −6.72 to 3.99; P = .61). Similar nonsignificant results were seen for pain, range of motion, and strength. However, a significant interaction effect was found between the 2 groups and concomitant corticosteroid use (P = .028), with the largest positive change in DASH in favor of PHLE for the group receiving concomitant corticosteroid. Conclusion: The study results showed no superior benefit from PHLE over traditional LLE among patients with rotator cuff tendinopathy. Further investigation of the possible interaction between exercise type and corticosteroid injection is needed to establish optimal and potentially synergistic combinations of these 2 factors. Registration: NCT01984203 (ClinicalTrials.gov identifier): Rotator Cuff Tendinopathy Exercise Trial (RoCTEx).
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Affiliation(s)
- Kim Gordon Ingwersen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark
| | - Steen Lund Jensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Aalborg University Hospital, Farsø Hospital, Farsø, Denmark
| | - Lilli Sørensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark
| | - Hans Ri Jørgensen
- Department of Orthopaedic Surgery, Shoulder Clinic, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Birgit Juul-Kristensen
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Health Sciences, Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
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Jo CH, Shin WH, Park JW, Shin JS, Kim JE. Degree of tendon degeneration and stage of rotator cuff disease. Knee Surg Sports Traumatol Arthrosc 2017; 25:2100-2108. [PMID: 27896393 DOI: 10.1007/s00167-016-4376-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 11/07/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE While tendon degeneration has been known to be an important cause of rotator cuff disease, few studies have objectively proven the association of tendon degeneration and rotator cuff disease. The purpose of this study was to investigate changes of tendon degeneration with respect to the stage of rotator cuff disease. METHODS A total of 48 patients were included in the study: 12 with tendinopathy, 12 with a partial-thickness tear (pRCT), 12 with a full-thickness tear (fRCT), and 12 as the control. A full-thickness supraspinatus tendon sample was harvested en bloc from the middle portion between the lateral edge and the musculotendinous junction of the tendon using a biopsy punch with a diameter of 3 mm. Harvested samples were evaluated using a semi-quantitative grading scale with 7 parameters after haematoxylin and eosin staining. RESULTS There was no significant difference in age, gender, symptom duration, and Kellgren-Lawrence grade between the groups except for the global fatty degeneration index. All of the seven parameters were significantly different between the groups and could be categorized as follows: early responders (fibre structure and arrangement), gradual responder (rounding of the nuclei), after-tear responders (cellularity, vascularity, and stainability), and late responder (hyalinization). The total degeneration scores were not significantly different between the control (6.08 ± 1.16) and tendinopathy (6.67 ± 1.83) (n.s.). However, the score of pRCT group (10.42 ± 1.31) was greater than that of tendinopathy (P < 0.001), and so was the score of fRCT (12.33 ± 1.15) than that of pRCT (p = 0.009). CONCLUSION This study showed that the degeneration of supraspinatus tendon increases as the stage of rotator cuff disease progresses from tendinopathy to pRCT, and then to fRCT. The degree of degeneration of tendinopathy was not different from that of normal but aged tendons, and significant tendon degeneration began from the stage of pRCT. The clinical relevance of the study is that strategies and goals of the treatment for rotator cuff disease should be specific to its stage, in order to prevent disease progression for tendinopathy and pRCT, as well to restore the structural integrity for fRCT. LEVEL OF EVIDENCE Diagnostic, Level I.
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Affiliation(s)
- Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, Korea.
| | - Won Hyoung Shin
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Ji Wan Park
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Ji Sun Shin
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Ji Eun Kim
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Dean BJF, Dakin SG, Millar NL, Carr AJ. Review: Emerging concepts in the pathogenesis of tendinopathy. Surgeon 2017; 15:349-354. [PMID: 28619548 PMCID: PMC5714045 DOI: 10.1016/j.surge.2017.05.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 02/07/2023]
Abstract
Tendinopathy is a common clinical problem and has a significant disease burden attached, not only in terms of health care costs, but also for patients directly in terms of time off work and impact upon quality of life. Controversy surrounds the pathogenesis of tendinopathy, however the recent systematic analysis of the evidence has demonstrated that many of the claims of an absence of inflammation in tendinopathy were more based around belief than robust scientific data. This review is a summary of the emerging research in this topical area, with a particular focus on the role of neuronal regulation and inflammation in tendinopathy.
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Affiliation(s)
- Benjamin J F Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - Stephanie G Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences University of Glasgow, Glasgow, Scotland, UK.
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK.
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Mohammad Ghandour A, El Ghazaly S, El Ghandour T. Greater tuberosity sclerosis: Does it correlate with tear size? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Shalaby MH, Shehata KAA, Farouk MA. Conventional MR in rotator cuff pathology. Is it sufficient? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Thorpe A, Hurworth M, O'Sullivan P, Mitchell T, Smith A. Rotator cuff disease: opinion regarding surgical criteria and likely outcome. ANZ J Surg 2017; 87:291-295. [DOI: 10.1111/ans.13862] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 08/09/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alison Thorpe
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Mark Hurworth
- Department of Orthopaedic Surgery; Royal Perth Hospital; Perth Western Australia Australia
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Tim Mitchell
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science; Curtin University; Perth Western Australia Australia
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Gismervik SØ, Drogset JO, Granviken F, Rø M, Leivseth G. Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance. BMC Musculoskelet Disord 2017; 18:41. [PMID: 28122541 PMCID: PMC5267375 DOI: 10.1186/s12891-017-1400-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Physical examination tests of the shoulder (PETS) are clinical examination maneuvers designed to aid the assessment of shoulder complaints. Despite more than 180 PETS described in the literature, evidence of their validity and usefulness in diagnosing the shoulder is questioned. METHODS This meta-analysis aims to use diagnostic odds ratio (DOR) to evaluate how much PETS shift overall probability and to rank the test performance of single PETS in order to aid the clinician's choice of which tests to use. This study adheres to the principles outlined in the Cochrane guidelines and the PRISMA statement. A fixed effect model was used to assess the overall diagnostic validity of PETS by pooling DOR for different PETS with similar biomechanical rationale when possible. Single PETS were assessed and ranked by DOR. Clinical performance was assessed by sensitivity, specificity, accuracy and likelihood ratio. RESULTS Six thousand nine-hundred abstracts and 202 full-text articles were assessed for eligibility; 20 articles were eligible and data from 11 articles could be included in the meta-analysis. All PETS for SLAP (superior labral anterior posterior) lesions pooled gave a DOR of 1.38 [1.13, 1.69]. The Supraspinatus test for any full thickness rotator cuff tear obtained the highest DOR of 9.24 (sensitivity was 0.74, specificity 0.77). Compression-Rotation test obtained the highest DOR (6.36) among single PETS for SLAP lesions (sensitivity 0.43, specificity 0.89) and Hawkins test obtained the highest DOR (2.86) for impingement syndrome (sensitivity 0.58, specificity 0.67). No single PETS showed superior clinical test performance. CONCLUSIONS The clinical performance of single PETS is limited. However, when the different PETS for SLAP lesions were pooled, we found a statistical significant change in post-test probability indicating an overall statistical validity. We suggest that clinicians choose their PETS among those with the highest pooled DOR and to assess validity to their own specific clinical settings, review the inclusion criteria of the included primary studies. We further propose that future studies on the validity of PETS use randomized research designs rather than the accuracy design relying less on well-established gold standard reference tests and efficient treatment options.
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Affiliation(s)
- Sigmund Ø Gismervik
- Department Physical Medicine and Rehabilitation, St.Olavs University Hospital, P.B. 3250 Sluppen, NO-7006, Trondheim, Norway. .,Department of Public Health and General Practice, Norwegian University of Science and Technology, P.B. 8905 MTFS, 7491, Trondheim, Norway.
| | - Jon O Drogset
- Institute of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, P.B 8905 MTFS, 7491, Trondheim, Norway.,Department of Orthopedic Surgery, Trondheim University Hospital, P.B. 3250 Sluppen, NO-7006, Trondheim, Norway
| | - Fredrik Granviken
- Department Physical Medicine and Rehabilitation, St.Olavs University Hospital, P.B. 3250 Sluppen, NO-7006, Trondheim, Norway
| | - Magne Rø
- Department Physical Medicine and Rehabilitation, St.Olavs University Hospital, P.B. 3250 Sluppen, NO-7006, Trondheim, Norway
| | - Gunnar Leivseth
- Department of Clinical Medicine, Neuromuscular Diseases Research Group, UiT The Arctic University of Norway, N-9037, Tromsø, Norway.,Unicare Medical Rehabilitation Centre, Hokksund, Norway
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Watts AR, Williams B, Kim SW, Bramwell DC, Krishnan J. Shoulder impingement syndrome: a systematic review of clinical trial participant selection criteria. Shoulder Elbow 2017; 9:31-41. [PMID: 28572848 PMCID: PMC5441616 DOI: 10.1177/1758573216663201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/04/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Shoulder impingement syndrome (SIS) is a common diagnosis for patients with pain and dysfunction of the shoulder. Variations in the signs and symptoms might lead to uncertainty regarding the definition of SIS. The aim of this review is to explore the participant selection criteria used in the literature when investigating SIS and to assess differences in criteria among treating professions. METHODS This is a PRISMA systematic review of publications from 2009 to 2014 from MEDLINE, PubMed, The Cochrane Library, Embase, Scopus and CINAHL. RESULTS Ninety-seven articles met inclusion criteria for this review. Twenty-five different surgical and nonsurgical treatments were investigated. Impingement-specific index tests were used in all studies. Exclusion index tests were used in 62% of studies. Twenty index tests were identified. Radiological investigations were reported in 53% of all studies, of which a further 53% reported using two or more radiological investigations. CONCLUSIONS This systematic review has illustrated that studies investigating SIS test for various signs and symptoms, which is in keeping with describing the condition as a 'syndrome'. However, there are inconsistencies in participant selection criteria between health disciplines, highlighting a need for harmonization of the selection criteria in the form of an international editorial consensus.
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Affiliation(s)
- Amy R. Watts
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Ben Williams
- Department of Orthopaedics, Flinders Medical Centre, Adelaide, Australia
| | - Susan W. Kim
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
| | - Donald C. Bramwell
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Jeganath Krishnan
- Department of Orthopaedics, School of Medicine, Flinders University, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
- Department of Orthopaedics, Flinders Medical Centre, Adelaide, Australia
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Cools AM, Michener LA. Shoulder pain: can one label satisfy everyone and everything? Br J Sports Med 2016; 51:416-417. [PMID: 27806952 DOI: 10.1136/bjsports-2016-096772] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/06/2016] [Accepted: 10/08/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
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Fennell J, Phadke CP, Mochizuki G, Ismail F, Boulias C. Shoulder Retractor Strengthening Exercise to Minimize Rhomboid Muscle Activity and Subacromial Impingement. Physiother Can 2016; 68:24-8. [PMID: 27504044 DOI: 10.3138/ptc.2014-83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE We investigated the best position for shoulder retractor strengthening exercise to maximize middle trapezius activity and minimize rhomboid major activity. Although both trapezius and rhomboids are scapular retractors, rhomboids also act as downward rotators of the scapula, which can worsen subacromial impingement. METHODS Twelve healthy participants (age 30 [SD 6] y) with no history of shoulder pain were recruited for this study, which used fine-wire electromyography to examine maximal muscle activation of the middle trapezius and rhomboid major muscle fibres in four different positions: with the shoulder in 90° abduction with elbow completely extended and (1) shoulder internal rotation, (2) shoulder neutral rotation, (3) shoulder external rotation, and (4) rowing (shoulder neutral rotation and elbow flexed 90°). The ratio of trapezius to rhomboid muscles was compared with Wilcoxon signed-rank tests. RESULTS Muscle activation ratio during shoulder retraction exercise was significantly lower by 22% (i.e., rhomboid was more active than middle trapezius) when performed with the shoulder in rowing position (elbow flexed) than with the shoulder in external rotation (elbow extended) position (p=0.031). All four positions produced coactivation of trapezius and rhomboids. DISCUSSION Rowing position may not be the best position for shoulder retractor strengthening in patients with impingement syndrome. The preferable position for maximizing middle trapezius activity and minimizing rhomboid activity may be shoulder external rotation with elbow extended.
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Affiliation(s)
- Jeremy Fennell
- Spasticity Research Program, West Park Healthcare Centre; Faculty of Medicine, University of Toronto
| | - Chetan P Phadke
- Spasticity Research Program, West Park Healthcare Centre; Faculty of Medicine, University of Toronto; Faculty of Health, York University
| | - George Mochizuki
- Faculty of Medicine, University of Toronto; Sunnybrook Research Institute, Toronto
| | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre; Faculty of Medicine, University of Toronto
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre; Faculty of Medicine, University of Toronto
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Heterogeneous MR arthrography findings in patients with subacromial impingement syndrome – Diagnostic subgroups? J Electromyogr Kinesiol 2016; 29:64-73. [DOI: 10.1016/j.jelekin.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/28/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022] Open
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Bonato L, Quinelato V, Pinheiro A, Amaral M, de Souza F, Lobo J, Aguiar D, Augusto L, Vieira A, Salles J, Cossich V, Guimarães J, de Gouvêa C, Granjeiro J, Casado P. ESRRB polymorphisms are associated with comorbidity of temporomandibular disorders and rotator cuff disease. Int J Oral Maxillofac Surg 2016; 45:323-31. [DOI: 10.1016/j.ijom.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 01/12/2023]
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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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Ketola S, Lehtinen J, Rousi T, Nissinen M, Huhtala H, Arnala I. Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment? Acta Orthop 2015; 86:641-6. [PMID: 25809315 PMCID: PMC4750760 DOI: 10.3109/17453674.2015.1033309] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Shoulder impingement syndrome is common, but treatment is controversial. Arthroscopic acromioplasty is popular even though its efficacy is unknown. In this study, we analyzed stage-II shoulder impingement patients in subgroups to identify those who would benefit from the operation. PATIENTS AND METHODS In a previous randomized study, 140 patients were either treated with a supervised exercise program or with arthroscopic acromioplasty followed by a similar exercise program. The patients were followed up at 2 and 5 years after randomization. Self-reported pain was used as the primary outcome measure. RESULTS Both treatment groups had less pain at 2 and 5 years, and this was similar in both groups. Duration of symptoms, marital status (single), long periods of sick leave, and lack of professional education appeared to increase the risk of persistent pain despite the treatment. Patients with impingement with radiological acromioclavicular (AC) joint degeneration also had more pain. The patients in the exercise group who later wanted operative treatment and had it did not get better after the operation. INTERPRETATION The natural course probably plays a substantial role in the outcome. Based on our findings, it is difficult to recommend arthroscopic acromioplasty for any specific subgroup. Regarding operative treatment, however, a concomitant AC joint resection might be recommended if there are signs of AC joint degeneration. Even more challenging for the development of a treatment algorithm is the finding that patients who do not recover after nonoperative treatment should not be operated either.
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Affiliation(s)
- Saara Ketola
- Coxa Hospital for Joint Replacement, Tampere,Correspondence:
| | | | - Timo Rousi
- Kanta-Häme Central Hospital, Hämeenlinna
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Litchfield R. Is It All in the Genes? Commentary on an article by S. Gumina, MD, PhD, et al.: "Subacromial Space Width: Does Overuse or Genetics Play a Greater Role in Determining It? An MRI Study on Elderly Twins". J Bone Joint Surg Am 2015; 97:e67. [PMID: 26491139 DOI: 10.2106/jbjs.o.00790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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