Subacromial impingement syndrome: management challenges

Exploration of causal relationship between shoulder impingement syndrome and rotator cuff injury: a bidirectional mendelian randomization

BACKGROUP

The pathogenesis of shoulder impingement syndrome (SIS) is still unclear, and its questionable causal relationship with rotator cuff (RC) injury has led to confusion in treatment. The purpose of this study was to explore the bidirectional causal relationship between SIS and RC injury.

METHODS

SIS and RC injury datasets downloaded from the IEU Open GWAS project and GWAS catalog databases. Inverse variance weighted (IVW), MR Egger, Weighted median, and Weighted mode were used in this Mendelian randomization (MR) analysis. Cochran's Q test, leave-one-out, and funnel plot method were used to evaluate heterogeneity between single nucleotide polymorphisms (SNPs). MR-Egger regression was used to test the horizontal pleiotropy of this study.

RESULTS

The IVW method (OR = 1.189, P = 0.0059) suggest the putative causal effect of RC injury on SIS. The results of MR Egger method (OR = 1.236, P = 0.2013), weighted median method (OR = 1.097, P = 0.2428) and weighted mode method (OR = 1.013, P = 0.930) showed no statistically significant (OR = 1.069071, P = 0.6173). Heterogeneity test and horizontal pleiotropy analysis suggested that there was no significant heterogeneity and horizontal pleiotropy in the results of this MR analysis. The reverse MR analysis showed heterogeneity, and the conclusion needs to be further explored.

CONCLUSIONS

The results of MR analysis support that RC injury may be causally associated with SIS.

Comparison of the efficacy of low intensity laser and peloid therapy in patients with subacromial impingement syndrome

The objective of this study was to compare the impact of peloid and low-level laser (LLLT) treatment in conjunction with a home exercise programme on short-term symptomatic pain, functional status and quality of life in individuals diagnosed with subacromial impingement syndrome (SIS). A total of 168 patients diagnosed with SIS were included in the study, with 56 receiving LLLT + exercise, 56 receiving peloidotherapy + exercise, and 56 receiving exercise only. Patients underwent clinical evaluations prior to treatment (first measurement), after treatment completion (second measurement), and one month post-treatment (third measurement). Pain was evaluated using the Visual Analog Scale (VAS). Functional status was evaluated using the Shoulder Pain and Disability Index (SPADI), and quality of life was evaluated using the Short Form 36 (SF-36). Active range of motion of the shoulder was measured by the same investigator using a goniometer. Statistically significant improvements in VAS, SPADI, SF-36, and ROM parameters were achieved after treatment and at 1 month follow-up compared to pretreatment in both active treatment groups (p < .05). The third group showed significant improvements in ROM and SF-36 physical components after treatment and 1 month later (p < .05). Low-level laser therapy or peloid therapy given in addition to home exercise therapy for SIS were found to have similar short-term effects on pain, functional status, quality of life and ROM.

Efficacy of manual therapy on shoulder pain and function in patients with rotator cuff injury: A systematic review and meta‑analysis

To critically evaluate the effects of manual therapy (MT) on pain and functional improvement in patients with rotator cuff injury (RCI), a systematic review of all randomized controlled trials (RCTs) on MT for RCI was conducted in the following databases: PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Physiotherapy Evidence Database, Chinese National Knowledge Infrastructure, Wan-fang Data, Chinese Scientific Journal Database, and Chinese Biomedical Literature database from inception to March 28, 2023. A total of 1,110 participants from 24 eligible RCTs were included in the analysis. Compared with placebo, MT could not effectively relieve pain [standardized mean difference (SMD)=-0.25; 95% CI: -0.51 to 0.01; P=0.06], although its impact on functional improvement appears limited (SMD=0.20; 95% CI: -0.09 to 0.49; P=0.18). Combining MT with exercise had significant advantages over exercise alone, as combined therapy contributed to both pain reduction (SMD=0.36; 95% CI: 0.08 to 0.64; P=0.01) and functional enhancement (SMD=0.32; 95% CI: 0.11 to 0.52; P=0.002). Furthermore, MT combined with multimodal physiotherapy showed additional benefits in pain reduction (mean difference=1.57; 95% CI: 0.18 to 2.96; P=0.03) and functional improvement (SMD=0.77; 95% CI: 0.43 to 1.12; P<0.0001) compared with multimodal physiotherapy alone. These findings highlight the superior pain alleviation and functional improvement provided by MT when combined with exercise or physiotherapy. Consequently, MT has emerged as a pivotal component of therapeutic intervention for RCI.

Distribution and analysis of subacromial spurs and the relationship with acromial classification and angle in healthy individuals

BACKGROUND

Subacromial spurs are considered the one of the pathology underlying shoulder impingement syndrome. Furthermore, few studies have focused on the morphology of the subacromial spurs in normal Chinese people. This study aimed to study the spur distribution and to illustrate the morphology of spurs, which may help guide the extent of acromioplasty.

METHODS

A total of 93 normal individuals were enrolled, and both shoulders of all enrolled individuals were analyzed. The subjects were divided and classified into three different groups by ages: group I = 18-40 years, group II = 41-60 years, and group III ≥ 61 years. The osteophyte distribution, osteophyte area, subacromial surface area and osteophyte area/subacromial surface area ratio were measured and illustrated using Mimics and 3-matic software. The shape of the acromion was classified according to the Bigliani and Morrison classification system. The acromial angle was also classified. Then, the relationship between osteophytes, acromial classification and acromial angle was analyzed.

RESULTS

Type II (curved shape) was the most common type of acromion, and the hooked shape was a rare form. A significant increase in the left subacromial surface area in males was observed in group III compared with group I (P < 0.001) and group II (P = 0.004). The total spur/subacromial area ratio was significantly higher in group II than I. An obvious increase in the right subacromial area was observed in group III compared with group I (P = 0.004). Furthermore, there was a significant increase in the right spur area (P = 0.021) and total spur/subacromial area ratio (P = 0.006) in females in group II compared with group I. Fewer spurs were observed on the left than on the right side (p = 0.0482). One spur was most common among type II acromions (29/36) (80.56%) on the left side and the right side (34/52, 65.38%).

CONCLUSIONS

Spurs osteophytes are mainly distributed with an irregular shape and mostly run through the medial and lateral sides of the subacromial surface in normal subjects. The characteristics of subacromial spurs are so diverse that a surgeon must conduct subacromial decompression completely based on the morphology of individual spurs.

Arthroscopic subacromial decompression improved outcomes in situationally depressed patients compared to clinically depressed or nondepressed patients

Background

The purpose of this study is to evaluate patient reported outcomes after arthroscopic extensive débridement of the shoulder with subacromial decompression (SAD) for subacromial impingement using the Patient-Reported Outcomes Measurement Information System (PROMIS) system and evaluate if depression (Dep) (clinical or situational) impacts patients achieving a Minimal Clinically Important Difference (MCID).

Methods

Preoperative PROMIS Physical function (PF), Mood, and Dep scores were obtained at the closest date prior to arthroscopic rotator cuff repair and postoperative scores were collected at every clinical visit thereafter. Final PROMIS score used for data analysis was determined by the patients final PROMIS value between 90 to 180 days. Clinical Dep was determined by patients having a formal diagnosis of "Depression or Major Depressive Disorder" at the time of their surgery. Situationally depressed patients, those without a formal diagnosis yet exhibited symptomatic depressive symptoms, were classified by having a PROMIS-Dep cutoff scores larger than 52.5.

Results

A total of 136 patients were included for final statistical analysis. 13 patients had a clinical but not situational diagnosis of Dep, 86 patients were identified who had no instance of clinical or situational Dep (nondepressed). 35 patients were situationally depressed. All three cohorts demonstrated a significant improvement in postoperative PROMIS Dep, PI, and PF score relative to their preoperative value (P = .001). Situationally depressed patients achieved greater delta PROMIS-Dep compared to patients with major depressive disorder. Depressed patients had a higher chance of achieving MCID for PROMIS-Dep compared to nondepressed patients (P = .01). Logistic regression analysis demonstrated that underlying Dep did not alter the odds of obtaining MCID compared to nondepressed patients. Nonsmoking patients had significantly greater odds of achieving MCID for PF (P = .02).

Discussion

Patients improved after undergoing SAD regardless of underlying Dep or depressive symptoms. Depressed patients exhibited greater change in PROMIS scores compared to nondepressed patients. Smoking remains a risk factor for postoperative outcomes in patients undergoing SAD for subacromial impingement. Identifying and counseling patients with underlying depressive symptoms without a formal major depressive disorder diagnosis may lead to improved outcomes. These findings may help guide clinicians in deciding who would benefit the most from this procedure.

The Effect of Acromioplasty Performed During Rotator Cuff Repairs on Clinical Outcomes in Patients With Type 3 Acromion: A Retrospective Study

OBJECTIVE

Rotator cuff (RC) tears often necessitate surgery, with acromioplasty being frequently performed alongside RC repair. However, the impact of acromioplasty on clinical outcomes remains a subject of discussion. The current study aimed to investigate the effect of acromioplasty during RC repair on clinical outcomes in patients with type 3 acromion.

MATERIALS AND METHODS

Eighty-five patients, who underwent RC repair between January 2016 and December 2020, were categorized into two groups: Group 1, comprising 40 patients without acromioplasty, and Group 2, including 45 patients who received acromioplasty. Subacromial distance (SAD) and clinical scores were assessed pre- and post-operatively.

RESULTS

Group 1, comprising 40 patients without acromioplasty, had an average age of 59.45±10.43 years. Among them, 27 (67.5%) were female. The mean symptom duration was 10.4±4.3 months, and the mean follow-up period was 16.2±1.9 months. Group 2, which underwent acromioplasty, included 45 patients with an average age of 56.49±8.97 years, with 30 (66.7%) of them being female. The mean symptom duration was 9.5±3.6 months, and the mean follow-up time was 15.78±2.17 months in this group. Group 2 showed a relatively greater improvement in SAD compared to Group 1. The evaluation of clinical outcomes did not reveal any significant differences between the groups.

CONCLUSION

Concomitant acromioplasty does not have a significant effect on clinical outcomes in patients undergoing arthroscopic RC repair.

Biomechanical and functional analysis of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome: A case control study

The motions of the shoulder are mainly carried out through the glenohumeral joint, but are also assisted by the scapulothoracic joint. Therefore, changes in the biomechanics of the thoracic spine and scapula affect the function of the shoulder. However, there is limited information on the biomechanical and functional characteristics of the shoulder complex and thoracic spine in patients with subacromial impingement syndrome (SIS). In this study, the biomechanical and functional characteristics of the shoulder complex and thoracic spine were analyzed in patients with SIS compared to healthy individuals. A total of 108 participants were included in this study. Participants were classified into 2 groups, the SIS (n = 55) and healthy (n = 53) groups. The shoulder and thoracic range of motion (ROM), scapular position, and isokinetic shoulder strength were measured in all participants. The shoulder ROM was significantly decreased in the SIS group compared to the healthy group (P < .001). The thoracic spine ROM showed significantly limited extension in the SIS group (P < .001). The scapular position showed significantly increased anterior tilting (P = .005), internal rotation (P = .032), protraction (P < .001), and decreased upward rotation (P = .002) in the SIS group. The isokinetic shoulder external rotation (P < .001) and abduction (P < .001) strength were significantly lower in the SIS group. Patients with SIS showed reduced shoulder ROM and end-range extension of the thoracic spine compared to healthy individuals, and the scapula was in a more anterior-tilted, protracted, and downward rotated position. In addition, it showed lower external rotation and abduction strength. These results suggest the need for interventions to improve the limited thoracic extension and altered scapular position, which may affect shoulder ROM and muscle strength in the rehabilitation of patients with SIS.

Physical and well-being effect of scapular kinesio taping combined with conventional physiotherapy in shoulder impingement syndrome: A randomized controlled study

BACKGROUND

Kinesio taping (KT) is one of the treatment methods used on patients with shoulder impingement syndrome (SIS). There are different results regarding its effectiveness in the literature.

OBJECTIVE

To investigate the effects of scapular KT combined with a conventional physiotherapy program on scapular dyskinesia, shoulder pain, upper extremity function, and well-being in patients with SIS.

METHODS

The study was conducted with 60 outpatients diagnosed with SIS, aged 40-65 years. The patients were divided into two groups: KT [conventional physiotherapy program + scapular KT (targets scapular retraction and is applied along the inferior-medial edge of the scapula, starting from the processus coracoids), n= 30] and control [conventional physiotherapy program, n= 30]. In before- and after-treatment evaluations, the Lateral Scapular Slide Test (LSST) for scapular dyskinesia, a Visual Analogue Scale (VAS) for shoulder pain, and the Disabilities of the Arm, Shoulder, and Hand (DASH) for upper extremity function were used. In addition, at the end of treatment, a Kinesio taping Satisfaction Survey, created by the researchers, was filled out by the KT group for the assessment of well-being.

RESULTS

The interaction effect of Group*Time was not statistically significant in all outcome measures (p> 0.05). However, the main effect of both group and time was statistically significant in the DASH-Function/Symptom, VAS-Rest, VAS-Activity, and VAS-Night (p< 0.05). Moreover, only the main effect of time was statistically significant in LSST-1 and LSST-3 (p< 0.05). In the KT group, the satisfaction level was 8.50 ± 1.69 and the recommendation level was 8.72 ± 1.81.

CONCLUSION

Both conventional physiotherapy programs and additional scapular KT improved scapular dyskinesia, reduced pain, and increased the upper extremity function. Adding scapular KT to treatment did not change the results, but it had positive psychological effects and yielded a high satisfaction rate.

Corticosteroid therapy versus physiotherapy on pain, mobility and function in shoulder impingement: A short note

Background

The global estimate of shoulder pain is 67% and is often associated with subacromial impingement syndrome. Interventions include corticosteroid injection (CSI) therapy and physiotherapy. Further information is needed to compare the effect of these interventions on pain, joint range of motion (ROM) and shoulder function.

Objectives

To summarise the best evidence comparing the effect of CSI versus physiotherapy on pain, shoulder ROM and shoulder function in patients with subacromial impingement syndrome.

Method

This evidence statement is based on a systematic review and meta-analysis of three randomised controlled trials (RCTs), namely, Rhon et al. (2014) (n = 136), Hay et al. (2003) (n = 207) and Van der Windt et al. (1998) (n = 109), with a total of 452 participants. A total of 14 studies were reviewed and only 3 studies met the inclusion criteria.

Results

An improvement in shoulder function was found in favour of CSI at 6- to 7-week follow-up (p < 0.0001), but no evidence was found for the superiority of CSI compared to physiotherapy for pain and ROM over 4-12 weeks. In 24 and 48 weeks, no evidence was found for the superiority of CSI compared to physiotherapy for shoulder function, pain or ROM.

Conclusion

No evidence was found for the superiority of CSI compared to physiotherapy for pain and ROM in the short term besides an improvement in shoulder function in favour of CSI at 6-7 weeks. There was a weak recommendation with moderate quality of evidence based on three RCTs (2B).

Clinical implications

This evidence statement may inform clinical practice when determining which intervention is best suited to manage patients with shoulder pain.

Machine Learning-Based Ultrasomics for Predicting Subacromial Impingement Syndrome Stages

OBJECTIVES

To determine the performance of machine learning (ML)-based ultrasomic analysis of subacromial impingement syndrome (SIS) stage evaluation.

METHODS

In this retrospective study, 324 patients with SIS were included. The SIS stage was evaluated with a Neer test. Regions of the musculi supraspinatus were manually segmented by an experienced radiologist. Then, 5936 ultrasomic features were extracted from the Ultrasomics Platform software. The Wilcoxon test was used to identify differentially expressed radiomic features. Then, these differentially expressed features were submitted to the least absolute shrinkage and selection operator (LASSO) for model construction. The area under the curve (AUC) of the receiver operating characteristic was used to evaluate the performance of the ultrasonic model for SIS stage evaluation.

RESULTS

Finally, a total of 223 early-stage and 101 advanced-stage SIS patients were randomly divided into a training cohort (n = 227) and a validation cohort (n = 97). After feature-dimensionality reduction, a total of 28 radiomic features were submitted to LASSO analysis. Finally, 10 radiomic features were finally included for radiomics model construction. The AUC results showed that the ultrasomics model had moderate performance for SIS stage evaluation in both the training cohort (AUC = 0.839) and the validation cohort (AUC = 0.789).

CONCLUSIONS

ML-derived ultrasomics can discriminate the SIS stage in patients with SIS. This noninvasive and low-cost approach may be helpful in the preliminary screening of shoulder pain.

Analysis of the Effects on the Level of Pain and Functional Improvement After Integrated Korean Medicine in Patients with Shoulder Impingement Syndrome: A Retrospective Chart Review

Background: This study investigated the clinical effectiveness of Korean medicine (KM) treatment for shoulder impingement syndrome (SIS).Methods: There were 61 patients who were diagnosed with SIS in the Jaseng hospital network of KM (7 hospitals located in Korea: Gangnam, Daejeon, Bucheon, Haeundae, Bundang, Ulsan, and Gwangju) between January 1st, 2015 and December 31st, 2020 who were retrospectively reviewed. The patients were grouped according to complications, intake of analgesics, duration of illness preadmission, and treatment. Treatments consisted of herbal medicine, acupuncture, cupping, Chuna, pharmacopuncture, bee venom pharmacopuncture, medicinal steaming, Daoyin exercises, and physical therapy. By comparing the Numeric Rating Scale (NRS), Shoulder Pain and Disability Index, and European Quality of Life 5-Dimensions questionnaire scores, the effectiveness of integrated KM treatment was evaluated.Results: There were 14 males and 47 females. For inpatients diagnosed with SIS, the mean NRS score decreased from 5.78 ± 1.33 to 3.40 ± 1.43 (p < 0.001). The mean Shoulder Pain and Disability Index score decreased from 53.87 ± 14.76 to 38.56 ± 18.87 (p < 0.001), and the mean European Quality of Life 5-Dimensions questionnaire increased from 0.67 ± 0.13 to 0.76 ± 0.09 (p < 0.001) after KM treatment. Medicinal steaming (0.398; p < 0.001), acupuncture (0.290), cupping (0.288), bee venom pharmacopuncture (0.282), and Daoyin exercises (0.262; p < 0.05) had a positive correlation with improved changes in the NRS score.Conclusion: Conclusion: Treatment with integrated KM treatment improved the pain, range of motion, shoulder function, and quality of life of patients with SIS.

Subacromial Impingement Syndrome: A Systematic Review of Existing Treatment Modalities to Newer Proprioceptive-Based Strategies

Musculoskeletal pain is a common reason for primary care visits, with many visits for shoulder pain due to subacromial impingement syndrome (SIS). Current treatments lack evidence for effective management, showing only temporary outcomes. This systematic review evaluates existing modalities in comparison to the use of more permanent proprioceptive-based strategies. Specifically, this meta-analysis compared the use of kinesiology tape, myofascial trigger point release (MPTR), scapular stabilization exercises (SSE), and resistance training. PubMed, BioMedCentral, and ScienceDirect databases were queried for studies evaluating proprioceptive-based exercises in the last nine years. In total, 48 studies met the inclusion and exclusion criteria. After removing duplicates, a total of 14 level 1 studies were left. Kinesiology tape use demonstrated a statistically significant reduction in pain-free range of motion. MPTR improved in all pain scores and the disability scores index. SSE also reduced pain; however, mixed results were seen for range of motion. Finally, resistance training not only reduced pain but improved proprioception and joint position sense. Even though all techniques showed some promise in treating SIS, further large-scale studies exploring related outcomes are needed.

Resident Case Series: Blood Flow Restriction as an Adjunct to Strengthening Exercises in Two Patients with Subacromial Impingement and High Irritability

Introduction

Evidence informed management of individuals presenting with subacromial impingement syndrome (SAIS) includes strengthening exercises directed at the shoulder musculature. Patients with subacromial impingement syndrome (SAIS) can present with pain during and after completion of heavy resistance training limiting the applicability of this recommended treatment approach. Blood flow restriction (BFR) training is indicated for patients who have pain while completing heavy resistance training and may represent an important treatment modification for patients with SAIS unable to fully participate in a strengthening exercise program. The purpose of this case series is to describe the inclusion of BFR in the treatment of two patients with SAIS.

Case descriptions

Two middle aged, non-operative patients with signs and symptoms consistent with SAIS and high levels of irritability were included. Treatment over one month consisted of three commonly used exercises in the treatment of SAIS in conjunction with a standard BFR protocol: 75 reps broken up into sets of 30,15,15,15 with the BFR cuff placed over proximal humerus.

Outcomes

Immediate within session improvements beyond measurement error were observed in resting pain and pain pressure thresholds at three sites. At the end of the course of treatment, clinically meaningful improvements were observed in patient reported outcomes including the PENN Score, ASES score, and the patient-specific functional scale. Clinically meaningful improvements and change beyond measurement error were also observed in range of motion and strength which (assessed via a handheld dynamometer).

Discussion

The incorporation of low load resistance training with BFR may be a useful adjunct for treating patients with SAIS to promote exercise-induced hypoalgesia, decrease pain, and increase function in the upper extremity.

Level of Evidence

5.

Does your sleeping position affect your shoulder pain?

Aim: This study aimed to evaluate patients with shoulder pain according to their sleeping positions based on their clinical and magnetic resonance imaging (MRI) findings and to determine possible factors affecting shoulder pain. Material and Method: A total of 115 patients were included in the study. The severity of shoulder pain was evaluated with the visual analog scale (VAS), shoulder function was evaluated with the simple shoulder test, and the ability to perform physical activities was evaluated with the QuickDASH questionnaire. The biceps tendon, rotator cuff (RC), subacromial-subdeltoid bursa, glenohumeral joint (GHJ), and acromioclavicular joint (ACJ) were evaluated using MRI. Results: Of the patients with shoulder pain, 66.1% were female, 50.4% were primary school graduates, 53.9% were housewives, and 41.7% had a systemic disease. The mean age of the patients was 50.48±13.61 years while the median BMI and VAS values were 26.1 (18.2-41.4) and 8 (2-10), respectively. Considering the sleeping positions, it was found that 39.1% (most common) of the patients were sleeping in the fetus position, and considering the results of patients’ MRI examinations, the most common problem was related to the pathologies of the supraspinatus tendon (42.6%). It was found that sleep quality, which was poor in all patients, was worse in females (p=0.311), in those over 50 years of age (p=0.007), and those with a systemic disease (0.325). It was discovered that Pittsburgh's sleep quality index score was generally worse in those who slept in the soldier position and in the log position (p>0.05). The rates of pathologies of the supraspinatus tendon were found to be the highest in those that slept in the fetus position (p=0.931). It was also found that the rates of impingement, bicipital tendinitis, combined problems, and adhesive capsulitis did not differ significantly according to sleeping positions. Although occupational variables for supraspinatus degeneration remained significant in the model, having a desk job statistically significantly increased the probability of supraspinatus degeneration by 3.38 times when compared to being a housewife (95% CI=1.143-9.996; p=0.028) and it was identified that the probability of acromioclavicular degeneration increased by 1.16 times for every 1-unit increase in BMI. Conclusion: Different sleeping positions may predispose to different shoulder pathologies and shoulder pain, and shoulder pathologies may lead to deterioration of sleep quality, especially in older patients. For this reason, suggesting correct and appropriate sleeping positions may be a useful treatment method in reducing pain and disability and increasing sleep quality.

Supraspinatus Fatty Infiltration Correlation with Handgrip Strength, Shoulder Strength, and Validated Patient-Reported Outcome Measures in Patients with Rotator Cuff Tears

Introduction

The purpose of this study was to investigate the relationships between supraspinatus atrophy on magnetic resonance imaging (MRI) and other objective parameters in patients with rotator cuff tears. It was hypothesized that high-grade supraspinatus fatty infiltration would be correlated negatively with handgrip strength, shoulder strength, and patient-reported outcome measures (PROMs).

Methods

Patients with MRI-proven rotator cuff tears treated by a single sports medicine fellowship-trained orthopaedist at a single institution underwent comprehensive preoperative evaluation including bilateral handgrip and shoulder strength measurements with dynamometers and multiple online questionnaires from the Surgical Outcomes SystemTM (Arthrex, Naples, FL). Available shoulder MRIs were reviewed to grade supraspinatus fatty infiltration severity according to the 5-tier Goutallier system and an alternate 3-tier classification scheme. Difference analysis and Spearman (rho) rank order correlation were applied to the collected data to define the relationships between supraspinatus fatty infiltration and key variables including handgrip strength, shoulder strength, and scores derived from the shoulder PROMs.

Results

Ninety of the 121 patients enrolled in the study had shoulder MRIs available for review. There was no correlation found between supraspinatus fatty infiltration and handgrip strength, shoulder abduction strength, or any of the seven common shoulder PROM scores evaluated. There was statistically significant, albeit weak, correlation between MRI-derived fatty infiltration and shoulder external rotation strength.

Conclusions

Contrary to the hypothesis, high-grade supraspinatus fatty infiltration is largely unrelated to and should not be considered predictive of handgrip strength, shoulder strength, or common shoulder PROM scores.

Arthroscopic Subacromial Decompression in the Treatment of Shoulder Impingement Syndrome: A Prospective Study in Malaysia

Introduction

Shoulder impingement syndrome (SIS) is one of the common problems which lead to shoulder disabilities. This condition has been described as impingement to the rotator cuff by the anterior third of the acromion process and has been classified into three stages. Treatment option varies depending on the grade of the disease. Arthroscopic subacromial decompression (ASAD) has become more popular in recent years and has shown to have a good outcome. The purpose of this study is to evaluate the outcomes following ASAD in terms of the functional, clinical, and radiological parameters in treating SIS in the ageing population in Kuantan, Pahang, Malaysia.

Materials and methods

This was an observational study looking at the outcomes of patients with stage 2 and stage 3 (partial cuff tear) impingement syndrome who underwent ASAD in Hospital Tengku Ampuan Afzan and International Islamic University Malaysia Medical Centre from May 2018 to June 2019. The functional outcomes were evaluated using American Shoulder and Elbow Surgeons (ASES) score taken at pre-operative, six weeks, three months, and six months post-operation. Clinical outcomes were evaluated using Constant score (CS) taken at six months post-operation. Radiological outcomes were measured by comparing acromiohumeral distance pre- and post-operation on anteroposterior (AP) view radiograph of the affected shoulder.

Results

A total of 28 patients were selected for the study. On functional outcome, there was a significant effect of time on the ASES scoring system (p-value <0.05) from pre-operative to six months post-operation. On clinical outcome, the CS at six months showed 13 patients have excellent scores, 10 have good, and five have fair scores. There was a statistically significant difference in mean values of all categories (p-value <0.05). In terms of the radiological outcome, this study observed a significant increase in patients’ subacromial space on X-ray from the pre-operative and post-operative treatment stages. In this study, we also observed that there was no significant difference in outcomes between partial and intact rotator cuff (RC) tears at six-month post-operation.

Conclusion

In this study, ASAD was found to be a beneficial intervention in the treatment of patients with shoulder impingement evidenced by the significant outcomes in terms of functional, clinical, and radiological parameters.

Generalizability of Eccentric Exercise for Patients with Subacromial Pain Syndrome to Real-world Clinical Practice: A Propensity Score-based Analysis

Objectives:

Subacromial pain syndrome is a common problem in primary care. Although several randomized controlled trials have shown that eccentric exercise is effective in patients with subacromial pain syndrome, its generalizability to real-world clinical practice is unknown. This study aimed to investigate, using propensity score analysis, the generalizability of eccentric exercise for patients with subacromial pain syndrome to real-world daily clinical practice.

Methods:

In this study, 78 patients underwent eccentric exercise in addition to traditional exercise, and 77 patients underwent only traditional exercise for 4 weeks. Outcomes measured using a visual analog scale (VAS) and American Shoulder and Elbow Surgeons Society Standardized Shoulder Assessment Form (ASES) scores were assessed at baseline and at 4 weeks.

Results:

In the propensity score-matched analysis, 65 patients in each group were successfully matched (130 of 155 patients, 84% overall). After 4 weeks of exercise, pain intensity was lower in the eccentric exercise group than in the traditional exercise group (VAS −14.5, 95% CI −21.2 to −7.9, P<0.001). No significant difference in the improvement in function was found between the two groups (ASES 4.1, 95% CI −2.0 to 10.2, P=0.18).

Conclusions:

Eccentric and traditional exercise in combination could reduce pain in patients with subacromial pain syndrome to a greater extent than traditional exercise alone. These findings have clinical relevance to primary care practitioners who provide conservative treatment for patients with subacromial pain syndrome.

Temperature and current flow effects of different electrode placement in shoulder capacitive-resistive electric transfer applications: a cadaveric study

BACKGROUND

Impingement syndrome is currently estimated to represent 60% of all shoulder pain disorders. Capacitive-Resistive electric transfer therapy is aimed to provoke temperature and current flow changes in superficial and deep tissues. This in vitro study has evaluated the variation of temperature and current flow in the shoulder tissues during two different areas of application of the movable capacitive-resistive electric transfer electrode.

METHODS

A cross-sectional study designed, five fresh cryopreserved cadavers (10 shoulders) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) were performed for 5 min each by a diathermy "T-Plus" device in two shoulder regions: postero-superior and antero-lateral. Supraspinatus tendon, glenohumeral capsule and superficial temperatures were recorded at 1-min intervals and 5 min after treatment.

RESULTS

A statistically significant difference was found only for the superficial area and time interaction, with high power-resistive application at the postero-superior shoulder area (P< 0.035). All the applications showed a 5 min after treatment temperature increase compared with the basal data, in all the application points. Superficial temperature in the high power-resistive application showed the greatest percent increase (42.93% ± 22.58), followed by the temperature in the tendon area with the same high power-resistive application (22.97% ± 14.70). The high power-resistive application showed the greatest percent of temperature increase in the applications, reaching 65.9% ± 22.96 at 5-min at the superficial level, and 32% ± 24.25 at 4-min at the level of the supraspinatus tendon. At the capsule level, high power-resistive was also the application that showed the greatest percent of increase, with 21.52% ± 16.16. The application with the lowest percent of temperature increase was the low power-capacitive, with a mean value of 4.86% at supraspinatus tendon level and 7.47% at capsular level.

CONCLUSION

The shoulder postero-superior or antero-lateral areas of application of capacitive-resistive electric transfer did not cause statistically significant differences in the temperature changes in either supraspinatus tendon or glenohumeral capsule tissues in cadaveric samples. The high power-resistive application in the postero-superior area significantly increased superficial temperature compared with the same application in the antero-lateral position area.

Subacromial impingement syndrome: a survey of Italian physiotherapists and orthopaedics on diagnostic strategies and management modalities

BACKGROUND AND AIM

The subacromial impingement syndrome (SIS) represents a common cause of disability in approximately 74% of patients with Shoulder Pain (SP). Even if contemporary research suggests that this mechanism is not (always) the dominant driver in SP, SIS is still a source of debate among scholars and clinicians. From a clinical point of view, evidence has suggested that clinicians can use both medical and physiotherapy approaches as effective methods to treat SIS.This survey aims to investigate models of management of patients with SIS in a sample of Italian physiotherapist specialists (Orthopaedic Manipulative Physical Therapists, -OMPTs-) and orthopaedic surgeons.

MATERIALS AND METHODS

An online survey with 29-item questionnaire was administered to assess the knowledge of OMPTs and orthopaedic surgeons about: a) strategies of clinical examination; b) the role of imaging in the diagnostic process; c) the physiotherapy management; and d) the pharmacological and surgical management in patients with SIS.

RESULTS

Six-hundred and twenty-nine respondents completed the survey (511 OMPTs (79.97%) and 128 orthopaedic surgeons (20.03%)). Ninety-two percent (n = 470) of the OMPTs and 80.5% (n = 103) of orthopaedic surgeons stated that in patients with SIS, a combination of diagnostic tests produced better accuracy (p = < 0.001). Twenty point seven % of OMPTs (n = 106) and 4.7% of orthopaedic surgeon (n = 6) stated that the Lift off was the most specific test (p = < 0.001). Four-hundred-and-twenty-four OMPTs (83%) and 40 orthopaedic surgeons (31.3%) answered that the gold standard for diagnosis of a patient with SIS are history and clinical examination (p < 0.001).

CONCLUSION

OMPTs and orthopaedic surgeons approach patients with SIS differently during both the assessment and the treatment. OMPTs appear to be appropriate in planning and managing clinical examination and therapeutic strategies to use with patients with SIS.

Effects of capacitive and resistive electric transfer therapy in patients with painful shoulder impingement syndrome: a comparative study

Objective

Capacitive and resistive electric transfer therapy (CARE) reduces pain and improves quality of life for many orthopaedic degenerative and inflammatory disorders. The research aim was to determine the effects of CARE on painful shoulder. The outcomes were pain reduction and recovery of shoulder function.

Methods

A retrospective, observational case-control study was conducted. Participants were 46 patients (22 in the CARE group and 24 in the SHAM group). Clinical data, pain (visual analogic scale, VAS) and functional scale scores (Disabilities of the Arm, Shoulder and Hand scale, and Constant–Murley Scale) were measured at baseline T0 (before treatment), T1 (after treatment) and follow-up T2 (2 months after the end of the treatment).

Results

VAS scores in the CARE group improved from 7.23 ± 1.11 at baseline to 2.68 ± 0.99 at follow-up. The SHAM group did not experience any improvement. Similarly, functional scale scores improved in the CARE group compared with the SHAM group.

Conclusion

Considering the small number of sessions needed, low cost and long-term benefits, CARE could be a useful therapeutic option for the conservative management of shoulder pain to restore pain-free and powerful movement to the shoulder joint.