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Marc T, Morana C. Effectiveness of a joint mobilizations protocol for shoulder subacromial pain syndrome: A pilot study. J Bodyw Mov Ther 2024; 38:574-582. [PMID: 38763611 DOI: 10.1016/j.jbmt.2024.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Subacromial pain syndrome (SPS) is the most frequent shoulder pathology. The aims of this prospective randomized study were to evaluate the effects of some specific shoulder joint mobilizations ("spin correction"), and the effectiveness of a rehabilitation program, named Shoulder Global Concept, in SPS patients. METHODS 45 patients with SPS were randomly assigned to two groups, to benefit from a different first session of mobilizations: the experimental group received all specific mobilizations, while the control group received the same program but without the spin correction mobilizations. The second session was identical for both groups, with all specific mobilizations. Before and after the first two sessions, range of motion (ROM) in flexion, abduction, external and internal rotations, pain and functional status with Constant score and Quick Dash were evaluated. Evaluation was repeated with 24 patients after 11 rehabilitation sessions. Rehabilitation with Shoulder Global Concept included 13 mobilizations aiming at improving the ROM with passive and active-assisted mobilizations, static stretching, and muscle strengthening. RESULTS All ROM were improved at the end of the first session for both groups, but significantly more in the experimental group for glenohumeral (GH) abduction and external rotation (p < 0.05). Functional scores, pain and strength were significantly improved after 11 rehabilitation sessions with the Shoulder Global Concept. CONCLUSION This manual therapy method was able to improve shoulder mobility in one session. The additional joint mobilizations (spin correction) specifically increased GH abduction and external rotation. Rehabilitation of SPS with Shoulder Global Concept allowed to improve functional capacity and decrease pain.
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Affiliation(s)
- Thierry Marc
- Centre de Rééducation Spécialisé, Montpellier, France
| | - Claire Morana
- Centre de Rééducation Spécialisé, Montpellier, France.
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Libardoni TDC, Armijo-Olivo S, Bevilaqua-Grossi D, de Oliveira AS. Relationship Between Intensity of Neck Pain and Disability and Shoulder Pain and Disability in Individuals With Subacromial Impingement Symptoms: A Cross-Sectional Study. J Manipulative Physiol Ther 2020; 43:691-699. [PMID: 32861520 DOI: 10.1016/j.jmpt.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/14/2018] [Accepted: 01/24/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to verify a possible relationship between shoulder disability and shoulder pain intensity and the variables related to cervical-spine dysfunction, and determine which of these can differentiate moderate to severe shoulder pain (>4 on a numerical rating scale [NRS]) from mild shoulder pain (≤4 on the NRS) in individuals with subacromial impingement symptoms. METHODS One hundred and forty volunteers with shoulder pain were evaluated. Demographic information and variables related to the shoulder and neck were collected. Self-reported pain and disability of the shoulder and cervical spine were measured using the Shoulder Pain and Disability Index (SPADI) and Neck Disability Index (NDI) questionnaires, respectively. An NRS was used to measure pain in the shoulder and cervical spine. A purposeful modeling strategy was used to determine the best model to predict shoulder disability and shoulder pain (dependent variables). Multiple logistic regression analysis followed by receiver operating curve analysis was used to determine which variables better differentiated moderate to severe shoulder pain from mild shoulder pain. RESULTS Variables such as Neck Disability Index (NDI) score (β = 1.09, P = .00) and age (β = -0.19, P = .03) were associated with the total SPADI score. Neck pain was significantly associated with shoulder pain (β = 0.40, P = .00). The combination of variables predicting moderate to severe shoulder pain was total SPADI score (odds ratio [OR] = 1.15, P = .003), neck pain (OR = 3.20, P = .04), and age (OR = 1.01, P = .05). CONCLUSION Our results demonstrate the important connection between shoulder- and neck-related symptoms in individuals with subacromial impingement symptoms.
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Affiliation(s)
- Thiele de Cássia Libardoni
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine/Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada
| | - Débora Bevilaqua-Grossi
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Chiu YC, Tsai YS, Shen CL, Wang TG, Yang JL, Lin JJ. The immediate effects of a shoulder brace on muscle activity and scapular kinematics in subjects with shoulder impingement syndrome and rounded shoulder posture: A randomized crossover design. Gait Posture 2020; 79:162-169. [PMID: 32416434 DOI: 10.1016/j.gaitpost.2020.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 03/21/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Round shoulder posture (RSP) is one of the potential risks for shoulder impingement syndrome (SIS) due to alignment deviation of the scapula. Evidence on how the characteristics of a shoulder brace affecting the degree of RSP, shoulder kinematics, and associated muscle activity during movements is limited. RESEARCH QUESTION The purposes of this study were (1) to compare the effects of a shoulder brace on clinical RSP measurements, muscle activities and scapular kinematics during arm movements in subjects with shoulder impingement syndrome (SIS) and RSP; and (2) to compare the effects of two configurations (parallel and diagonal) and two tensions (comfortable and forced tension) of the brace straps on muscle activities and scapular kinematics during arm movements in subjects with SIS and RSP. METHODS Twenty-four participants (12 males; 12 females) with SIS and RSP were randomly assigned into 2 groups (comfortable then forced, and forced then comfortable) with 2 strap configurations in each tension condition. The pectoralis minor index (PMI), acromial distance (AD) and shoulder angle (SA) were used to assess the degree of RSP. Three-dimensional electromagnetic motion analysis and electromyography were used to record the scapular kinematics and muscle activity during arm movements. RESULTS All clinical measurements with the brace were significantly improved (p < 0.05). Under forced tension, muscle activities were higher with the diagonal configuration than with the parallel configuration in the lower trapezius (LT) (1.2-2.3% MVIC, p < 0.05) and serratus anterior (SA) (2.3% MVIC, p = 0.015). For upward rotation and posterior tilting of the scapula, the diagonal configuration was larger than the parallel configuration (1.5°, p = 0.038; 0.4°-0.5°, p < 0.05, respectively). SIGNIFICANCE Different characteristics of the straps of the shoulder brace could alter muscle activity and scapular kinematics at different angles during arm movement. Based on the clinical treatment preference, the application of a shoulder brace with a diagonal configuration and forced tension is suggested for SIS and RSP subjects.
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Affiliation(s)
- Yuan-Chun Chiu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan
| | - Yung-Shen Tsai
- Department of Sports Sciences and Institute of Sports Equipment Technology, University of Taipei, Taiwan
| | - Chien-Lung Shen
- Department of Products, Taiwan Textile Research Institute, Taiwan
| | - Tyng-Guey Wang
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan
| | - Jing-Lan Yang
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan.
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan; Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taiwan.
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Cleland T, Jain NB, Chae J, Hansen KM, Hisel TZ, Gunzler DD, Whitehair VC, Kim CH, Wilson RD. The protocol for a multisite, double blind, randomized, placebo-controlled trial of axillary nerve stimulation for chronic shoulder pain. Trials 2020; 21:248. [PMID: 32143732 PMCID: PMC7059286 DOI: 10.1186/s13063-020-4174-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shoulder impingement syndrome is one of the most common causes of shoulder pain, accounting for approximately 30% of all shoulder pain. Approximately 35% of patients with shoulder impingement syndrome are refractory to conservative treatment. For patients who fail conservative treatment, there is no established treatment to successfully treat their chronic pain. Prior randomized control trials have demonstrated efficacy for the use of a single lead intramuscular peripheral nerve stimulation of the axillary nerve at the motor points of the deltoid muscle for treatment of hemiplegic shoulder pain. This is the first controlled trial to utilize the same novel technology to treat shoulder impingement syndrome outside of the stroke population. METHODS This is a dual-site, placebo-controlled, double-blinded, randomized control trial. Participants will be randomized to two treatment groups. The intervention group will be treated with active peripheral nerve stimulation of the axillary nerve of the affected shoulder and the control group will be treated with sham peripheral nerve stimulation of the axillary nerve of the affected shoulder. Both groups will receive a standardized exercise therapy program directed by a licensed therapist. DISCUSSION This study protocol will allow the investigators to determine if this novel, non-pharmacologic treatment of shoulder pain can demonstrate the same benefit in musculoskeletal patients which has been previously demonstrated in the stroke population. TRIAL REGISTRATION Clinicaltrials.gov, NCT03752619. Registered on 26 November 2018.
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Affiliation(s)
- Travis Cleland
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Nitin B. Jain
- Vanderbilt University Medical Center, 3319 West End Ave, Nashville, TN 37203 USA
| | - John Chae
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Kristine M. Hansen
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Terri Z. Hisel
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Douglas D. Gunzler
- Center for Healthcare Research and Policy, MetroHealth System, 2500 MetroHealth Dr., Cleveland, OH 44109 USA
| | - Victoria C. Whitehair
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Chong H. Kim
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
| | - Richard D. Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Rd, N5-27, Cleveland, OH 44109 USA
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Mozingo JD, Akbari-Shandiz M, Murthy NS, Van Straaten MG, Schueler BA, Holmes DR, McCollough CH, Zhao KD. Shoulder mechanical impingement risk associated with manual wheelchair tasks in individuals with spinal cord injury. Clin Biomech (Bristol, Avon) 2020; 71:221-229. [PMID: 32035338 PMCID: PMC7050284 DOI: 10.1016/j.clinbiomech.2019.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most individuals with spinal cord injury who use manual wheelchairs experience shoulder pain related to wheelchair use, potentially in part from mechanical impingement of soft tissue structures within the subacromial space. There is evidence suggesting that scapula and humerus motion during certain wheelchair tasks occurs in directions that may reduce the subacromial space, but it hasn't been thoroughly characterized in this context. METHODS Shoulder motion was imaged and quantified during scapular plane elevation with/without handheld load, propulsion with/without added resistance, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury using biplane fluoroscopy and computed tomography. For each position, minimum distance between rotator cuff tendon insertions (infraspinatus, subscapularis, supraspinatus) and the coracoacromial arch was determined. Tendon thickness was measured with ultrasound, and impingement risk scores were defined for each task based on frequency and amount of tendon compression. FINDINGS Periods of impingement were identified during scapular plane elevation and propulsion but not during pressure reliefs in most participants. There was a significant effect of activity on impingement risk scores (P < 0.0001), with greatest impingement risk during scapular plane elevation followed by propulsion. Impingement risk scores were not significantly different between scapular plane elevation loading conditions (P = 0.202) or propulsion resistances (P = 0.223). The infraspinatus and supraspinatus tendons were both susceptible to impingement during scapular plane elevation (by acromion), whereas the supraspinatus was most susceptible during propulsion (by acromion and coracoacromial ligament). INTERPRETATION The occurrence of mechanical impingement during certain manual wheelchair tasks, even without increased load/resistance, demonstrates the importance of kinematics inherent to a task as a determinant of impingement. Frequency of and technique used to complete daily tasks should be carefully considered to reduce impingement risk, which may help preserve shoulder health long-term.
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Affiliation(s)
- Joseph D Mozingo
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - David R Holmes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
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Savva C, Mougiaris P, Xadjimichael C, Karagiannis C, Efstathiou M. Test-Retest Reliability of Handgrip Strength as an Outcome Measure in Patients With Symptoms of Shoulder Impingement Syndrome. J Manipulative Physiol Ther 2019; 41:252-257. [PMID: 29549892 DOI: 10.1016/j.jmpt.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 07/30/2017] [Accepted: 09/08/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the degree of test-retest reliability of grip strength measurement using a hand dynamometer in patients with shoulder impingement syndrome. METHODS A total of 19 patients (10 women and 9 men; mean ± standard deviation age, 33.2 ± 12.9 years; range 18-59 years) with shoulder impingement syndrome were measured using a hand dynamometer by the same data collector in 2 different testing sessions with a 7-day interval. During each session, patients were encouraged to exert 3 maximal isometric contractions on the affected hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC2,1) as well as the standard error of measurement (SEM) and Bland-Altman plot were used to estimate the degree of test-retest reliability and the measurement error, respectively. RESULTS Grip strength data analysis revealed an ICC2,1 score of 0.94, which, based on the Shrout classification, is considered as excellent test-retest reliability of grip strength measurement. The small values of SEMs reported in both sessions (SEM1, 2.55 Kgf; SEM2, 2.39 Kgf) and the small width of the 95% limits of agreement in the Bland-Altman plot (ranging from -7.39 Kgf to 7.03 Kgf) reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. CONCLUSIONS Results from this study identified excellent test-retest reliability of grip strength measurement in shoulder impingement syndrome, indicating its potential use as an outcome measure in clinical practice.
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Affiliation(s)
- Christos Savva
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.
| | - Paraskevas Mougiaris
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | | | - Christos Karagiannis
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | - Michalis Efstathiou
- Department of Life and Health Science, 46 Makedonitissas Avenue, Engomi, University of Nicosia, Cyprus
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Papalia R, Torre G, Papalia G, Baums MH, Narbona P, Di Lazzaro V, Denaro V. Frozen shoulder or shoulder stiffness from Parkinson disease? Musculoskelet Surg 2019; 103:115-119. [PMID: 30276531 DOI: 10.1007/s12306-018-0567-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To understand the role of camptocormia (increased kyphosis) and postural alteration in Parkinson's disease in the development of shoulder pathology, with a special concern for adhesive capsulitis and shoulder stiffness. METHODS A preliminary online search was carried out, with combination of keywords including "Parkinson," "Shoulder stiffness," "Frozen shoulder," "Adhesive capsulitis," "Postural alteration," "Camptocormia". The retrieved papers were screened by title and abstract and those considered relevant to the aim of the review were read in full text and included. Relevant information were extracted and reported into text. RESULTS Due to a severe impairment of posture, patients affected by PD show an increased thoracic kyphosis (camptocormia) and decreased mobility of the trunk that can yield a humeroacromial impingement syndrome and capsulitis, resulting in inflammation of the bursa, shoulder pain and reduction of movement. Furthermore, kinematic of the shoulder is allowed by the combined movement of the humerus, the scapula, the clavicle, the thoracic wall and thoracic spine. The thoracic spine and wall mobility are severely impaired in the parkinsonian patient, thus limiting the shoulder motion. CONCLUSION The postural alteration observed in PD is the primum movens for shoulder pathology, since anterior tilt of the scapula, which occurs with the increment of thoracic kyphosis, yields to a subacromial impingement. A closed loop is then created, as the rigidity of the shoulder causes further alteration in the posture, which worsens the impingement syndrome and so on.
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Affiliation(s)
- R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - G Torre
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - G Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - M H Baums
- Department of Orthopaedic Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - P Narbona
- Departamento de Artroscopía, Sanatorio Allende, Córdoba, Argentina
| | - V Di Lazzaro
- Institute of Neurology, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Navarro-Ledesma S, Fernandez-Sanchez M, Struyf F, Martinez-Calderon J, Miguel Morales-Asencio J, Luque-Suarez A. Differences in scapular upward rotation, pectoralis minor and levator scapulae muscle length between the symptomatic, the contralateral asymptomatic shoulder and control subjects: a cross-sectional study in a Spanish primary care setting. BMJ Open 2019; 9:e023020. [PMID: 31196895 PMCID: PMC6575639 DOI: 10.1136/bmjopen-2018-023020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the potential differences in both scapular positioning and scapular movement between the symptomatic and asymptomatic contralateral shoulder, in patients with unilateral subacromial pain syndrome (SAPS), and when compared with participants free of shoulder pain. SETTING Three different primary care centres. PARTICIPANTS A sample of 73 patients with SAPS in their dominant arm was recruited, with a final sample size of 54 participants. PRIMARY OUTCOME MEASURES The scapular upward rotation (SUR), the pectoralis minor and the levator scapulae muscles length tests were carried out. RESULTS When symptomatic shoulders and controls were compared, an increased SUR at all positions (45°, 90° and 135°) was obtained in symptomatic shoulders (2/3,98/8,96°, respectively). These differences in SUR surpassed the minimal detectable change (MDC95) (0,91/1,55/2,83° at 45/90/135° of shoulder elevation). No differences were found in SUR between symptomatic and contralateral shoulders. No differences were found in either pectoralis minor or levator scapulae muscle length in all groups. CONCLUSIONS SUR was greater in patients with chronic SAPS compared with controls at different angles of shoulder elevation.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physiotherapy, University of Granada. Faculty of Health Sciences, Granada, Spain
- Department of Physiotherapy, University of Malaga. Faculty of Health Sciences, Malaga, Spain
| | | | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Universiteit Antwerpen, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | | | - Jose Miguel Morales-Asencio
- Universidad de Málaga. Facultad de Ciencias de la Salud. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Department of Nursing, University of Malaga. Faculty of Health Sciences, Malaga, Spain
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, University of Malaga. Faculty of Health Sciences, Malaga, Spain
- Universidad de Málaga. Facultad de Ciencias de la Salud. Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
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Caceres AP, Permeswaran VN, Goetz JE, Hettrich CM, Anderson DD. The Influence of Different Rotator Cuff Deficiencies on Shoulder Stability Following Reverse Shoulder Arthroplasty. Iowa Orthop J 2019; 39:63-68. [PMID: 31413676 PMCID: PMC6604531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The primary indication for reverse shoulder arthroplasty (RSA) is rotator cuff arthropathy caused by a deficient rotator cuff. Cuff deficiency in patients is highly variable in its distribution and extent, with mechanical implications that may significantly affect post-operative recovery. This study investigated the effects of variable cuff deficiency on the propensity for impingement between the scapula and humeral component and resulting subluxation, the source of two common complications (scapular notching and instability). METHODS Five different finite element models of an RSA were analyzed with varying degrees of rotator cuff deficiency: (1) baseline, with intact subscapularis, infraspinatus and teres minor, (2) no subscapularis, (3) no subscapularis or infraspinatus, (4) no infraspinatus, and (5) no infraspinatus or teres minor. The supraspinatus was not included in any models, as it is absent in rotator cuff arthropathy. Each model was moved through a prescribed arc of 45° internal/ external rotation originating from neutral. RESULTS Greater rotator cuff deficiency was associated with more impingement and larger magnitudes of subluxation. The largest subluxation (7.5 mm) and highest impingement-related contact stress (479 MPa) was in the model lacking all rotator cuff muscle groups. Posterior subluxation was present in most models lacking the infraspinatus, while anterior subluxation was present in all models lacking the subscapularis. CONCLUSIONS This study helps clarify how different rotator cuff deficiencies influence shoulder stability following RSA and can ultimately help predict which patients may be at greater risk for impingement-related scapular notching and subluxation. CLINICAL RELEVANCE Surgeons should carefully consider the nature of the rotator cuff deficiency and its influence on impingement and instability when planning for RSA.Level of Evidence: V.
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Affiliation(s)
- Andrea P. Caceres
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA USA
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA USA
| | - Vijay N. Permeswaran
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA USA
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA USA
| | - Jessica E. Goetz
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA USA
- Department of Biomedical Engineering, The University of Iowa, Iowa City, IA USA
| | - Carolyn M. Hettrich
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA USA
| | - Donald D. Anderson
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, IA USA
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Kim SJ, Jang SW, Jung KH, Kim YS, Lee SJ, Yoo YS. Analysis of impingement-free range of motion of the glenohumeral joint after reverse total shoulder arthroplasty using three different implant models. J Orthop Sci 2019; 24:87-94. [PMID: 30268356 DOI: 10.1016/j.jos.2018.08.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/05/2018] [Accepted: 08/08/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND This study aimed to investigate impingement-free range of motion (ROM) of the glenohumeral joint following reverse total shoulder arthroplasty (RTSA) with three types of implant models using computational motion analysis. METHODS Three-dimensional (3D) scapulohumeral models were created from preoperative computed tomography (CT) images of seven patients by using visualization and computer-aided design software. Three types of implant designs, namely, typical medialization, in between, and lateralization implants, were used for the reconstruction of 3D model; each design was designated as group I, II, and III, respectively. All possible combinations of virtual surgeries were evaluated for impingement-free ROM in all three groups. Maximal ROMs were compared. The effect of implant positions on ROM of the shoulder joints were investigated in each group. RESULTS The all lateralization group (group III) showed significantly greatest maximal adduction, abduction and external rotation (ER). Adduction and abduction were significantly increased by the glenoid component inferior translation in all three groups. (In group I, p < 0.001 for adduction, p = 0.002 for abduction, respectively; in group II, p = 0.025, p < 0.001, respectively; in group III, p = 0.038, p = 0.011, respectively). Increasing humerus retroversion might have some effect on increasing abduction. In group II and III, internal rotation (IR) and ER were significantly affected by the humerus retroversion (in group II, p = 0.033 for IR, p = 0.007 for ER, respectively; in group III, p = 0.004, p < 0.001, respectively). In group III, ER was also significantly affected by the glenoid component inferior translation (p = 0.003). CONCLUSIONS Lateralization design model showed greatest ROM of the shoulder joint. The effects of implant positions on impingement-free ROM exhibited different tendencies between medialization and lateralization implant models. Humerus retroversion affected both IR and ER, especially in lateralization design. Increasing glenoid inferior translation increases both adduction and abduction regardless of implant designs.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopaedic Surgery, Dongtan Sacred Hospital, Hallym University, College of Medicine, Hwasung, Republic of Korea
| | - Seong-Wook Jang
- School of Computer Science and Engineering, Korea University of Technology and Education (KOREATECH), Cheonan, Republic of Korea
| | - Koo-Hyun Jung
- Department of Orthopaedic Surgery, Dongtan Sacred Hospital, Hallym University, College of Medicine, Hwasung, Republic of Korea
| | - Yoon Sang Kim
- School of Computer Science and Engineering, Korea University of Technology and Education (KOREATECH), Cheonan, Republic of Korea
| | - Seung-Jin Lee
- Department of Orthopaedic Surgery, Dongtan Sacred Hospital, Hallym University, College of Medicine, Hwasung, Republic of Korea
| | - Yon-Sik Yoo
- Department of Orthopaedic Surgery, Dongtan Sacred Hospital, Hallym University, College of Medicine, Hwasung, Republic of Korea.
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Golz A, Mica MC, Salazar D, Pellegrini A, Tonino P. Comparison of Scapular Mechanics After Activity With and Without a Targeted Compression Garment. J Surg Orthop Adv 2019; 28:18-23. [PMID: 31074732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Muscle fatigue can result in scapular dyskinesis, which has been implicated in impingement, labral injury, and rotator cuff injury. This study evaluated the ability of a compression shirt to maintain scapular alignment after fatiguing of periscapular musculature. Subjects' scapular movements were monitored before and after a periscapular muscle- fatiguing exercise program. In the anterior and posterior tilt and medial and lateral rotation dimensions, control and shirt subjects both exhibited differences between the prefatigue and postfatigue measurements throughout humeral elevation. In the retraction and protraction dimension, control subjects exhibited differences between prefatigue and postfatigue measurements for a large portion of elevation, while shirt subjects only had different measurements toward the extreme of shoulder flexion. Thus the shirt does not stabilize the scapula in the anterior and posterior tilt and medial and lateral rotation dimensions. In the retraction and protraction dimension, the shirt provides stability to the scapula and maintains prefatigue position. It is currently unclear if preserving one plane of scapular motion has clinical significance. (Journal of Surgical Orthopaedic Advances 28(1):18-23, 2019).
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Affiliation(s)
- Andrew Golz
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois; e-mail:
| | - Michael Conti Mica
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Andrea Pellegrini
- Orthopaedic and Traumatologic Department, Parma University, Parma, Italy
| | - Pietro Tonino
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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12
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Keener JD, Patterson BM, Orvets N, Aleem AW, Chamberlain AM. Optimizing reverse shoulder arthroplasty component position in the setting of advanced arthritis with posterior glenoid erosion: a computer-enhanced range of motion analysis. J Shoulder Elbow Surg 2018; 27:339-349. [PMID: 29332666 DOI: 10.1016/j.jse.2017.09.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/28/2017] [Accepted: 09/09/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our study purpose was to determine the optimal glenoid and humeral reverse shoulder arthroplasty (RSA) component design and position in osteoarthritic shoulders with severe glenoid retroversion deformities. METHODS Computed tomography scans from 10 subjects were analyzed with advanced software including RSA range of motion (ROM) analysis. Variables included glenoid component retroversion of 0°, 5°, 10°, 15°, and 20° and baseplate lateralization of 0, 5, and 10 mm. Humeral variables included 135°, 145°, and 155° angle of inclination (AOI) combined with variable humeral offset. RESULTS Glenoid component lateralization had the greatest influence on ROM. In comparing each ROM direction among all lateralization options independently, there were significantly greater adduction, abduction, external rotation, extension, and flexion motions with progressively greater lateralization. Internal rotation motion was greater at 10 mm only. In analyzing the effects of glenoid version independently, no differences in adduction or abduction ROM were seen. With greater retroversion, decreased external rotation and extension motion was noted; however, greater internal rotation and flexion motion was seen with the exception of flexion at 10 mm of lateralization. For adduction, external rotation, and extension, a more valgus AOI resulted in less ROM at each progressively greater AOI independent of humeral lateralization. Internal rotation and flexion motions were greater with a more varus AOI but not significant between each inclination angle. Abduction ROM was maximized with a more valgus AOI. Humeral lateralization had no effect on ROM. CONCLUSIONS In the setting of RSA for advanced glenoid osteoarthritic deformities, optimal ROM is achieved with 10-mm baseplate lateralization and neutral to 5° of retroversion mated to a humeral implant with a varus (135°) inclination angle.
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Affiliation(s)
- Jay D Keener
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA.
| | - Brendan M Patterson
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Nathan Orvets
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
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Šmíd P, Hart R, Komzák M, Paša L, Puskeiler M. [Treatment of the Shoulder Impingement Syndrome with PRP Injection]. Acta Chir Orthop Traumatol Cech 2018; 85:261-265. [PMID: 30257756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF THE STUDY This study aimed to explore the effects of new therapeutic procedures in patients with shoulder impingement syndrome. The primary goal of the study was to confirm the hypothesis that the application of the platelet-rich plasma (PRP) in patients with shoulder impingement syndrome will have a positive effect on both the subjective and objective evaluation of their condition. The clinical condition before and after the treatment was evaluated. The secondary goal was to compare the effect achieved by a series of 3 PRP injections and that achieved by treating the impingement syndrome with a standard single depot corticosteroid injection. MATERIAL AND METHODS The randomized prospective blinded study carried out in the period 2013-2015 included 25 patients (Group I), to whom 3 PRP injections were applied in the subacromial (SA) space at a 1-week interval at the outpatient department. The control group of 25 patients (Group II) was treated by a standard single depot corticosteroid injection applied in the SA space. The subjective and objective conditions were evaluated immediately before the treatment, at 6 weeks, 3 months and 6 months after the administration of the injection. The evaluation comprised a physical examination, an evaluation using the Visual Analogue Scale (VAS), ASES (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form) and the Constant score. A part of the study was the statistical processing of the results. RESULTS Both the groups were comparable when assessing the mean age of patients as well as the share of both sexes in the groups; Group I with the mean age of 48.7 years (15 men and 10 women), Group II with the mean age of 50.1 years (16 men and 9 women), but also when assessing the baseline mean VAS score, Constant score and ASES score. In Group I, the baseline mean VAS score improved from 2.96 (range: 1-5; median: 3.0; SD: 0.77) to 2.0 (range: 1-3; median: 2.0; SD: 0.49) at 3 months after the administration and to the mean value of 1.16 (range: 0-2; median: 1.0; SO: 0.67) at 6 months after the last PRP injection. In Group II, the baseline mean VAS score improved from 3.12 (range: 2-5; median: 3.0; SD: 0.82) to the mean value of 2.16 (range: 1-4; median: 2.0; SD: 0.73) at 3 months after the administration of the depot corticosteroid injection and to 1.8 (range: 1-3; median: 2.0; SD: 0.57) at 6 months after the administration. In both the groups of patients, the p-value obtained by the Student s t-test was statistically significant (p < 0.05) when comparing the results of all the three scoring systems before the treatment and 6 months after the treatment. DISCUSSION Although the treatment of musculoskeletal disorders with the concentrate of a platelet-rich plasma (PRP) is a frequently used method, particularly in private medical practice, the scientific literature can offer just a very few studies studying in depth the use of this method of treatment in humane medicine. CONCLUSIONS Based on the results of our study, the hypothesis can be accepted that the concentrate of platelet-rich plasma administered through a series of 3 injections applied in the subacromial space in patients with shoulder impingement syndrome has positive effects on the daily activities of patients as well as on the objective evaluation via the selected scoring systems. Key words:platelet-rich plasma, shoulder impingement syndrome.
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Affiliation(s)
- P Šmíd
- Ortopedicko-traumatologické oddělení, Nemocnice Znojmo
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14
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Kontaxis A, Chen X, Berhouet J, Choi D, Wright T, Dines DM, Warren RF, Gulotta LV. Humeral version in reverse shoulder arthroplasty affects impingement in activities of daily living. J Shoulder Elbow Surg 2017; 26:1073-1082. [PMID: 28162877 DOI: 10.1016/j.jse.2016.11.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 11/17/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Impingement after reverse shoulder arthroplasty (RSA) has been correlated with implant design and surgical techniques. Previous studies suggested that humeral retroversion can reduce impingement and increase external rotation range of motion (ROM). The purpose of this study was to determine how humeral version affects impingement in activities of daily living (ADLs). MATERIALS AND METHODS A single surgeon performed virtual RSA on 30 arthritic shoulders that were reconstructed from preoperative computed tomography scans. For each subject, the humeral component was placed into 5 versions: -40°,-20°, 0°, +20°, and +40° (- indicates retroversion, + indicates anteversion). Intra-articular and extra-articular impingement was calculated for 10 ADLs. Impingement-free ROM was also calculated for abduction, forward flexion, scapula plane elevation, and internal/external rotation (standardized tests). Risk of impingement for ADLs was assessed as the collective duration and frequency of impingement across all motions. Frequent impingement sites were identified. RESULTS For the ADLs, 0° version showed the least amount of impingement. In contrast, 40° retroversion resulted in the largest ROM for the standardized tests (118° ± 19° abduction, 109° ± 16° forward flexion, 111° ± 10° scapula plane elevation, 140° ± 15° internal/external rotation). The site of impingement changed with version: retroversion increased the extra-articular impingement, and anteversion increased the contact between the inferior glenoid and the humeral cup. CONCLUSIONS Humeral version can significantly affect impingement in RSA. Maximizing ROM in standardized tests may not reduce the risk of impingement during ADLs. Our results showed that an average 0° of version should be preferred, but the large variability among subjects suggested that optimum version may vary among individuals.
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Affiliation(s)
- Andreas Kontaxis
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA.
| | - Xiang Chen
- Biomechanics Department, Hospital for Special Surgery, New York, NY, USA
| | - Julien Berhouet
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY, USA; Department of Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Choi
- Biomechanics Department, Hospital for Special Surgery, New York, NY, USA
| | - Timothy Wright
- Biomechanics Department, Hospital for Special Surgery, New York, NY, USA
| | - David M Dines
- Department of Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Russell F Warren
- Department of Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V Gulotta
- Department of Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
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Pekyavas NO, Ergun N. Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: Short term effect. Acta Orthop Traumatol Turc 2017; 51:238-242. [PMID: 28446376 PMCID: PMC6197467 DOI: 10.1016/j.aott.2017.03.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/08/2016] [Accepted: 06/07/2016] [Indexed: 11/16/2022]
Abstract
Objective The aim of this study was to compare the short term effects of home exercise program and virtual reality exergaming in patients with subacromial impingement syndrome (SAIS). Methods A total of 30 patients with SAIS were randomized into two groups which are Home Exercise Program (EX Group) (mean age: 40.6 ± 11.7 years) and Virtual Reality Exergaming Program (WII Group) (mean age: 40.33 ± 13.2 years). Subjects were assessed at the first session, at the end of the treatment (6 weeks) and at 1 month follow-up. The groups were assessed and compared with Visual Analogue Scale (based on rest, activity and night pain), Neer and Hawkins Tests, Scapular Retraction Test (SRT), Scapular Assistance Test (SAT), Lateral Scapular Slide Test (LSST) and shoulder disability (Shoulder Pain and Disability Index (SPADI)). Results Intensity of pain was significantly decreased in both groups with the treatment (p < 0.05). The WII Group had significantly better results for all Neer test, SRT and SAT than the EX Group (p < 0.05). Conclusion Virtual reality exergaming programs with these programs were found more effective than home exercise programs at short term in subjects with SAIS. Level of Evidence Level I, Therapeutic study.
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Affiliation(s)
| | - Nevin Ergun
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
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16
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Turgut E, Duzgun I, Baltaci G. Scapular asymmetry in participants with and without shoulder impingement syndrome; a three-dimensional motion analysis. Clin Biomech (Bristol, Avon) 2016; 39:1-8. [PMID: 27614041 DOI: 10.1016/j.clinbiomech.2016.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 08/21/2016] [Accepted: 09/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study analyzed the dynamic three-dimensional scapular kinematics and scapular asymmetry in participants with and without shoulder impingement syndrome. METHODS Twenty-nine participants with shoulder impingement syndrome, have been suffering from unilateral shoulder pain at the dominant arm lasting more than six weeks and thirty-seven healthy controls participated in the study. Scapular kinematics was measured with an electromagnetic tracking device during shoulder elevation in the sagittal plane. Data for bilateral scapular orientation were analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevation and lowering. The symmetry angle was calculated to quantify scapular asymmetry throughout shoulder elevation. FINDINGS Statistical comparisons indicated that the scapula was more downwardly rotated (p<0.001) and anteriorly tilted (p=0.005) in participants with shoulder impingement syndrome compared to healthy controls. Side-to-side comparisons revealed that the scapula was more anteriorly tilted on the involved side of participants with shoulder impingement syndrome (p=0.01), and the scapula was rotated more internally (p=0.02) and downwardly (p=0.01) on the dominant side of healthy controls. Although there were side-to-side differences in both groups, symmetry angle calculation revealed that the scapular movement was more asymmetrical for scapular internal and upward rotation in individuals with shoulder impingement syndrome when compared with healthy controls (p<0.05). INTERPRETATION The findings of the study increase our knowledge and understanding of scapular alterations in symptomatic and asymptomatic populations, which creates biomechanical considerations for shoulder assessment and rehabilitation.
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Affiliation(s)
- Elif Turgut
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100, Samanpazari, Ankara, Turkey.
| | - Irem Duzgun
- Hacettepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 06100, Samanpazari, Ankara, Turkey.
| | - Gul Baltaci
- Private Guven Hospital, Şimşek Sk. 29 D, Kavaklıdere, 06540 Ankara, Turkey.
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Vicenti G, Moretti L, De Giorgi S, Caruso I, La Malfa M, Carrozzo M, Solarino G, Moretti B. Thyroid and shoulder diseases: the bases of a linked channel. J BIOL REG HOMEOS AG 2016; 30:867-870. [PMID: 27655513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The association between thyroid disorders and musculoskeletal diseases has long been suspected, but it is still debated whether they have a role in the pathogenesis of shoulder diseases. In vivo and in vitro studies describe the role of thyroid hormones in bone, cartilage and tendon biology. Retrospective studies and case reports suggest that thyroid diseases should be considered as risk factors and hold prognostic value in some of the most common causes of shoulder pain. Thus, it is advisable to search for underlying thyroid disorders in these patients. The pathophysiologic mechanisms by which thyroid hormone imbalance affects the onset, progression and response to treatment of these diseases are yet to be thoroughly defined and demand further studies.
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Affiliation(s)
- G Vicenti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - L Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - S De Giorgi
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - I Caruso
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - M La Malfa
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - M Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - G Solarino
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
| | - B Moretti
- Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, ltaly
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Abstract
OBJECTIVE The short-term effectiveness of high-intensity laser therapy (HILT) was investigated as a retrospective case series for the treatment of the pain and disability associated with subacromial impingement syndrome (SAIS). MATERIALS AND METHODS A total of 42 patients, who were diagnosed with subacromial impingement syndrome, underwent a total of nine sessions (three sessions per week) of high-intensity laser therapy. The patients were evaluated before therapy and 8 weeks after therapy using the pain and disability subscales and the total scores of the Shoulder Pain and Disability Index (SPADI), as well as scores for the University of California at Los Angeles (UCLA) shoulder rating scale. RESULTS Significant differences were observed between SPADI pain, disability, and total scores and UCLA scores of the patients. CONCLUSIONS HILT was found to be effective in the short term in the treatment of pain and disability in patients with SAIS.
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Affiliation(s)
- Burcu Karaca
- Department of Physical Medicine and Rehabilitation, Kırıkkale University Faculty of Medicine , Kirrikale, Turkey
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Michener LA, Elmore KA, Darter BJ, Timmons MK. Biomechanical measures in participants with shoulder pain: Intra-rater reliability. ACTA ACUST UNITED AC 2015; 22:86-93. [PMID: 26578162 DOI: 10.1016/j.math.2015.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 12/29/2022]
Abstract
Biomechanical measures are used to characterize the mechanisms of treatment for shoulder pain. The objective was to characterize test-retest reliability and measurement error of shoulder surface electromyographic(sEMG) and kinematic measures. Individuals(n = 12) with subacromial pain syndrome were tested at 2 visits. Five repetitions of shoulder scapular plane elevation were performed while collecting sEMG of the upper trapezius(UT), middle trapezius(MT), lower trapezius(LT), serratus anterior(SA) middle-deltoid, and infraspinatus muscles during ascending and descending phases. Simultaneously, electromagnetic sensors measured 3-dimensional kinematics of scapular internal/external rotation, upward/downward rotation, posterior/anterior tilt, and clavicular elevation/depression and clavicular protraction/retraction. Kinematic and sEMG variables were reduced for the total phase of ascending and descending elevation (30°-120°, 120°-30°), at 30° intervals for sEMG, and at every 30° discrete kinematic angle. The intraclass correlation coefficients(ICC) ranged from 0.08 to 0.99 for sEMG and 0.23-0.95 for kinematics. Correspondingly, the standard error of the measurement(SEM) and minimal detectable change(MDC) for sEMG measures varied from 2.3% to 103.8% of a reference contraction(REF-contraction). For kinematics, the SEM and MDC varied from 1.4° to 5.9°. Between-day reliability was good to very good, except for scapular internal/external rotation kinematics, and sEMG for the LT, UT, and SA. sEMG error values were highest (>25%REF-contraction) for most of the LT, UT, and SA variables. Kinematic error values indicate changes or differences of 2°-3° are meaningful, except for upward/downward rotation and internal/external rotation with MDCs of 4°-6°. Generally, data from the total phase of movement had better reliability and lower error than the data from sEMG interval or kinematic discrete angles.
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Affiliation(s)
- Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA.
| | - Kevin A Elmore
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Benjamin J Darter
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Mark K Timmons
- School of Kinesiology, Marshall University, Huntington, WV 25755, USA
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Lädermann A, Gueorguiev B, Charbonnier C, Stimec BV, Fasel JHD, Zderic I, Hagen J, Walch G. Scapular Notching on Kinematic Simulated Range of Motion After Reverse Shoulder Arthroplasty Is Not the Result of Impingement in Adduction. Medicine (Baltimore) 2015; 94:e1615. [PMID: 26402829 PMCID: PMC4635769 DOI: 10.1097/md.0000000000001615] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Impingement after reverse shoulder arthroplasty (RSA) is believed to occur from repetitive contact in adduction between the humeral component and the inferior scapular pillar. The primary purpose of this biomechanical study was to confirm the presence of different types of impingement and to examine which daily-life movements are responsible for them. A secondary aim was to provide recommendations on the type of components that would best minimize notching and loss of range of motion (ROM). The study included 12 fresh frozen shoulder specimens; each had a computed tomography (CT) image of the entire scapula and humerus in order to acquire topological information of the bones before RSA implantation. Cyclic tests were run postimplantation with 3 shoulders in each modalities. To quantify bone loss due to impingement, 3-dimensional anatomical models of the scapula were reconstructed from the CT scans and compared to their intact states. We found 8 bony impingements in 7 specimens: 2 at the lateral acromion, 1 at the inferior acromion, 4 scapular notching, and 1 with the glenoid resulting to wear at the 3:00 to 6:00 clock-face position. Impingements occurred in all kinds of tested motions, except for the internal/external rotation at 90° of abduction. The 3 specimens tested in abduction/adduction presented bone loss on the acromion side only. Scapular notching was noted in flexion/extension and in internal/external rotation at 0° of abduction. The humeral polyethylene liner was worn in 2 specimens--1 at the 6:00 to 8:00 clock-face position during internal/external rotation at 0° of abduction and 1 at the 4:00 clock-face position during flexion/extension. The present study revealed that 2 types of impingement interactions coexist and correspond to a frank abutment or lead to a scapular notching (friction-type impingement). Scapular notching seems to be caused by more movements or combination of movements than previously considered, and in particular by movements of flexion/extension and internal/external rotation with the arm at the side. Polyethylene cups with a notch between 3 and 9 o'clock and lower neck-shaft angle (145° or 135°) may play an important role in postoperative ROM limiting scapular notching.
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Affiliation(s)
- Alexandre Lädermann
- From the Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin (AL); Faculty of Medicine, University of Geneva (AL); Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva (AL); AO Research Institute Davos, Davos (BG, IZ, JH); Artanim Foundation, Medical Research Department (CC); Faculty of Medicine, Department of Cellular Physiology and Metabolism, Anatomy Sector, University of Geneva, Geneva, Switzerland (BVS, JHF); and Department of Orthopaedics, Shoulder Unit, Santy Orthopaedic Center and Jean Mermoz Hospital GDS, Lyon, France (GW)
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Huang TS, Ou HL, Huang CY, Lin JJ. Specific kinematics and associated muscle activation in individuals with scapular dyskinesis. J Shoulder Elbow Surg 2015; 24:1227-34. [PMID: 25704212 DOI: 10.1016/j.jse.2014.12.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Knowledge of the kinematics and associated muscular activity in individuals with scapular dyskinesis may provide insight into the injury mechanism and inform the planning of treatment strategies. We investigated scapular kinematics and associated muscular activation during arm movements in individuals with scapular dyskinesis. METHODS A visual-based palpation method was used to evaluate 82 participants with unilateral shoulder pain. Scapular movements during arm raising/lowering movements were classified as abnormal single pattern (inferior angle prominence, pattern I; medial border prominence, pattern II; excessive/inadequate scapular elevation or upward rotation, pattern III), abnormal mixed patterns, or normal pattern (pattern IV). Scapular kinematics and associated muscular activation were assessed with an electromagnetic motion-capturing system and surface electromyography. RESULTS More scapular internal rotation was found in pattern II subjects (4°, P = .009) and mixed pattern I and II subjects (4°, P = .023) than in control subjects during arm lowering. Scapular posterior tipping (3°, P = .028) was less in pattern I subjects during arm lowering. Higher upper trapezius activity (14%, P = .01) was found in pattern II subjects during arm lowering. In addition, lower trapezius (5%, P = .025) and serratus anterior activity (10%, P = .004) were less in mixed pattern I and II subjects during arm lowering. CONCLUSIONS Specific alterations of scapular muscular activation and kinematics were found in different patterns of scapular dyskinesis. The findings also validated the use of a comprehensive classification test to assess scapular dyskinesis, especially in the lowering phase of arm elevation.
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Affiliation(s)
- Tsun-Shun Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Ling Ou
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Ying Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
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22
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Keramat Ullah Keramat. Conservative treatment preferences and the plausible mechanism of Neer's stage 1 of shoulder impingement in younger people. J PAK MED ASSOC 2015; 65:542-7. [PMID: 26028390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The interaction of various factors in the vicious cycle (VC) of subacromial impingement syndrome (SIS) is complex and there are conservative treatment preferences for speedy rehabilitation. The mechanism of SIS is not fully understood and the inappropriate treatment priorities cause delay in rehabilitation. SIS is related to the reduction in the subacromial space (SS). Posterior capsular tightness (PCT) and rotator cuff (RC) dysfunction are the two basic mechanisms in this regard. PCT may cause anterosuperior translation of humeral head (HH) and anterior acromion tipping through scapular dyskinesis, thereby reducing the subacromial space. Alteration in the force couple of muscle secondary to scapular dyskinesis eventually causes injury to subacromial structures. The rotator cuff is important in centring the humeral head in the glenoid cavity and superior translation of humeral head occurs if their function is compromised. Posterior capsular tightness may affect the function of rotator cuff action which leads to early fatigue, dysfunction of these muscles and eventually impingement. Adhesive changes take place in various structures around the shoulder secondary to impingement pain and relative immobility, which further aggravates the problem. To reverse the vicious cycle, conservative intervention should therefore be directed to loosen posterior capsular tightness, restore rotator cuff function through appropriate exercise in a pain-free range through appropriate exercise, mobilisation of adhesion through teraservers friction or pain-free mobilisation or grade I and grade II manipulation. Depending on the level of irritability, pain control intervention could be considered alongside.
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Tasaki A, Nimura A, Nozaki T, Yamakawa A, Niitsu M, Morita W, Hoshikawa Y, Akita K. Quantitative and qualitative analyses of subacromial impingement by kinematic open MRI. Knee Surg Sports Traumatol Arthrosc 2015; 23:1489-1497. [PMID: 24509879 DOI: 10.1007/s00167-014-2876-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Quantitative and qualitative kinematic analyses of subacromial impingement by 1.2T open MRI were performed to determine the location of impingement and the involvement of the acromioclavicular joint. METHODS In 20 healthy shoulders, 10 sequential images in the scapular plane were taken in a 10-s pause at equal intervals from 30° to maximum abduction in neutral and internal rotation. The distances between the rotator cuff (RC) and the acromion and the acromioclavicular joint were measured. To comprehend the positional relationships, cadaveric specimens were also observed. RESULTS Although asymptomatic, the RC came into contact with the acromion and the acromioclavicular joint in six and five cases, respectively. The superior RC acted as a depressor for the humeral head against the acromion as the shoulder elevated. The mean elevation angle and distance at the closest position between the RC and the acromion in neutral rotation were 93.5° and 1.6 mm, respectively, while those between the RC and the acromioclavicular joint were 86.7° and 2.0 mm. When comparing this distance and angle, there was no significant difference between the RC to the acromion and to the acromioclavicular joint. The minimum distance between the RC and the acromion was significantly shorter than that between the greater tuberosity and the acromion. The location of RC closest to the acromion and the acromioclavicular joint differed significantly. CONCLUSION Although asymptomatic, contact was found between the RC and the acromion and the acromioclavicular joint. The important role of the RC to prevent impingement was observed, and hence, dysfunction of the RC could lead to impingement that could result in a RC lesion. The RC lesions may differ when they are caused by impingement from either the acromion or the acromioclavicular joint.
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Affiliation(s)
- Atsushi Tasaki
- Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Akimoto Nimura
- Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Akira Yamakawa
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Mamoru Niitsu
- Department of Radiology, Saitama Medical College, Moro, Saitama, Japan
| | - Wataru Morita
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Yoshimitsu Hoshikawa
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Keiichi Akita
- Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Aydin A, Yildiz V, Topal M, Tuncer K, Köse M, Şenocak E. Effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome. Turk J Med Sci 2014; 44:871-4. [PMID: 25539560 DOI: 10.3906/sag-1303-91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To investigate the effects of conservative therapy applied before arthroscopic subacromial decompression on the clinical outcome in patients with stage 2 shoulder impingement syndrome. MATERIALS AND METHODS Sixty-eight patients having stage 2 shoulder impingement syndrome and treated with arthroscopic subacromial decompression were included in the study. We divided these patients into 2 groups, whereby 32 (47%) patients received conservative therapy before arthroscopic subacromial decompression and 36 (53%) patients did not receive conservative therapy. We compared both groups in terms of the the Constant, UCLA, and VAS scores for shoulder pain before and after arthroscopic subacromial decompression. RESULTS Constant, UCLA, and VAS scores were statistically significantly improved in both groups after arthroscopic subacromial decompression (P <0.001). Constant, UCLA, and VAS scores before arthroscopic subacromial decompression were statistically better in Group 1 than in Group 2 (P < 0.001). No statistically significant difference was found between the groups in terms of Constant, UCLA, and VAS scores after arthroscopic subacromial decompression (P > 0.05). CONCLUSION Conservative therapy applied in patients with stage 2 shoulder impingement syndrome before arthroscopic subacromial decompression does not have a positive contribution on the clinical outcome after arthroscopic subacromial decompression.
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Otoshi K, Takegami M, Sekiguchi M, Onishi Y, Yamazaki S, Otani K, Shishido H, Kikuchi S, Konno S. Association between kyphosis and subacromial impingement syndrome: LOHAS study. J Shoulder Elbow Surg 2014; 23:e300-e307. [PMID: 25107600 DOI: 10.1016/j.jse.2014.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/01/2014] [Accepted: 04/08/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Kyphosis is a cause of scapular dyskinesis, which can induce various shoulder disorders, including subacromial impingement syndrome (SIS). This study aimed to clarify the impact of kyphosis on SIS with use of cross-sectional data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). METHODS The study enrolled 2144 participants who were older than 40 years and participated in health checkups in 2010. Kyphosis was assessed by the wall-occiput test (WOT) for thoracic kyphosis and the rib-pelvic distance test (RPDT) for lumbar kyphosis. The associations between kyphosis, SIS, and reduction in shoulder elevation (RSE) were investigated. RESULTS Age- and gender-adjusted logistic regression analysis demonstrated significant association between SIS and WOT (odds ratio, 1.65; 95% confidence interval, 1.02, 2.64; P < .05), whereas there was no significant association between SIS and RPDT. Multivariable logistic regression analysis demonstrated no significant association between SIS and both WOT and RPDT, whereas there was significant association between SIS and RSE. CONCLUSION RSE plays a key role in the development of SIS, and thoracic kyphosis might influence the development of SIS indirectly by reducing shoulder elevation induced by the restriction of the thoracic spine extension and scapular dyskinesis.
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Affiliation(s)
- Kenichi Otoshi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shin Yamazaki
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroaki Shishido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Kikuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Shinohara H, Urabe Y, Maeda N, Xie D, Sasadai J, Fujii E. Does shoulder impingement syndrome affect the shoulder kinematics and associated muscle activity in archers? J Sports Med Phys Fitness 2014; 54:772-779. [PMID: 25350034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Archery related injuries, such as shoulder impingement syndrome are caused by repeated motion of the shoulder. The aim of this study was to analyze differences in the shoulder kinematics and the associated muscle activity between archers with shoulder impingement and uninjured archery players. METHODS Thirty male archers, who were divided into an impingement group and an uninjured group, were included in this study. The angle of scapular elevation, shoulder joint abduction, horizontal extension, and elbow joint flexion as well as the electromyographic activity of the upper trapezius, lower trapezius, deltoid middle, deltoid posterior, biceps brachii, and triceps brachii muscles at the point of stabilization during shooting were measured. Variables differing between impingement and uninjured groups were identified, and a stepwise regression analysis was performed to identify a combination of variables that effectively impingement syndrome. RESULTS The results indicated that the angle of scapular elevation was significantly greater than that uninjured group (P<0.05). The angle of horizontal extension in the impingement group was significantly smaller than that in the uninjured group (P<0.05). The angle of elbow flexion in the impingement group was significantly smaller than that in the uninjured group (P<0.05). The levels of upper trapezius and deltoid middle muscle activity were significantly higher in the impingement group, while the level of lower trapezius muscle activity was significantly lower (P<0.05) when compared to the uninjured group. The impingement group had a greater angle of scapular elevation, smaller angle of horizontal extension, smaller angle of elbow flexion, higher the levels of upper trapezius, lower the levels of lower trapezius, higher deltoid middle muscle activity and higher UT/LT ratio (all differences were significant). A logistic model for predicting impingement syndrome showed that UT/LT ratio was significantly related impingement syndrome (P<0.05). CONCLUSION The authors concluded that archers with shoulder impingement syndrome exhibit different kinematics and muscle activity compared to uninjured archers. Therefore, in order to prevent shoulder joint impingement during archery, training is necessary what can make lower trapezius muscle activity increased to decrease the UT/LT ratio.
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Affiliation(s)
- H Shinohara
- Graduate School of Biomedical and Health Sciences Hiroshima University, Kasumi 1‑2‑3 Minami‑ku, Hiroshima, Japan -
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Michener LA, Kardouni JR, Sousa CO, Ely JM. Validation of a sham comparator for thoracic spinal manipulation in patients with shoulder pain. ACTA ACUST UNITED AC 2014; 20:171-5. [PMID: 25261090 DOI: 10.1016/j.math.2014.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 08/13/2014] [Accepted: 08/26/2014] [Indexed: 11/16/2022]
Abstract
The evidence to guide use of spinal manipulative therapy (SMT) for patients with shoulder pain is limited. A validated sham comparator is needed to ascertain the unique effects of SMT. We investigated the plausibility of a thoracic sham-SMT comparator for SMT in patients with shoulder pain. Participants (n = 56) with subacromial impingement syndrome were randomized to thoracic SMT or a sham-SMT. An examiner blinded to group assignment took measures pre- and post-treatment of shoulder active range of motion (AROM) and perceived effects of the assigned intervention. Treatment consisted of six upper, middle and lower thoracic SMT or sham-SMT. The sham-SMT was identical to the SMT, except no thrust was applied. Believability as an active treatment was measured post-treatment. Believability as an active treatment was not different between groups (χ(2) = 2.19; p = 0.15). Perceptions of effects were not different between groups at pre-treatment (t = 0.12; p = 0.90) or post-treatment (t = 0.40; p = 0.69), and demonstrated equivalency with 95% confidence between groups at pre- and post-treatment. There was no significant change in shoulder flexion in either group over time, or in the sham-SMT for internal rotation (p > 0.05). The SMT group had an increase of 6.49° in internal rotation over time (p = 0.04). The thoracic sham-SMT of this study is a plausible comparator for SMT in patients with shoulder pain. The sham-SMT was believable as an active treatment, perceived as having equal beneficial effects both when verbally described and after familiarization with the treatment, and has an inert effect on shoulder AROM. This comparator can be considered for used in clinical trials investigating thoracic SMT. IRB number: HM 13182.
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Affiliation(s)
- Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar Street, CHP 155, Los Angeles, CA 90089, USA.
| | - Joseph R Kardouni
- United States Army Research Institute for Environmental Medicine, 15 Kansas Street, Natick, MA 01760, USA
| | - Catarina O Sousa
- Faculdade de Ciências de Saúde do Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
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Svendsen SW, Christiansen DH, Haahr JP, Andrea LC, Frost P. Shoulder function and work disability after decompression surgery for subacromial impingement syndrome: a randomised controlled trial of physiotherapy exercises and occupational medical assistance. BMC Musculoskelet Disord 2014; 15:215. [PMID: 24952581 PMCID: PMC4098960 DOI: 10.1186/1471-2474-15-215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgery for subacromial impingement syndrome is often performed in working age and postoperative physiotherapy exercises are widely used to help restore function. A recent Danish study showed that 10% of a nationwide cohort of patients retired prematurely within two years after surgery. Few studies have compared effects of different postoperative exercise programmes on shoulder function, and no studies have evaluated workplace-oriented interventions to reduce postoperative work disability. This study aims to evaluate the effectiveness of physiotherapy exercises and occupational medical assistance compared with usual care in improving shoulder function and reducing postoperative work disability after arthroscopic subacromial decompression. METHODS/DESIGN The study is a mainly pragmatic multicentre randomised controlled trial. The trial is embedded in a cohort study of shoulder patients referred to public departments of orthopaedic surgery in Central Denmark Region. Patients aged ≥18-≤63 years, who still have shoulder symptoms 8-12 weeks after surgery, constitute the study population. Around 130 participants are allocated to: 1) physiotherapy exercises, 2) occupational medical assistance, 3) physiotherapy exercises and occupational medical assistance, and 4) usual care. Intervention manuals allow individual tailoring. Primary outcome measures include Oxford Shoulder Score and sickness absence due to symptoms from the operated shoulder. Randomisation is computerised with allocation concealment by randomly permuted block sizes. Statistical analyses will primarily be performed according to the intention-to-treat principle. DISCUSSION The paper presents the rationale, design, methods, and operational aspects of the Shoulder Intervention Project (SIP). SIP evaluates a new rehabilitation approach, where physiotherapy and occupational interventions are provided in continuity of surgical episodes of care. If successful, the project may serve as a model for rehabilitation of surgical shoulder patients. TRIAL REGISTRATION Current Controlled Trials ISRCTN55768749.
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Affiliation(s)
- Susanne W Svendsen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - David H Christiansen
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - Jens Peder Haahr
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - Linda C Andrea
- Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
| | - Poul Frost
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
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Lubiatowski P, Kaczmarek PK, Ślęzak M, Długosz J, Bręborowicz M, Dudziński W, Romanowski L. Problems of the glenohumeral joint in overhead sports - literature review. Part II - pathology and pathophysiology. Pol Orthop Traumatol 2014; 79:59-66. [PMID: 24941456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In throwing sports shoulder is exposed to enormous and often repetitive overloads. Some sports (contact sports) are also connected with direct trauma. We are thus dealing with traumatic injuries, overload and degenerative damage. The article discusses the most frequent injuries of the shoulder characteristic for throwing sports. These are mainly disorders of arm rotation, internal impingement, lesion of the labrum (SLAP) and rotator cuff tears (PASTA).
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Affiliation(s)
- Przemysław Lubiatowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Marta Ślęzak
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Jan Długosz
- Department of Orthopaedics, Rehasport Clinic, Poznań, Poland
| | - Maciej Bręborowicz
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
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Melchiorre D, Maresca M, Bracci R, Ravaschio A, Valiensi B, Casale R, Bandinelli F, Candelieri A, Maddali Bongi S, Porta F, Innocenti M, Carulli C, Matucci Cerinic M. Muscle shortening manoeuvre reduces pain and functional impairment in shoulder impingement syndrome: clinical and ultrasonographic evidence. Clin Exp Rheumatol 2014; 32:5-10. [PMID: 24050647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To evaluate the short-term efficacy of muscle shortening manoeuvre (MSM), by inducing an increase in strength of the shoulder muscles, for the treatment of shoulder impingement syndrome (SIS). METHODS Sixty subjects (mean age: 58.6 years) with SIS were assigned to one of 3 different treatment interventions: 1) MSM: a series of fast accelerations in the upward direction was applied to the upper limb that was also submitted to forces acting in the opposite direction (added mass); 2) traditional physiotherapeutic technique: scapulothoracic gliding; 3) simple traction: the added mass was applied to the limb without the series of fast accelerations. Pain intensity, Neer's impingement sign, range of motion and muscle strength were assessed. Ultrasound (US) examination was performed before, immediately after and 30 days after each treatment to study the width of the subacromial-subdeltoid bursa, long biceps tendon sheath and acromioclavicular joint. Impingement was evaluated by dynamic examination. RESULTS After treatment with MSM, pain was significantly reduced (p<0.001), Neer's impingement sign was negative, range of motion and muscle strength were increased. US examination showed that the widths of the subacromial-subdeltoid bursa (p<0.001), long biceps tendon sheath (p<0.001) and acromioclavicular joint (p<0.001) were significantly reduced; impingement was no more detected. After 30 days, improvement in clinical and US findings was maintained. In the two control groups, no significant changes were observed after treatment. CONCLUSIONS Clinical and US findings demonstrate that MSM, by inducing an increase in muscle strength, is effective in the short-term treatment of SIS.
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Affiliation(s)
- Daniela Melchiorre
- Department of Medicine, Rheumatology Unit, University of Florence, Italy.
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Rol Y, Haldorsen B, Svege I, Bergland A. Development and reliability of a clinician-rated instrument to evaluate function in individuals with shoulder pain: a preliminary study. Physiother Res Int 2013; 18:230-8. [PMID: 23716317 PMCID: PMC4286020 DOI: 10.1002/pri.1555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 09/05/2012] [Accepted: 04/05/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Subacromial impingement syndrome (SIS) is a common and disabling condition in the population. Interventions are often evaluated with patient-rated outcome measures. The purpose of this study was to develop a simple clinician-rated measure to detect difficulties in the execution of movement-related tasks among patients with subacromial impingement syndrome. METHOD The steps in the scale development included a review of the clinical literature of shoulder pain to identify condition-specific questionnaires, pilot testing, clinical testing and scale construction. Twenty-one eligible items from thirteen questionnaires were extracted and included in a pilot test. All items were scored on a five-point ordinal scale ranging from 1 (no difficulty) to 5 (cannot perform). Fourteen items were excluded after pilot testing because of difficulties in standardization or other practical considerations. The remaining seven items were included in a clinical test-retest study with outpatients at a hospital. Of these, four were excluded because of psychometric reasons. From the remaining three items, a measure named Shoulder Activity Scale (summed score ranging from 3 to 15) was developed. RESULTS A total of 33 men and 30 women were included in the clinical study; age range 27-80 years. The intraclass correlation coefficient results for inter-rater reliability and test-retest reliability were 0.80 (95% CI = 0.51-0.90) and 0.74 (95% CI = 0.58-0.84), respectively. The standard error of measurement and minimal detectable change were 1.19 and 3.32, respectively. The scale was linked to the International Classification of Functioning, Disability and Health second level categories lifting and carrying objects (d430), dressing (d540), hand and arm use (d445) and control of voluntary movement (b760). CONCLUSION The Shoulder Activity Scale showed acceptable reliability in a sample of outpatients at a hospital, rated by clinicians experienced in shoulder rehabilitation. The validity of the scale should be investigated in future studies before application to common practice. © 2013 The Authors. Physiotherapy Research International published by John Wiley & Sons Ltd.
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Affiliation(s)
- Yngve Rol
- Faculty of Health Sciences, Oslo and Akershus University College of Applied SciencesOslo, Norway
| | | | - Ida Svege
- Norwegian research center for Active Rehabilitation (NAR)Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo and Akershus University College of Applied SciencesOslo, Norway
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Roren A, Fayad F, Poiraudeau S, Fermanian J, Revel M, Dumitrache A, Gautheron V, Roby-Brami A, Lefevre-Colau MM. Specific scapular kinematic patterns to differentiate two forms of dynamic scapular winging. Clin Biomech (Bristol, Avon) 2013; 28:941-7. [PMID: 24074807 DOI: 10.1016/j.clinbiomech.2013.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 08/31/2013] [Accepted: 09/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dynamic scapular winging (DSW) is a rare and misdiagnosed disorder causing considerable disability due to reduced scapular stability and abnormal motion. Two common causes are long thoracic nerve lesions resulting in serratus anterior muscle palsy and spinal accessory nerve lesions resulting in trapezius muscle palsy. The aim of this study was to analyse 3D scapular kinematic patterns in patients with DSW due to long thoracic (LTNL) or spinal accessory nerve lesions (SANL). METHODS 3D scapular kinematics were assessed using a non invasive method involving an electromagnetic device during arm elevation in the frontal and sagittal planes in 9 patients (4 with SANL and 5 with LTNL) with unilateral DSW confirmed by electrical evidence. Within subject affected-unaffected differences were measured and compared between pathological groups (Mann-Whitney). FINDINGS Differences between affected and unaffected shoulders were significantly greater for scapular posterior tilt (at rest and 30° for sagittal arm elevation, at rest, 30° and 60° for frontal arm elevation) in the LTNL compared to the SANL group. Differences between affected and unaffected shoulders were significantly greater for scapular protraction (at rest and 60° of sagittal arm elevation, at rest, 30° and 60° of frontal arm elevation) and scapular lateral rotation at 60° for frontal arm elevation in the SANL compared to the LTNL group. INTERPRETATIONS These kinematic findings show two different scapular patterns that are specific to the neurological lesion. Moreover our kinematic data relate to specific clinical signs and the functional roles of the muscles involved.
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Affiliation(s)
- Alexandra Roren
- Department of Physical Medicine and Rehabilitation, Cochin Hospital (AP-HP), Paris Descartes University, 75679 Paris Cedex 14, France.
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Tsvetkova EM. [The early rehabilitation of the patients with shoulder impingement syndrome using robotic technologies]. Vopr Kurortol Fizioter Lech Fiz Kult 2013:9-10. [PMID: 24137927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of the present study was to develop a complex of rehabilitative measures for the treatment of the patients presenting with shoulder impingement syndrome including the combined application of the robotic technology based on the Multi-Joint System (Italy) in conjunction with physical therapy and massage. In addition, we estimated dynamics of the "American assessment shoulder and elbow surgery" test, the shoulder score index, the range of motion in the shoulder joint on the affected side with the help of the Multi-Joint System. It is concluded that the early use of the Multi-Joint System in combination with physical therapy and massage techniques provides the highly efficacious tool for the management of the patients suffering impingement syndrome.
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Ostreicher M, Schwarz M. [Relation between shoulder impingement syndrome and club head velocity in high-performance amateur golfers]. Sportverletz Sportschaden 2013; 27:108-111. [PMID: 23712389 DOI: 10.1055/s-0033-1335519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Joint structure damages due to overstrain often occur even in commonly not injury-prone golfing. Triggered by the golf swing's repetitive movement pattern and technique deficits of the player these structural damages are most likely to affect the lumbar spine as well as shoulder and elbow joint. As a synonym for shoulder impingement symptoms in golfers the term golf shoulder has been established in medical terminology. Despite this fact, currently there exist no studies addressing the relation between shoulder impingement syndrome and club head velocity. OBJECTIVE The aim of this study was to highlight the relation between club head velocity deficits of high-performance amateur golfers and persisting shoulder impingement syndrome. METHOD All of the 31 high-performance amateur golfers included in this study were male, active tournament players and right hander. Each golfer was examined for shoulder impingement syndrome using the Neer test, the Hawkins-Kennedy test, the painful arc and the functional test of the M. infraspinatus. Based on the test results the participants were allocated to an impingement group or a non-impingement group. Additionally, each golfer's club head velocity was determined. RESULTS Between the two groups a significant difference concerning the club head velocity has been reported. CONCLUSIONS A persisting shoulder impingement syndrome can have a negative effect on club head velocity. In many shoulder studies predominantly the influence of pathological muscular balance alterations (myofascial dysfunction) is not taken into consideration.
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Ulaşlı AM, Erkeç S, Uyar S, Nacır B, Yılmaz Ö, Erdem HR. The effect of acromioclavicular joint degeneration on orthopedic shoulder tests. Eklem Hastalik Cerrahisi 2013; 24:77-81. [PMID: 23692193 DOI: 10.5606/ehc.2013.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES This study aims to investigate the effect of acromioclavicular joint (ACJ) degeneration on orthopedic shoulder tests (OST) and to determine complementary role of ACJ injections in the treatment of subacromial shoulder impingements. PATIENTS AND METHODS At a secondary care center, 62 patients (56 females, 6 males; mean age 55.8±9.3 years; range 35 to 74 years) with the clinical and radiological diagnosis of shoulder impingement syndrome were enrolled to the study. Two injections were applied to ACJ and subacromial space. Patients were assessed through OSTs (Neer, Hawkins-Kennedy, empty can, full can, external rotation resistance, lift-off and cross-body adduction tests) at baseline and after injection to ACJ and subacromial space. Visual analog scale was used for overall pain. RESULTS Two injections and three sets of OSTs were performed on the patients. A significant difference was found in the all OSTs after ACJ injection (p<0.001). Visual analog scale scores improved significantly following both ACJ and subacromial injections (p<0.001). CONCLUSION Concomitant ACJ diseases should assessed carefully in the patients with rotator cuff lesions, as it may change the type of management approach.
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Affiliation(s)
- Alper Murat Ulaşlı
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Afyon Kocatepe University, Afyon, Turkey.
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Elhassan BT, Wagner ER, Bishop AT. Feasibility of contralateral trapezius transfer to restore shoulder external rotation: part I. J Shoulder Elbow Surg 2012; 21:1363-9. [PMID: 22137375 DOI: 10.1016/j.jse.2011.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/18/2011] [Accepted: 10/25/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE We evaluated the feasibility of contralateral trapezius transfer to restore shoulder external rotation. MATERIALS AND METHODS The length of the lower trapezius and distance necessary for contralateral trapezius transfer were measured in 20 volunteers and directly in 12 cadavers. The average distances between the medial spine of the scapula and T12 (length of lower trapezius) and the spine to the greater tuberosity (distance for transfer) were measured with the scapula neutral, maximally protracted, and maximally retracted. In cadavers, the origin of the lower trapezius was detached, transferred to the contralateral greater tuberosity, and retracted to determine its effectiveness in external rotation and tension on the vascular pedicle. RESULTS In volunteers, the average difference between the length of the lower trapezius and the transfer distance was 19 mm in neutral. When the scapula was protracted and retracted, the difference was 79 and -49 mm. In the cadavers, the average transfer distance (in mm) was 290 ± 12, 365 ± 15, and 209 ± 25 in the neutral, protracted, and retracted positions, respectively. The average length of the lower trapezius (in mm) was 270 ± 10, 285 ± 12, and 258 ± 10 in the neutral, protracted, and retracted positions. The transfer was universally feasible when the scapula was partially retracted. Prolongation of the lower trapezius with lumbar fascia made the transfer possible in all scapular positions. Pulling on the transferred muscle resulted in contralateral shoulder external rotation without tension or impingement on the neurovascular pedicle. CONCLUSION Contralateral trapezius transfer to the infraspinatus insertion appears feasible and potentially effective in restoration of shoulder external rotation.
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Affiliation(s)
- Bassem T Elhassan
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
The biomechanical properties of, and mechanical environment surrounding, the rotator cuff continue to be a research area of great interest as injury and failure of these tendons are among the most common of shoulder pathologies, with incidence increasing in older populations. Recent literature has refined our knowledge of the anatomy, the role of the various tendons in movement and shoulder stability, and structural and material properties of the human rotator cuff. Furthermore, animal models have characterized the effects of mechanical loading on rotator cuff properties, the biomechanical interactions among cuff tendons in uninjured and deficient rotator cuffs have been described, and more recent imaging studies have provided novel insights into the function of the rotator cuff in vivo. Research to advance our understanding of the biomechanical factors contributing to rotator cuff disease is needed, as the etiology, prognostic indicators, and reasons for treatment failure are poorly understood. We summarize published biomechanical literature on the rotator cuff to provide a current perspective on potential mechanisms involved in cuff pathology.
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de Witte PB, Nagels J, van Arkel ERA, Visser CPJ, Nelissen RGHH, de Groot JH. Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM). BMC Musculoskelet Disord 2011; 12:282. [PMID: 22168667 PMCID: PMC3296676 DOI: 10.1186/1471-2474-12-282] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The subacromial impingement syndrome (SIS) is the most common diagnosed disorder of the shoulder in primary health care, but its aetiology is unclear. Conservative treatment regimes focus at reduction of subacromial inflammatory reactions or pathologic scapulohumeral motion patterns (intrinsic aetiology). Long-lasting symptoms are often treated with surgery, which is focused at enlarging the subacromial space by resection of the anterior part of the acromion (based on extrinsic aetiology). Despite that acromionplasty is in the top-10 of orthopaedic surgical procedures, there is no consensus on its indications and reported results are variable (successful in 48-90%). We hypothesize that the aetiology of SIS, i.e. an increase in subacromial pressure or decrease of subacromial space, is multi-factorial. SIS can be the consequence of pathologic scapulohumeral motion patterns leading to humerus cranialisation, anatomical variations of the scapula and the humerus (e.g. hooked acromion), a subacromial inflammatory reaction (e.g. due to overuse or micro-trauma), or adjoining pathology (e.g. osteoarthritis in the acromion-clavicular-joint with subacromial osteophytes).We believe patients should be treated according to their predominant etiological mechanism(s). Therefore, the objective of our study is to identify and discriminate etiological mechanisms occurring in SIS patients, in order to develop tailored diagnostic and therapeutic strategies. METHODS In this cross-sectional descriptive study, applied clinical and experimental methods to identify intrinsic and extrinsic etiologic mechanisms comprise: MRI-arthrography (eligibility criteria, cuff status, 3D-segmented bony contours); 3D-motion tracking (scapulohumeral rhythm, arm range of motion, dynamic subacromial volume assessment by combining the 3D bony contours and 3D-kinematics); EMG (adductor co-activation) and dynamometry instrumented shoulder radiographs during arm tasks (force and muscle activation controlled acromiohumeral translation assessments); Clinical phenotyping (Constant Score, DASH, WORC, and SF-36 scores). DISCUSSION By relating anatomic properties, kinematics and muscle dynamics to subacromial volume, we expect to identify one or more predominant pathophysiological mechanisms in every SIS patient. These differences in underlying mechanisms are a reflection of the variations in symptoms, clinical scores and outcomes reported in literature. More insight in these mechanisms is necessary in order to optimize future diagnostic and treatment strategies for patients with SIS symptoms. TRIAL REGISTRATION Dutch Trial Registry (Nederlands Trial Register) NTR2283.
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Affiliation(s)
- Pieter Bas de Witte
- Department of Orthopaedics, Leiden University Medical Centre (LUMC), Postzone J11R, Postbus 9600, 2300 RC Leiden, The Netherlands
- Laboratory for Kinematics and Neuromechanics, Departments of Rehabilitation and Orthopaedics, Leiden University Medical Centre, Postzone B0-Q, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Centre (LUMC), Postzone J11R, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Ewoud RA van Arkel
- Department of Orthopaedics, Medical Centre Haaglanden (MCH), Postbus 432, 2501 CK Den Haag, The Netherlands
| | - Cornelis PJ Visser
- Department of Orthopaedics, Rijnland Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands
| | - Rob GHH Nelissen
- Department of Orthopaedics, Leiden University Medical Centre (LUMC), Postzone J11R, Postbus 9600, 2300 RC Leiden, The Netherlands
| | - Jurriaan H de Groot
- Laboratory for Kinematics and Neuromechanics, Departments of Rehabilitation and Orthopaedics, Leiden University Medical Centre, Postzone B0-Q, Postbus 9600, 2300 RC Leiden, The Netherlands
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Akyol Y, Ulus Y, Durmus D, Canturk F, Bilgici A, Kuru O, Bek Y. Effectiveness of microwave diathermy on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome: a randomized placebo-controlled clinical study. Rheumatol Int 2011; 32:3007-16. [PMID: 21898066 DOI: 10.1007/s00296-011-2097-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 08/21/2011] [Indexed: 11/24/2022]
Abstract
The aim of this clinical trial was to evaluate the effectiveness of therapeutic MD on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome (SIS). A total of 40 inpatient subjects with definite SIS were included in this study. These patients were sequentially randomized into 2 groups. Group 1 (n = 20) received therapeutic MD. Group 2 (n = 20) was served as control group and received sham MD. Superficial heat and exercise program were given to both groups. Both of the programs were performed 5 times weekly for 3 weeks. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Outcome measures included visual analogue scale, goniometry, Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, shoulder isokinetic muscle testing, handgrip strength, Short Form 36, and Beck Depression Index. The patients with SIS in each group had significant improvements in pain, shoulder ROM, disability, shoulder muscles and grip strength, quality of life, and depression AT and F when compared with their initial status (P < 0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P > 0.05). A 2,450-MHz MD regimen showed no beneficial effects in patients with SIS, so the superficial heat and exercise program, as it is efficient, may be preferable for the treatment of SIS, alone.
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Affiliation(s)
- Yesim Akyol
- Medical Faculty, Ondokuz Mayis University, Samsun, Turkey.
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Calis HT, Berberoglu N, Calis M. Are ultrasound, laser and exercise superior to each other in the treatment of subacromial impingement syndrome? A randomized clinical trial. Eur J Phys Rehabil Med 2011; 47:375-380. [PMID: 21946399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Subacromial impingement syndrome (SIS) is the most common reason for shoulder pain. Ultrasound and laser are the physical therapy modalities, in conservative treatment of SIS. AIM The aim of this study was to define and compare the efficacy of ultrasound, laser and exercise in the treatment of SIS. DESIGN This was a randomized controlled trial with-pre and post-treatment evaluations SETTING Out-patients referred to physical medicine and rehabilitation unit. POPULATION This study was performed on 52 patients with SIS. The patients were randomly allocated into three groups METHODS The patients were treated five days a week for three weeks with hotpack+ultrasound+exercise (the first group); hotpack+laser+exercise (the second group), or hotpack+exercise (the third group). The pre and post treatment ranges of motion were measured in the patients. The visual analogue scale (VAS) was used to evaluate the severity of pain. Constant scoring was used to evaluate the shoulder functions and the results were compared after the treatment. RESULTS When the post-treatment results of the groups were compared with the pretreatment results, there was a statistically significant improvement in each of the three groups, in the pain, the range of motion and the functional improvement at the shoulder (P<0.05). However, the inter-group comparison did not reveal any statistically significant difference in the parameters indicating improvement (P>0.05). CONCLUSION The results of this study demonstrated that ultrasound and laser treatments were not superior to each other in the treatment of SIS. CLINICAL REHABILITATION IMPACT . Exercise treatment forms the base for the conservative treatment.
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Affiliation(s)
- H T Calis
- Kayseri Education and Research Hospital, Physical Therapy and Rehabilitation Clinic, Kayseri, Turkey.
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Hall LC, Middlebrook EE, Dickerson CR. Analysis of the influence of rotator cuff impingements on upper limb kinematics in an elderly population during activities of daily living. Clin Biomech (Bristol, Avon) 2011; 26:579-84. [PMID: 21458122 DOI: 10.1016/j.clinbiomech.2011.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite a high prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on how this injured population adapts to perform tasks of daily living. The current study investigated the influence of rotator cuff impingements in this population on kinematics and shoulder loading differences, while completing activities of daily living. METHODS Upper limb and trunk movement was measured for thirteen asymptomatic elderly and ten elderly subjects with rotator cuff impingements during five range of motion tasks and six activities of daily living. Thoracohumeral kinematics was derived from this data. FINDINGS Symptomatic populations showed significantly decreased ranges of flexion/extension, abduction and internal and external rotation when compared to the asymptomatic population. The asymptomatic population had a 44% larger range of angle of elevation than the symptomatic population. Task was found to be a main effect for most variables examined including angle of elevation. Participants with impingements had significantly lower ranges of humeral rotations during the tasks with ranges of 40° (SD 40°) and 51° (SD 36°) respectively. Perineal care, hair-combing and reaching tasks were the most demanding in terms of the required range of motion. The reaching tasks resulted in the highest shoulder moment. INTERPRETATION Developing adaptations for perineal care, hair-combing and reaching tasks should be prioritized when working with persons with rotator cuff impingements, as these tasks demanded the largest ranges of motion while producing high shoulder moments. Substantial differences existed between the experimental groups for a number of kinematic measures.
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Affiliation(s)
- Laurie C Hall
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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Bayam L, Ahmad MA, Naqui SZ, Chouhan A, Funk L. Pain mapping for common shoulder disorders. Am J Orthop (Belle Mead NJ) 2011; 40:353-358. [PMID: 22013572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We conducted a study to ascertain specific patterns of pain in patients with common shoulder disorders and to describe a comprehensive shoulder pain map. We prospectively studied 94 cases involving an upper limb pain map and correlated the maps with the final diagnoses made by 2 clinicians who were blinded to the pain map findings. Pattern, severity, and type of pain were specific to each common shoulder disorder. In subacromial impingement, pain was predominantly sharp, occurred around the anterior aspect of the shoulder, radiated down the arm, and was associated with dull, aching pain radiating to the hand. A similar pain pattern was found in rotator cuff tears. In acromioclavicular joint pathology, pain was sharp, stabbing, and well localized to the anterosuperior shoulder area. Glenohumeral joint arthritis was marked by the most severe pain, which occurred in a mixed pattern and affected the entire arm. Whereas the pain of instability was a mixture of sharp and dull pain, the pain of calcific tendonitis was severe and sharp. Both pains were limited to the upper arm and shoulder. Pain mapping revealed definitive patterns for shoulder pathologies. We advocate using pain maps as useful diagnostic guides and research tools.
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Edelstein L, Thomas SJ, Soslowsky LJ. Rotator cuff tears: what have we learned from animal models? J Musculoskelet Neuronal Interact 2011; 11:150-162. [PMID: 21625052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Rotator cuff tendon tears are among the most common soft tissue injuries that occur at the shoulder. Despite advancements in surgical repair techniques, rotator cuff repairs experience a high rate of failure. The common occurrence of tears and the frequency of re-tears require a further understanding of the mechanisms associated with injuries, healing, and regeneration of the rotator cuff. This paper reviews in vivo studies using the various animal shoulder models of the rat, rabbit, sheep, canine, and primate. These animal models have been used to study intrinsic and extrinsic factors leading to shoulder degeneration, various suture techniques, effects of post-surgical treatment, numerous biologic and synthetic scaffolds, and an assortment of biologic augmentations used to accelerate healing. These effects can be examined in a controlled manner using animal models without other confounding factors that sometimes limit clinical studies. The clinically impactful results will be explained to highlight the specific knowledge gained from using animal models in rotator cuff research.
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Affiliation(s)
- L Edelstein
- McKay Orthopaedic Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
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Jia X, Ji JH, Pannirselvam V, Petersen SA, McFarland EG. Does a positive neer impingement sign reflect rotator cuff contact with the acromion? Clin Orthop Relat Res 2011; 469:813-8. [PMID: 20878281 PMCID: PMC3032859 DOI: 10.1007/s11999-010-1590-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 09/10/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND One possible cause of shoulder pain is rotator cuff contact with the superior glenoid (cuff-glenoid contact) with the arm in flexion, as occurs during a Neer impingement sign. It has been assumed that the pain with a Neer impingement sign on physical examination of the shoulder was secondary to the rotator cuff making contact with the anterior and lateral acromion. QUESTIONS/PURPOSES We determined if the arm position where pain occurs with a Neer impingement sign would correlate with the position where the rotator cuff made contact with the superior glenoid, as determined by arthroscopic evaluation. PATIENTS AND METHODS We prospectively studied 398 consecutive patients with a positive Neer impingement sign during office examination and used a handheld goniometer to measure (in degrees of flexion) the arm position in which impingement pain occurred. During subsequent arthroscopy, the arm was moved into a similar position, and we measured the arm's position in flexion at the point the rotator cuff made contact with the superior glenoid using a handheld goniometer. We compared the degrees of flexion at which pain occurred preoperatively and at which there was cuff-glenoid contact. RESULTS Among the 398 patients, 302 (76%) had arthroscopically documented cuff-glenoid contact, whereas 96 did not. For the 302 patients with a positive Neer sign preoperatively and with arthroscopically documented cuff-glenoid contact, the average preoperative impingement pain position was 120.1°±26.7°, similar to that of the average intraoperative cuff-glenoid contact position of 120.6°±14.7°. CONCLUSIONS Our data suggest pain associated with a positive Neer sign more often relates to contact of the rotator cuff with the superior glenoid than to contact between the rotator cuff and acromion. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Xiaofeng Jia
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Jong Hun Ji
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Vinodhkumar Pannirselvam
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Steve A. Petersen
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
| | - Edward G. McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD USA
- c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780 USA
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Ludewig PM, Braman JP. Shoulder impingement: biomechanical considerations in rehabilitation. Man Ther 2011; 16:33-9. [PMID: 20888284 PMCID: PMC3010321 DOI: 10.1016/j.math.2010.08.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 08/23/2010] [Accepted: 08/27/2010] [Indexed: 11/19/2022]
Abstract
Shoulder impingement is a common condition presumed to contribute to rotator cuff disease. Impingement can occur externally with the coracoacromial arch or internally with the glenoid rim. Normal scapulothoracic motions that occur during arm elevation include upward rotation, posterior tilting, and either internal or external rotation. These scapulothoracic motions and positions are the result of coupled interactions between sternoclavicular and acromioclavicular joints. The sternoclavicular and acromioclavicular joints both contribute to scapulothoracic upward rotation. Posterior tilting is primarily an acromioclavicular joint motion. The sternoclavicular and acromioclavicular joint motions offset one another regarding final scapulothoracic internal/external rotation position. This manuscript discusses these coupled interactions in relation to shoulder muscle function. Two case examples are presented to demonstrate application of understanding these interactions and potential mechanisms of movement abnormalities in targeting treatment interventions for movement based subgroups of impingement patients.
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Affiliation(s)
- Paula M Ludewig
- Department of Physical Medicine & Rehabilitation, Programs in Physical Therapy & Rehabilitation Sciences, The University of Minnesota, Minneapolis, MN 55455,USA.
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Garofalo R, Karlsson J, Nordenson U, Cesari E, Conti M, Castagna A. Anterior-superior internal impingement of the shoulder: an evidence-based review. Knee Surg Sports Traumatol Arthrosc 2010; 18:1688-93. [PMID: 20700579 DOI: 10.1007/s00167-010-1232-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 07/20/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Internal impingement syndrome is a painful shoulder condition related to the impingement of the soft tissue, including the rotator cuff, joint capsule and the long head of the biceps tendon and glenoid labrum. Two types of internal impingement syndrome can be differentiated: posterior-superior impingement and anterior-superior impingement (ASI). The aetiology of ASI in particular is not clear. The purpose of this paper is to discuss the different aetiological theories relating to ASI, try to clarify the clinical, radiological and arthroscopic findings and, finally, suggesting treatment for this complex shoulder syndrome. METHODS The article is based on own research and clinical experience, as well as a non-systematic search in the PubMed database. RESULTS The aetiology of ASI appears to be related to the pulley lesion and instability of the long head of the biceps tendon. It can be caused by trauma or degenerative factors, which produces anterior shoulder pain in middle-aged patients, particularly when performing overhead activities. CONCLUSION The ASI is probably more frequent than previously reported. There is no evidence to prove the efficacy of a specific rehabilitative protocol, and the gold standard of surgical management has to be ascertained. However, in patients with a pulley lesion, there is some evidence that early surgical management, when minor soft injury lesions are present, produces better clinical outcomes.
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Saggini R, Cavezza T, Di Pancrazio L, Pisciella V, Saladino G, Zuccaro MC, Bellomo RG. Treatment of lesions of the rotator cuff. J BIOL REG HOMEOS AG 2010; 24:453-459. [PMID: 21122285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The impingement syndrome and tendinopathy of the rotator cuff are the most common causes (complaints) of pain and disability of the shoulder. The aim of this study is to evaluate the efficacy of a specific rehabilitative protocol, integrated with the administration of a nutritional supplement, in the conservative rehabilitative treatment, as well as in post-surgery, of patients with lesions of the rotator cuff. Two groups with syndrome of the rotator cuff were formed to follow different therapeutic courses, in relation to the choice of each subject to undergo the conservative treatment (Arm A) or the surgical one (Arm B). In Arm A the study included the association of therapy with ESWT (shock waves) with the proprioceptive Multi Joint System, for rehabilitating joint movement and muscle strength of the shoulder, and a specific nutritional supplement to reduce the pain and conserve the cartilage tissue. Between February 2009 and June 2009, we enrolled 30 subjects (randomized into three homogenous groups A1, A2, A3), average age 45±10 years, with rotator cuff syndrome with calcification of the shoulder, diagnosed through clinical examination and investigative instruments (X-ray, echography or NMR). In Arm B, from September 2009 to January 2010, we enrolled 50 patients (randomized into two groups, B1 and B2), 24 male (average age 58.4: min 28 and max 78) and 26 females (average age 59.5: min 30 and max 80), who had undergone rotator cuff operations and acromionplasty for non-massive lesions without important gleno-humeral instability, with either open or arthroscopic procedures. The analysis of the results of Arm A highlights that in terms of reducing pain the main benefits were found in Group A1 where the supplement was given. From the analysis of the data of Arm B, in both groups an improvement of the first 4 items evaluated was evident. In Group B1, 84 percent of the patients declared to be satisfied and improved and 16 percent were dissatisfied; in Group B2, where the nutritional supplement was given, 92 percent were satisfied and 8 percent were dissatisfied. In conclusion, we retain that in cases of rotator cuff syndrome, an integrated rehabilitative approach, whether conservative or post-surgical, directed at taking total control of the patient, must observe particular attention to the optimization of the articular tissular metabolic balance in order to favour better functional recovery.
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Affiliation(s)
- R Saggini
- Physical Therapy Institute, Neurosciences and Imaging Department, Faculty of Medicine, University G. d'Annunzio, Chieti, Italy.
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Chester R, Smith TO, Hooper L, Dixon J. The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies. BMC Musculoskelet Disord 2010; 11:45. [PMID: 20214817 PMCID: PMC2846868 DOI: 10.1186/1471-2474-11-45] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 03/09/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subacromial impingement syndrome (SIS) is a commonly reported cause of shoulder pain. The purpose of this study was to systematically review the literature to examine whether a difference in electromyographic (EMG) activity of the shoulder complex exists between people with SIS and healthy controls. METHODS Medline, CINAHL, AMED, EMBASE, and grey literature databases were searched from their inception to November 2008. Inclusion, data extraction and trial quality were assessed in duplicate. RESULTS Nine studies documented in eleven papers, eight comparing EMG intensity and three comparing EMG onset timing, representing 141 people with SIS and 138 controls were included. Between one and five studies investigated each muscle totalling between 20 and 182 participants. The two highest quality studies of five report a significant increase in EMG intensity in upper trapezius during scaption in subjects with SIS. There was evidence from 2 studies of a delayed activation of lower trapezius in patients with SIS. There was otherwise no evidence of a consistent difference in EMG activity between the shoulders of subjects with painful SIS and healthy controls. CONCLUSIONS A difference may exist in EMG activity within some muscles, in particular upper and lower trapezius, between people with SIS and healthy controls. These muscles may be targets for clinical interventions aiding rehabilitation for people with SIS. These differences should be investigated in a larger, high quality survey and the effects of therapeutically targeting these muscles in a randomised controlled trial.
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Affiliation(s)
- Rachel Chester
- Institute of Health and Social Sciences Research, Faculty of Health, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
- Physiotherapy Department, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
| | - Toby O Smith
- Institute of Health and Social Sciences Research, Faculty of Health, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
- Institute of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, NR4 7UY, UK
| | - Lee Hooper
- Institute of Biomedical and Clinical Sciences, Faculty of Health, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - John Dixon
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, TS1 3BA, UK
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