Subacromial Motion Metrics in Painful Shoulder Impingement: A Dynamic Quantitative Ultrasonography Analysis

ObjectivesTo explore the subacromial motion metrics in patients with and without subacromial impingement syndrome (SIS) and to investigate whether the abnormality was associated with rotator cuff pathologies.DesignThis cross-sectional observational study used dynamic quantitative ultrasonography imaging for shoulder joint assessment.SettingOutpatient rehabilitation clinic.ParticipantsIndividuals with SIS on at least 1 shoulder (n=32) and asymptomatic controls (n=32) (N=64).InterventionsNot applicable.Main Outcome MeasuresFrame-by-frame, the humeral greater tuberosity against the lateral edge of the acromion was traced to obtain the minimal vertical acromiohumeral distance (AHD). The rotation angle and radius of the humerus were computed using the least-squares curve fitting method.ResultsApproximately two-thirds of the shoulders with SIS did not have any sonographically identifiable rotator cuff pathologies. There was a consistent trend of nonsignificantly increased humeral rotation angles in painful shoulders. The generalized estimating equation demonstrated that the decreased minimal vertical AHD was associated with painful subacromial impingement (β coefficient: ?0.123cm, 95% confidence interval [CI], ?0.199 to ?0.047). The area under the curve for the minimal vertical AHD to discriminate painful or impinged shoulders ranged from 0.624-0.676. The increased rotation angle (β coefficient: 10.516°; 95% CI, 3.103-17.929) and decreased rotation radius (β coefficient: ?2.903cm; 95% CI, ?5.693 to ?0.111) were shown to be significantly related to the presence of supraspinatus tendinopathy.ConclusionsShoulders with SIS were characterized by a decreased minimal vertical AHD during dynamic examination. Abnormal subacromial metrics can develop in patients with mild (or no) rotator cuff pathologies. More prospective cohort studies are warranted to investigate the changes in subacromial motion metrics in populations at risk for painful or impinged shoulders.     

The potential role of upper extremity muscle fatigue in the generation of extrinsic subacromial impingement syndrome: a kinematic perspective

Abstract

Background:

Subacromial impingement syndrome (SAIS) of the shoulder has a multi-factorial aetiology which includes both intrinsic and extrinsic mechanisms. Upper extremity muscle fatigue has been proposed as a potential causative factor in extrinsic SAIS development.

Objectives:

This review summarises the current state of knowledge regarding fatigue-induced glenohumeral (GH) and scapulothoracic (ST) kinematic changes as they relate to subacromial space reduction and subsequent SAIS. It specifically addresses evidence for mechanisms including superior humeral head translation and scapular reorientation.

Major findings:

Global upper extremity muscle fatigue elicits GH kinematic changes that increase SAIS risk. Concurrent compensatory ST kinematic alterations, primarily scapular upward rotation (UR), lessen this risk. Additionally, fatiguing protocols aimed to selectively exhaust certain muscles or muscle groups without fatiguing the rotator cuff were unsuccessful, suggesting that rotator cuff fatigue is likely for a wide range of fatiguing upper extremity tasks.

Conclusions:

Despite the compensatory response of scapular reorientation in fatigued conditions, the dimensions of the subacromial space still pose increased risk for SAIS development, and the variability in kinematic responses produces highly differential risk, particularly for those exposed to tasks requiring increased rotator cuff muscle demand.     

Shoulder external rotation range of motion and pectoralis minor length in individuals with and without shoulder pain

ABSTRACT

Background: There is evidence that pectoralis minor (PM) length influences scapula position and that scapula position relates to glenohumeral joint (GHJ) external rotation (ER) range of motion (ROM). Objectives: To explore the association between PM resting length and GHJ ER ROM in individuals with and without shoulder pain. The influence of GHJ ER ROM measurement position on this association was also evaluated. Design: Cross-Sectional. Methods: Fifty individuals (25 asymptomatic and 25 with shoulder pain) participated. PM resting length was measured using a tape measure with subjects standing, while GHJ ER ROM was quantified using a digital inclinometer with participants in both supine and seated positions. The same blinded investigator took all measurements. Results/Findings: A significant negative correlation between PM resting length and GHJ ER ROM in the seated position was noted in the asymptomatic group (r = ?0.41; p = 0.04), but not in the symptomatic group (r = ?0.33; p = 0.11). A nonsignificant negative correlation was also demonstrated in the supine position for both groups (r ranged from ?0.35 to ?0.17; p > 0.05). There was a significant group x position interaction (F = 4.06; p = 0.04) with more GHJ ER ROM (6.80°) for asymptomatic group in the seated position. Conclusions: PM length is not strongly correlated with GHJ ER ROM in individuals with or without shoulder pain. However, the position in which GHJ ER ROM is measured influenced the motion in asymptomatic individuals.     

肩袖损伤合并肩峰下撞击综合征的MRI表现

目的探讨肩袖损伤合并肩峰下撞击综合征的MRI影像表现。材料与方法对33例X线片无骨折但临床怀疑肩袖损伤或肩峰下撞击综合征的患者,用1.5 T MRI机检查,观察肩袖损伤及肩峰下撞击综合征在MR上的影像特征,分析两者的相关性,并与手术结果对比,计算准确率。结果 33例中肩袖损伤20例(合并肩峰下撞击综合征10例),肩峰下撞击综合征15例(合并肩袖损伤10例)。肩袖损伤和肩峰下撞击综合征术前MR诊断准确率分别约为95.0%、71.3%。结论肩关节MRI扫描对肩袖损伤及肩峰下撞击综合征的诊断有较高的临床应用价值,肩袖损伤者中至少半数合并肩峰下撞击综合征,临床和影像应予重视。     

肩峰下撞击综合征的经皮超声引导下肩峰下滑囊造影表现

目的 探讨肩峰下撞击综合征（SIS）的经皮超声引导下肩峰下滑囊造影（PUSB）表现。方法 对150例经临床诊断为SIS患者行PUSB检查,动态观察造影剂在滑囊内的弥散情况及是否进入肩袖、关节腔。结果 53例造影剂在滑囊内呈线状均匀分布,诊断为单纯性肩峰下滑囊炎。97例造影剂在滑囊内分布不均匀,诊断为粘连性肩峰下滑囊炎。40例可见造影剂由滑囊进入肩袖肌腱,但未达肱骨头表面;32例可见造影剂由滑囊进入肩袖肌腱,到达肱骨头表面;78例造影剂未进入肩袖肌腱。结论 PUSB可实时动态评估肩峰下滑囊炎、滑囊粘连、肩袖损伤等情况,对SIS的诊断具有较高的应用价值。     

Three-dimensional scapular morphology is associated with rotator cuff tears and alters the abduction moment arm of the supraspinatus

BackgroundNumerous studies have reported an association between rotator cuff injury and two-dimensional measures of scapular morphology. However, the mechanical underpinnings explaining how these shape features affect glenohumeral joint function and lead to injury are poorly understood. We hypothesized that three-dimensional features of scapular morphology differentiate asymptomatic shoulders from those with rotator cuff tears, and that these features would alter the mechanical advantage of the supraspinatus.MethodsTwenty-four individuals with supraspinatus tears and twenty-seven age-matched controls were recruited. A statistical shape analysis identified scapular features distinguishing symptomatic patients from asymptomatic controls. We examined the effect of injury-associated morphology on mechanics by developing a morphable model driven by six degree-of-freedom biplanar videoradiography data. We used the model to simulate abduction for a range of shapes and computed the supraspinatus moment arm.FindingsRotator cuff injury was associated with a cranial orientation of the glenoid and scapular spine (P = .011, d = 0.75) and/or decreased subacromial space (P = .001, d = 0.94). The shape analysis also identified previously undocumented features associated with superior inclination and subacromial narrowing. In our computational model, warping the scapula from a cranial to a lateral orientation increased the supraspinatus moment arm at 20° of abduction and decreased the moment arm at 160° of abduction.InterpretationsThree-dimensional analysis of scapular morphology indicates a stronger relationship between morphology and cuff tears than two-dimensional measures. Insight into how morphological features affect rotator cuff mechanics may improve patient-specific strategies for prevention and treatment of cuff tears.     

The effect of a rotator cuff tear and its size on three-dimensional shoulder motion

BackgroundRotator cuff-disease is associated with changes in kinematics, but the effect of a rotator cuff-tear and its size on shoulder kinematics is still unknown in-vivo.MethodsIn this cross-sectional study, glenohumeral and scapulothoracic kinematics of the affected shoulder were evaluated using electromagnetic motion analysis in 109 patients with 1) subacromial pain syndrome (n = 34), 2) an isolated supraspinatus tear (n = 21), and 3) a massive rotator cuff tear involving the supraspinatus and infraspinatus (n = 54). Mixed models were applied for the comparisons of shoulder kinematics between the three groups during abduction and forward flexion.FindingsIn the massive rotator cuff-tear group, we found reduced glenohumeral elevation compared to the subacromial pain syndrome (16°, 95% CI [10.5, 21.2], p < 0.001) and the isolated supraspinatus tear group (10°, 95% CI [4.0, 16.7], p = 0.002) at 110° abduction. Reduced glenohumeral elevation in massive rotator cuff tears coincides with an increase in scapulothoracic lateral rotation compared to subacromial pain syndrome (11°, 95% CI [6.5, 15.2], p < 0.001) and supraspinatus tears (7°, 95% CI [1.8, 12.1], p = 0.012). Comparable differences were observed for forward flexion. No differences in glenohumeral elevation were found between the subacromial pain syndrome and isolated supraspinatus tear group during arm elevation.InterpretationThe massive posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential.     

Relationship between strength and functional indexes (Rowe and Walch-Duplay scores) after shoulder surgical stabilization by the Latarjet technique

IntroductionThe rotator cuff muscles help stabilize the glenohumeral joint. Postoperative recovery of rotator cuff muscle strength appears to be an important factor for optimal joint stabilization and the resumption of professional and/or sports activities.ObjectiveTo study the relationship between internal rotator (IR) and external rotator (ER) muscle strength, shoulder function and the resumption of sports activities (as typically evaluated with functional scores) following surgical stabilization with the Bristow-Latarjet procedure in cases of chronic shoulder instability.Patients and methodsTwenty patients with anterior, post-traumatic, chronic shoulder instability were included prospectively in a cohort study. The Rowe and Walch-Duplay functional scores were rated for the operated shoulder and the isokinetic IR and ER peak torque values were evaluated with a Con-Trex^® dynamometer before surgery and then 3, 6 and 21 months afterwards. The isokinetic evaluation was performed (at 180°/s, 120°/s and 60°/s) in the seated position, with the arms in 45° of abduction and 30° of antepulsion in the plane of the scapula.ResultsThere were no significant postoperative correlations between shoulder function (as judged by the Rowe and Walch-Duplay scores) and IR or ER muscle strength.ConclusionThis study did not provide evidence for a correlation between IR and ER muscle strength and functional scores after surgical stabilization of the shoulder. However, it is necessary to objectively measure the rotator cuff strength recovery to adequate the strengthening of rotator muscle prior to the resumption of sports activities. Isokinetic strength assessment may thus be a valuable decision support tool for the resumption of sports activities and would complement the functional scores studied here.     

In vivo dynamic acromiohumeral distance in shoulders with rotator cuff tears

BackgroundThere are no previous studies on the acromiohumeral distance in shoulders with large-to-massive full-thickness rotator cuff tears. In this study, the acromiohumeral distance in rotator cuff tear and healthy shoulders was measured using 3D-to-2D model-to-image registration techniques.MethodsThe dynamic glenohumeral kinematics during scapular plane abduction and axial rotation were analyzed in 11 rotator cuff tear patients and 10 healthy control subjects. Periodic radiographic images of scapular plane abduction and axial rotation were taken using a flat-panel radiograph image detector. Movements of the shoulder joint were assessed using radiographic images and computed tomography-derived digitally reconstructed radiographs. The acromiohumeral distance was defined as the shortest 3D distance between the acromion and the proximal humerus.FindingsFor scapular plane abduction, the rotator cuff tear group had significantly smaller acromiohumeral distance than the control group at 15°, 30°, 45°, 60°, 75°, 135°, and 150° of humeral abduction (P < 0.05 at each measured angle). For axial rotation in the adducted position, the rotator cuff tear group had significantly smaller acromiohumeral distance than the control group at each point between −20° and 40° of glenohumeral external rotation (P < 0.05 at each measured angle).InterpretationThe minimum measured acromiohumeral distance was 0.9 mm in the rotator cuff tear shoulders and 2.1 mm in the healthy shoulders at 90° of scapular plane abduction. The findings are of clinical relevance because quantitative evaluation of the dynamic acromiohumeral distances in rotator cuff tear and healthy shoulders might provide important insight into subacromial impingement.     

The influence of muscle length on one-joint shoulder internal and external rotator muscle strength

Abstract

Background and purpose: Kendall suggests testing the rotator cuff muscles in their maximally shortened position, since one-joint muscles are thought to be strongest. We found little evidence to support this concept. The purpose of this study was to determine if the shoulder internal rotator (IR) and external rotator (ER) muscles are strongest when placed in their shortened length position. Methods: Fifty-three subjects participated. Glenohumeral joint internal rotation and external rotation motion was measured. Muscle strength was then tested using a hand-held dynamometer in four positions: (1) end-range ER; (2) neutral 0°; (3) glenohumeral joint mid-range and (4) end-range IR. Data were analyzed using two repeated measures ANOVA’s. Results: The results suggest that rotator muscle strength is dependent on muscle length. IR strength was weakest at end-range IR in its shortest length; ER muscle strength was weakest at end-range ER in its shortest length. Muscle strength of the IR or ER was not significantly different when comparing neutral 0° to the mid-range position and at their most lengthened position. Conclusion: The IR and ER muscles were found to be weakest when placed in a position of shortest muscle length, while the neutral 0° and mid-range positions were the strongest positions.     

Subacromial corticosteroid injection on poststroke hemiplegic shoulder pain: a randomized, triple-blind, placebo-controlled trial

Rah UW, Yoon S-H, Moon DJ, Kwack K-S, Hong JY, Lim YC, Joen B. Subacromial corticosteroid injection on poststroke hemiplegic shoulder pain: a randomized, triple-blind, placebo-controlled trial.ObjectiveTo evaluate the effect of subacromial corticosteroid injection on hemiplegic shoulder pain (HSP).DesignMulticenter, randomized, triple-blind, placebo-controlled trial.SettingThree primary and 1 university-affiliated tertiary-care hospitals.ParticipantsPoststroke HSP patients (N=58) with evidence of rotator cuff disorder.InterventionsParticipants were randomly assigned to receive ultrasound-guided subacromial injection with triamcinolone 40mg (treatment group, n=29), or lidocaine (placebo group, n=29). After a single injection, participants were followed up for 8 weeks.Main Outcome MeasuresVisual analog scale (VAS) of the average shoulder pain level at day and night (VAS-day/night, the primary outcome measures), Modified Barthel Index, Shoulder Disability Questionnaire (SDQ), and angles of shoulder active range of motion (flexion, abduction, external rotation, and internal rotation) at pretreatment and weeks 2, 4, and 8 posttreatment.ResultsThere was no significant difference between the 2 groups in the main outcome measures at pretreatment. Compared with the placebo group, VAS-day/night, SDQ, flexion, external rotation, and internal rotation showed significant improvement in the treatment group.ConclusionsTo our knowledge, this is the first randomized, placebo-controlled study to assess the efficacy of subacromial injection in HSP patients with evidence of rotator cuff disorder. Subacromial corticosteroid injection showed improvement in pain, disability, and active range of motion, and the duration of its efficacy continued up to 8 weeks.     

Online Information About the Effectiveness of Shoulder Surgery Is Not Based on the Best Available Evidence: A Content Analysis

ObjectiveTo summarize the proportion of consumer webpages on subacromial decompression and rotator cuff repair surgery that make an accurate portrayal of the evidence for these operations (primary outcome), mention the benefits and harms of surgery, outline alternatives to surgery, and make various surgical recommendations.DesignContent analysis.SettingOnline consumer information about subacromial decompression and rotator cuff repair surgery. Webpages were identified through (1) Google searches using terms synonymous with “shoulder pain” and “shoulder surgery” and searching “orthopedic surgeon” linked to each Australian capital city and (2) websites of relevant professional associations (eg, Australian Orthopaedic Association). Two reviewers independently identified webpages and extracted data.ParticipantsNot applicable.InterventionsNot applicable.Main Outcome MeasuresWhether the webpage made an accurate portrayal of the evidence for subacromial decompression or rotator cuff repair surgery (primary outcome), mentioned benefits and harms of surgery, outlined alternatives to surgery, and made various surgical recommendations (eg, delay surgery). Outcome data were summarized using counts and percentages.ResultsA total of 155 webpages were analyzed (n=89 on subacromial decompression, n=90 on rotator cuff repair, n=24 on both). Only 18% (n=16) and 4% (n=4) of webpages made an accurate portrayal of the evidence for subacromial decompression and rotator cuff repair surgery, respectively. For subacromial decompression and rotator cuff repair, respectively, 85% (n=76) and 80% (n=72) of webpages mentioned benefits, 38% (n=34) and 47% (n=42) mentioned harms, 94% (n=84) and 92% (n=83) provided alternatives to surgery, and 63% (n=56) and 62% (n=56) recommended delayed surgery (the most common recommendation).ConclusionsMost online information about subacromial decompression and rotator cuff repair surgery does not accurately portray the best available evidence for surgery and may be inadequate to inform patient decision making.     

Shoulder kinematics impact subacromial proximities: a review of the literature

BackgroundAlterations in glenohumeral and scapulothoracic kinematics have been theorized to contribute to rotator cuff pathology by impacting the magnitude of the subacromial space.ObjectiveThe purpose of this review is to summarize what is currently known about the relationship between shoulder kinematics and subacromial proximities.ConclusionsA variety of methods have been used to quantify subacromial proximities including photographs, MR imaging, ultrasonography, and single- and bi-plane radiographs. Changes in glenohumeral and scapulothoracic kinematics are associated with changes in subacromial proximities. However, the magnitude and direction of a particular motion's impact on subacromial proximities often vary between studies, which likely reflects different methodologies and subject populations. Glenohumeral elevation angle has been consistently found to impact subacromial proximities. Plane of humeral elevation also impacts subacromial proximities but to a lesser degree than the elevation angle. The impact of decreased scapulothoracic upward rotation on subacromial proximities is not absolute, but instead depends on the angle of humerothoracic elevation. The effects of scapular dyskinesis and humeral and scapular axial rotations on subacromial proximities are less clear. Future research is needed to further investigate the relationship between kinematics and subacromial proximities using more homogenous groups, determine the extent to which compression and other factors contribute to rotator cuff pathology, and develop accurate and reliable clinical measures of shoulder motion.     

A Systematic Comparison on Postoperative Analgesia Effect Between Subacromial and Intravenous Analgesia Pumps for Arthroscopic Rotator Cuff Repair

PurposeArthroscopic rotator cuff repair is often associated with severe postoperative pain. Various agents, routes, and modes are used for the treatment of postoperative pain with a minimum of side effects. This systematic work was conducted to compare the postoperative effect of subacromial patient-controlled analgesia with intravenous patient-controlled analgesia after an arthroscopic rotator cuff repair surgery.DesignA systematic review of relevant studies were retrieved from electronic databases and included based on criteria and eligibility.MethodsThe articles were retrieved from 1997 to 2018 by computerized searches of Scopus, PubMed, and EMBASE using different combinations of search terms, such as shoulder, rotator cuff, analgesic, analgesia, arthroscopic, pain, cuff repair, rotator cuff repair, acromion, and intravenous.FindingsA total of 10 articles were included in this study from the initial search of 778 records. Compared with subacromial procedure, the intravenous procedure helps in reducing the postoperative pain but with more side effects.ConclusionsThis study described that the direct continuous infusion of anesthetic under subacromial analgesic pump showed a greater pain relief with less side effects compared with intravenous infusion for arthroscopic rotator cuff repair.     

Immediate effects of kinesiotaping on acromiohumeral distance and shoulder proprioception in individuals with symptomatic rotator cuff tendinopathy

BackgroundKinesiotaping is widely used for the rehabilitation of rotator cuff tendinopathy. It has been argued to reduce symptoms and functional limitations through improvement of proprioceptive feedback. In addition, kinesiotaping has been reported to increase the subacromial space in healthy subjects. However, its effects on the acromiohumeral distance and shoulder proprioception of individuals with rotator cuff tendinopathy have not been ascertained. This study investigated the immediate effects of kinesiotaping on the acromiohumeral distance and shoulder proprioception in individuals with rotator cuff tendinopathy.MethodsTwenty-two individuals with chronic rotator cuff tendinopathy were included. The acromiohumeral distance was measured using an ultrasound scanner at rest and 60° shoulder abduction. Proprioception was measured through active joint repositioning in low- (45°–65°) and mid-amplitude (80°–100°) of shoulder flexion and abduction. A wireless inertial measurement unit system was used to quantify shoulder angles. First, measurements were taken without kinesiotaping. Thereafter, kinesiotaping was applied on the symptomatic shoulder, and the same measurements were retaken. Repeated measures ANOVAs were used for statistical analyses.FindingsKinesiotaping induced a significant increase in acromiohumeral distance at 60° abduction (∆AHD = 0.94 mm; 95%CI: 0.50–1.38, p < 0.001), exceeding the minimal detectable change (0.70 mm). No significant difference was observed in acromiohumeral distance at rest or in proprioception during active joint repositioning in both low- and mid-amplitude (p > 0.05).InterpretationKinesiotaping led to an immediate increase in acromiohumeral distance at 60° of abduction that, although it seems a minor change (↑10.5%), it may be significant for symptomatic patients, whereas it had no immediate effect on active joint repositioning.     

Immediate Effects of Thoracic Spine Manipulation Upon Shoulder Functionality in Patients With Sutured Rotator Cuff Repair: A Prospective Study

Objectives

The purpose of this study was to evaluate the immediate effect of thoracic spine manipulation upon active flexion and abduction mobility of the shoulder, spine temperature, and the size of the subacromial space as measured by ultrasound in 3 positions (internal, neutral, and external rotation) of the glenohumeral joint in patients who have undergone surgery because of subacromial impingement.

Fracture of the scapular neck combined with rotator cuff tear: A case report

BACKGROUNDScapular fracture has a low incidence rate, accounting for 0.4%-0.9% of all fractures, and scapular neck fractures are extremely rare, comprising approximately 7%-25% of all scapular fractures. Scapular neck fractures are often studied as case reports mostly accompanied by other injuries, thus leading to confusion. All previous cases of scapular neck fractures are not associated with rotator cuff injuries.CASE SUMMARYA 62-year-old man was admitted to our emergency department 6 h after his right shoulder and back were impacted by heavy objects. The patient presented chest tightness and shortness of breath. Chest computed tomography (CT) showed pneumohemothorax, multiple rib fractures, and right scapula fractures. Three-dimensional CT reconstruction of the right shoulder joint showed a trans-spinous scapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injury was suspected because the patient had a glenohumeral joint dislocation and was then confirmed by shoulder magnetic resonance imaging. A staged surgery was performed, including open reduction and internal fixation of the right scapula fracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mo follow-up, the fracture line was blurred and the shoulder joint function was good.CONCLUSIONFracture of the scapular neck combined with rotator cuff tear is rare and the rotator cuff injury should not be ignored in clinical work. Stable internal fixation combined with secondary arthroscopic repair of rotator cuff tear can achieve good results.     

Hip external rotator exercise contributes to improving physical functions in the early stage after total hip arthroplasty using an anterolateral approach: a randomized controlled trial

Purpose: The purpose of this study was to investigate the effects of an exercise program focusing on hip external rotator muscle on physical recovery in the early post-operative period of total hip arthroplasty (THA).

Methods: Patients who underwent THA were randomized to an exercise group (n = 14) or a control group (n = 14). In exercise group, the hip external rotator exercise program was performed 5 times per week for four weeks. Outcome measures were hip pain, hip range of motion, muscle strength of lower extremity and Timed Up and Go (TUG) test.

Results: Both the hip abductor strength (effect size?=?0.60) and TUG test (effect size=??0.53) in the exercise group improved significantly after the intervention.

Conclusions: The results of the present study demonstrated that exercise program focusing on hip external rotator muscle was an effective intervention, especially in improving both hip abductor strength and walking ability in the acute post-THA stage.

• Implication for Rehabilitation

• After THA, in order to safely progress patients back to their desired activity level, there is a need to develop rehabilitation strategies to expedite and promote the recovery during the acute postoperative period.

• Exercise program focusing on hip external rotator muscle may lead to significant improvement of hip abductor muscle strength and gait ability in the acute post-THA stage.

     

The ability of preoperative factors to predict patient-reported disability following surgery for rotator cuff pathology

Purpose: Minimal research has examined the prognostic ability of shoulder examination data or psychosocial factors in predicting patient-reported disability following surgery for rotator cuff pathology. The purpose of this study was to examine these factors for prognostic value in order to help clinicians and patients understand preoperative factors that impact disability following surgery.

Methods: Sixty-two patients scheduled for subacromial decompression with or without supraspinatus repair were recruited. Six-month follow-up data were available for 46 patients. Patient characteristics, history of the condition, shoulder impairments, psychosocial factors, and patient-reported disability questionnaires were collected preoperatively. Six months following surgery, the Western Ontario Rotator Cuff Index (WORC) and global rating of change dichotomized subjects into responders versus nonresponders. Logistic regression quantified prognostic ability and created the most parsimonious model to predict outcome.

Results: Being on modified job duty (OR?=?.17, 95%CI: 0.03–0.94), and having a worker’s compensation claim (OR?=?0.08, 95%CI: 0.01–0.74) decreased probability of a positive outcome, while surgery on the dominant shoulder (OR?=?11.96, 95%CI: 2.91–49.18) increased probability. From the examination, only impaired internal rotation strength was a significant univariate predictor. The Fear-avoidance Beliefs Questionnaire (FABQ) score (OR?=?0.95, 95%CI: 0.91–0.98) and the FABQ_work subscale (OR?=?0.92, 95%CI: 0.87–0.97) were univariate predictors. In the final model, surgery on the dominant shoulder (OR?=?8.9, 95%CI 1.75–45.7) and FABQ_work subscale score?≤25 (OR?=?15.3, 95%CI 2.3–101.9) remained significant.

Discussion: Surgery on the dominant arm resulted in greater improvement in patient-reported disability, thereby increasing the odds of a successful surgery. The predictive ability of the FABQ_work subscale highlights the potential impact of psychosocial factors on patient-reported disability.

• Implications for Rehabilitation

• Impairment-based shoulder measurements were not strong predictors of patient-reported outcome.

• Having high fear-avoidance behavior scores on the FABQ, especially the work subscale, resulted in a much lower chance of responding well to rotator cuff surgery as measured by self-reported disability.

• Having surgery on the dominant shoulder, as compared to the nondominant side, resulted in larger improvements in disability levels.

     

Comparison of acromiohumeral distance in symptomatic and asymptomatic patient shoulders and those of healthy controls

BackgroundThe reduction of the subacromial space has traditionally been linked to rotator cuff pathology. The contribution of this narrowing, both in the development and maintenance of rotator cuff tendinopathy, is still under debate. The objective of the present study was compare the acromiohumeral distance at 0 and 60 degrees of active shoulder abduction in scapular plane, static position, in both symptomatic and contralateral shoulders, between participants with unilateral rotator cuff related shoulder pain, and in asymptomatic participants.MethodThis was a cross-sectional observational study. Seventy-six participants with chronic shoulder pain were assessed. Forty participants without shoulder pain were also recruited to compare the acromiohumeral distance with symptomatic participants. The acromiohumeral distance was measured at 0 and 60 degrees of active shoulder abduction in all the groups by ultrasound imaging. Mean differences between symptomatic versus contralateral shoulders, and versus healthy controls, were calculated.FindingsThere were no statistical significant differences (p > .05) in the acromiohumeral distance at 0 degrees of shoulder elevation between the groups. However, significant differences were found at 60° between symptomatic and contralateral shoulder groups (0,51 mm; 95% CI: −0.90 to −0.12).InterpretationsDifferences in shoulder pain perception at 0° are not attributable to acromiohumeral distance differences. However, treatments focused on increasing AHD at 60° could be prescribed, as a significantly reduced AHD was found in symptomatic shoulders when compared with contralateral shoulders. Further research is needed to determine, not only static differences in AHD, but also dynamic differences.