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Seo JB, Jung JW, Yoo JS. Combination of arthroscopic biologic tuberoplasty and bursal acromial reconstruction. J Orthop 2024; 51:1-6. [PMID: 38299060 PMCID: PMC10825636 DOI: 10.1016/j.jor.2023.10.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 02/02/2024] Open
Abstract
Background Recently, among the various method for irreparable rotator cuff tears, the "tension-free allodermis graft technique" has been introduced as a method for arthroscopic biologic tuberoplasty(ABT) and bursal acromial reconstruction(BAR).The objective was to analyze the outcomes of ABT and BAR combination surgical technique. Methods Eighteen cases who underwent simultaneous ABT and BAR procedures were retrospectively recruited. Before the surgery and at one year post-surgery, the researchers assessed the patients' Visual Analog Scale(VAS), American Shoulder and Elbow Surgeons(ASES) scores, pain scores, range of motion(ROM), retear, and acromiohumeral distance (AHD). Results One year post-surgery, both the VAS pain scores, ASES scores, and ROM showed statistically significant improvement compared to before the surgery. Upon reviewing the radiological results, the AHD significantly improved from 4.3 ± 4.1 mm before surgery to 9.2 ± 1.9 mm at one year post-surgery (p < 0.001). Moreover, in the one year follow-up, there was no observed failure of the allodermis graft in any of the cases. Conclusion The combination of ABT and BAR demonstrated significantly improved clinical outcomes after surgery, showing a substantial increase in AHD and preventing graft failure effectively.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Wook Jung
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Sung Yoo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
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Hsu KL, Kuan FC, Velasquez Garcia A, Hong CK, Chen Y, Shih CA, Su WR. Factors association with reparability of rotator cuff tears: A systematic review and meta-analysis. J Shoulder Elbow Surg 2024:S1058-2746(24)00261-1. [PMID: 38642872 DOI: 10.1016/j.jse.2024.03.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To identify and quantify the factors associated with the reparability of rotator cuff tears (RCTs). METHODS PubMed, Scopus, and Web of Science databases were searched for clinical studies published in English focusing on RCT reparability by using the keywords "rotator cuff tear" and "reparability". A meta-analysis was conducted if ≥3 studies examined the same factor and provided enough data to assess RCT reparability. Quality assessment was completed using the QUADAS-2 tool. RESULTS Eighteen studies (2700 patients) were enrolled, and 26 factors were included in the meta-analysis. The dichotomous variables associated with irreparability were Patte stage 3 (Odds ratio (OR): 8.0, 95% CI: 4.3-14.9), massive tear versus large tear (OR: 3.1, 95% CI: 1.3-7.2), Goutallier stage for each tendon, and tangent sign (OR: 11.1, 95% CI: 4.3-28.4). The continuous variables associated with irreparability were age (Mean difference (MD): 3.25, 95% CI: 1.4-5.1), mediolateral tear size (MD: 12.3, 95% CI: 5.8-18.9), anteroposterior tear size (MD: 10.4, 95% CI: 5.2-15.6), acromiohumeral distance on X-ray (MD: -2.3, 95% CI: -3.0 to -1.6) and magnetic resonance imaging (MD: -1.8, 95% CI: -2.8 to -0.9), and inferior glenohumeral distance on MRI (MD: 2.2, 95% CI: 1.4-3.0). CONCLUSION This study revealed that older age, larger tear size, severe fatty infiltration, muscle atrophy, and advanced superior migration of the humeral head were strongly associated with irreparable RCTs. Conversely, clinical symptoms provided limited information for predicting reparability. Additionally, the tangent sign emerged as a powerful and simple tool for individual prediction, and several quantitative scoring systems also proved useful.
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Affiliation(s)
- Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Clinica Universidad de los Andes, Department of Orthopedic Surgery, Santiago, Chile
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Yueh Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan.
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Chang CY, Weng YH, Chang CH, Yang JL, Chen PT, Lin JJ. Neuromuscular electrical stimulation of humeral adductors in subjects with rotator cuff tear. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05316-3. [PMID: 38613614 DOI: 10.1007/s00402-024-05316-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION In symptomatic patients with rotator cuff tear, MRI and radiographic studies have ascribed the pain symptom to insufficient humeral head depression during arm elevations. The arm adductors such as the teres major and pectoralis major may contribute to depression of the humerus head during arm elevations. Researchers have demonstrated that neuromuscular electrical stimulation (NMES) of the serratus anterior and lower trapezius can control scapular motions and improve acromiohumeral distance. It is unknown, however, if adductor neuromuscular training could help patients with rotator cuff tear. MATERIALS AND METHODS A cross-sectional study of NMES of the teres major and pectoralis major was conducted on 30 symptomatic subjects with rotator cuff tear. We measured the acromiohumeral distance by ultrasonography and scapular kinematics during arm elevation with a three-dimensional motion tracking system. RESULTS The acromiohumeral distance significantly increased during NMES of the teres major (0.73 mm, p < 0.001). However, the distance significantly decreased with NMES of the pectoralis major (0.78 mm, p < 0.001). Additionally, scapular upward rotation was greater during NMES of the teres major than during NMES of the pectoralis major (3.4°, p < 0.001). Scapular external rotation decreased significantly more during NMES of the pectoralis major than during NMES of the teres major (1.6°, p = 0.003). CONCLUSIONS NMES of the teres major can increase acromiohumeral distance and scapular upward rotation during arm elevation. However, the decreased upward and external rotation of the scapula during arm elevation with NMES of the pectoralis major may be associated with subacromial impingement.
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Affiliation(s)
- Che-Yuan Chang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Rm. 327, 3F., No. 17, Xuzhou Rd. Zhongzheng Dist, Taichung, Taipei City, 100, Taiwan
| | - Yi Hsuan Weng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Hsun Chang
- Department of Orthopedic Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Lan Yang
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Tsun Chen
- School of Physical Therapy, Master Program in Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Jiu-Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Koç M, Aydoğmuş H, Dinç F, Bayar K, Oskay D. Immediate effects of Kinesio taping and Dynamic taping on acromiohumeral distance in individuals with symptomatic rotator cuff tendinopathy. J Hand Ther 2024:S0894-1130(23)00176-X. [PMID: 38378298 DOI: 10.1016/j.jht.2023.12.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/26/2023] [Accepted: 12/08/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND It has been suggested that the reduction in subacromial space during arm elevation is one of the potential mechanisms in the etiology of Rotator cuff tendinopathy. While it is known that Kinesio taping reduces the narrowing of the acromiohumeral distance (AHD) during arm elevation, the effect of Dynamic taping remains unknown. PURPOSE This study aimed to compare the immediate effects of Kinesio taping and Dynamic taping on AHD in individuals with symptomatic Rotator Cuff Tendinopathy. STUDY DESIGN Two group pre-post-test repeated measures design was used. METHODS Thirty-two participants were randomly assigned to two groups: Kinesio taping group (n = 16) and Dynamic taping group (n = 16). AHD measurements were taken via ultrasound at 0° (rest) and 60° shoulder abduction both before and immediately after taping. Repeated measures ANOVAs were used for statistical analyses. RESULTS The study demonstrated that both taping methods led to a significant increase in AHD at both neutral and 60° abduction. However, the increase in AHD with Dynamic taping was statistically greater than with Kinesio taping in both neutral (p < 0.05) and 60° abduction (p < 0.001). CONCLUSIONS The findings of this study suggest that Dynamic taping techniques may be a more effective approach for improving AHD for symptomatic patients. Therefore, Dynamic taping has the potential to be clinically beneficial before engaging in exercises.
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Affiliation(s)
- Meltem Koç
- Muğla Sıtkı Koçman University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Muğla, Türkiye; Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Muğla, Türkiye; Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Türkiye.
| | - Hüseyin Aydoğmuş
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Muğla, Türkiye
| | - Funda Dinç
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Radiology, Muğla, Türkiye
| | - Kılıçhan Bayar
- Muğla Sıtkı Koçman University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Muğla, Türkiye; Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Muğla, Türkiye; Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Türkiye
| | - Deran Oskay
- Gazi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Türkiye
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Cavaggion C, Navarro-Ledesma S, Luque-Suarez A, Juul-Kristensen B, Voogt L, Struyf F. Subacromial space measured by ultrasound imaging in asymptomatic subjects and patients with subacromial shoulder pain: an inter-rater reliability study. Physiother Theory Pract 2023; 39:2196-2207. [PMID: 35505639 DOI: 10.1080/09593985.2022.2072251] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/28/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT) measured by ultrasound (US) can be combined in the occupation ratio (OR). Inter-rater reliability on these subacromial measures depends on the US experience of raters and on the subject status, differing between asymptomatic or patients with subacromial shoulder pain (SSP). OBJECTIVE To evaluate inter-rater reliability between two raters with different US experience (experienced examiner and novice examiner). METHODS In total, 20 asymptomatic subjects (controls) and 21 patients with SSP were examined on one shoulder. Inter-rater reliability was evaluated with intraclass correlation coefficient (ICC). RESULTS ICC for controls was good for AHD at rest and at 60° (0.76-0.77), moderate for STT and AHD at 60° with weights (0.53-0.72), while OR was poorly reliable (below 0.44). ICC for SSP was moderate for AHD at rest and at 60°, STT, OR at rest and at 60° (0.52-0.74) and poor for AHD at 60° with weights and OR at 60° with weights (0.33-0.36). Bland-Altman plots showed systematic bias. CONCLUSION Inter-rater reliability varied largely from poor to good between two examiners with different US experience. Clinicians might use the US as additional tool for detecting the subacromial structures, but a structured training including also symptomatic subjects is suggested. Researchers may further investigate the OR in matched case-control studies, and an overall agreement phase is recommended before starting the inter-rater reliability phase.
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Affiliation(s)
- Claudia Cavaggion
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | - Alejandro Luque-Suarez
- Department of Physiotherapy, University of Malaga, Malaga, Spain
- Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lennard Voogt
- Department of Physical Therapy Studies and Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Filip Struyf
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Aydin M, Capkin S, Surucu S, Karahasanoglu R, Yilmaz M. The effect of biceps tenotomy on superior humeral migration in arthroscopic repaired full-thickness supraspinatus tears. JSES Int 2023; 7:768-773. [PMID: 37719819 PMCID: PMC10499908 DOI: 10.1016/j.jseint.2023.05.012] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Lesions of the long head of the biceps (LHB) tendon are a prevalent injury that frequently coexists with rotator cuff injuries. This study aimed to assess the effect of supraspinatus (SST) repair with concurrent LHB tenotomy on superior migration of the humeral head. The acromiohumeral distance (AHD) was determined via ultrasound to evaluate the superior migration of the humeral head. Methods The study population was retrospectively recruited from patients who underwent unilateral arthroscopic repair of isolated degenerative full-thickness SST tears between January 2017 and December 2019. Patients were divided into 2 subgroups based on whether they underwent LHB tenotomies during arthroscopy. While 37 patients underwent arthroscopic single-row SST repair, the other 33 patients underwent arthroscopic single-row SST repair with LHB tenotomy. The subject group consisted of people who had undergone arthroscopic shoulder surgery. Contralateral shoulders without rotator cuff injuries were included in the control group. The AHD and SST thicknesses of patients were examined via the ultrasound in both groups and subgroups. Results The mean age in the SST repair group was 55.52 ± 4.58 years (range, 46-63 years), whereas it was 58.24 ± 3.98 (range, 52-73 years) in the SST repair + LHB tenotomy group. In the SST repair group, 57.6% of patients were female and 42.4% were male, whereas 56.8% and 43.2% were in the SST repair + LHB tenotomy group, respectively. The mean body mass index was 28.06 ± 1.31 kg/m2 (range, 25.7-31.2 kg/m2) in the SST repair group and 28.95 ± 1.79 kg/m2 in the SST repair + LHB tenotomy group. Groups were not different for sex, surgery side, dominant side, tear size, and follow-up time; however, the SST repair + LHB tenotomy group had significantly higher mean age and body mass index than the SST repaired group. The mean AHD value and SST thickness were significantly less in both the rotator cuff repair group and the rotator cuff repair + LHB tenotomy group compared to the healthy shoulder. The mean AHD value was significantly lower in the SST repaired + LHB tenotomy group than in the SST repair group (P = .02). Conclusion The AHD was narrowed in patients who underwent LHB tenotomy and radiologically demonstrated the depressor effect of the LHB tendon on the humeral head. As a secondary outcome, we demonstrated that regardless of tenotomy, AHD could not be restored in patients who underwent arthroscopic single-row SST repair.
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Affiliation(s)
- Mahmud Aydin
- Department of Orthopaedics, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Sercan Capkin
- Department of Orthopaedics, Aksaray Universty Education Research Hospital, Aksaray, Turkey
| | - Serkan Surucu
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Ridvan Karahasanoglu
- Department of Orthopaedics, Haseki Training and Research Hospital, İstanbul, Turkey
| | - Murat Yilmaz
- Department of Orthopaedics, Haseki Training and Research Hospital, İstanbul, Turkey
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Umay-Altaş E, Ecem-Konak H, Ünsal-Delialioğlu S, Şahin-Onat Ş, Günay-Uçurum S. Mid-term effects of two different Kinesio tape treatments in female patients with subacromial impingement syndrome: Randomized controlled ultrasonographic study. J Hand Ther 2023; 36:514-522. [PMID: 36918309 DOI: 10.1016/j.jht.2022.09.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/09/2022] [Accepted: 09/13/2022] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Randomized controlled study. PURPOSE OF THE STUDY To evaluate the effect of Kinesio Tape (KT) applied differently in patients diagnosed with Subacromial Impingement Syndrome (SIS) on acromiohumeral distance (AHD) and supraspinatus tendon (SsT) thickness using ultrasound (US) and its effect on pain, upper limb functional status and hand grip muscle strength in the short and mid-term. METHODS The 90 patients diagnosed with unilateral SIS by clinical examination were randomized into 3 groups. In addition to exercise therapy, the deltoid in group 1 and the supraspinatus muscle in group 2 were taped from insertion to origin. Group 3, which was the control group, was applied 9 sessions of sham taping for 3 weeks. Cases were evaluated for AHD and SsT thickness, pain was evaluated with the Visual Analog Scale (VAS), function with the Disabilities of the arm, shoulder and hand (DASH) and the Western Ontario Rotator Cuff Index (WORC), and hand grip strength (HGS) using a dynamometer before, and 3rd week and 3rd month after the KT application. RESULTS There was a significant improvement in all parameters in the short and mid-term intra group comparisons in Group 1 and 2 after taping (P < .05). In intergroup comparisons, significant improvement was achieved in all parameters in Group 1 and Group 2 in the mid and short term compared to the control group (P < .05). In comparison of Group 1 and Group 2, HGS in the short term (p: 0.07) and the SsT thickness in the short and mid-term (p: 0.36, p: 0.85) did not exhibit any difference. The improvement in all other parameters in group 1 was statistically significant. CONCLUSION The findings of our study provide definitive evidence for the effectiveness of KT treatment depending on the method of tape application employed.
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Affiliation(s)
- Elif Umay-Altaş
- Department of Physical Medicine and Rehabilitation, İzmir Bakırçay University Çiğli Training and Research Hospital, Izmir, Turkey.
| | - Hatice Ecem-Konak
- Ankara City Hospital, Physical Medicine and Rehabilitation, Ankara, Turkey
| | | | - Şule Şahin-Onat
- Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Sevtap Günay-Uçurum
- İzmir Katip Çelebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
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Egli RJ, Widmer ECJ, Waltenspül M, Bouaicha S, Sutter R. The robustness of glenohumeral centering measurements in dependence of shoulder rotation and their predictive value in shoulders with rotator cuff tears. Skeletal Radiol 2023; 52:183-91. [PMID: 36002755 DOI: 10.1007/s00256-022-04159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE De-centering of the shoulder joint on radiographs is used as indicator for severity of rotator cuff tears and as predictor for clinical outcome after surgery. The objective of the study was to assess the effect of malrotation on glenohumeral centering on radiographs and to identify the most reliable parameter for its quantification. SUBJECTS AND METHODS In this retrospective study (2014-2018), 249 shoulders were included: 92 with imaging-confirmed supra- and infraspinatus tears (rupture; 65.2 ± 9.9 years) and 157 without tears (control; 41.1 ± 13.0 years). On radiographs in neutral position and external rotation, we assessed three radiographic parameters to quantify glenohumeral centering: acromiohumeral distance (ACHD), craniocaudal distance of the humeral head and glenoid center (Deutsch), and scapulohumeral arch congruity (Moloney). Non-parametric statistics was performed. RESULTS In both positions, only the distance parameters ACHD (< 0.5 mm) and Deutsch (< 1 mm) were comparable in the two study groups rupture and control. Comparing the parameters between the study groups revealed only ACHD to be significantly different with a reduction of more than 2 mm in the rupture group. Among the parameters, ACHD ≤ 6 mm was the only cut-off discriminating rupture (12-21% of the shoulders with ACHD ≤ 6 mm) and control (none of the shoulders with ACHD ≤ 6 mm). Ninety percent of shoulders with ACHD ≤ 6 mm presented with a massive rotator cuff tear (defined as ≥ 67% of the greater tuberosity exposed). CONCLUSION Glenohumeral centering assessed by ACHD and Deutsch is not affected by rotation in shoulders with and without rotator cuff tear. An ACHD ≤ 6 mm has a positive predictive value of 90% for a massive rotator cuff tear.
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Sürücü S, Aydın M, Çapkın S, Karahasanoglu R, Yalçın M, Atlıhan D. Evaluation of bilateral acromiohumeral distance on magnetic resonance imaging and radiography in patients with unilateral rotator cuff tears. Arch Orthop Trauma Surg 2022; 142:175-80. [PMID: 34218320 DOI: 10.1007/s00402-021-04026-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the difference in the acromiohumeral distance (AHD) between the shoulders with full-thickness rotator cuff tear and contralateral healthy shoulders of the same patients on magnetic resonance imaging (MRI) and radiograph. MATERIALS AND METHODS We included 49 patients with unilateral full-thickness rotator cuff tears. The mean age of the patients (29 women and 20 men) was 54.57 ± 7.10 years. The shoulders were divided into those with a full-thickness rotator cuff tear and healthy shoulders. The mean AHDs on radiograph and MRI were calculated by two radiologists experienced in the musculoskeletal system. Shoulders with rotator cuff tears on coronal plane and sagittal MRI were divided into 3 (Patte I, II, III) and 4 subgroups (S: superior, AS: anterosuperior, PS: posterosuperior, APS: anteroposterosuperior), respectively. The relationship between the groups and the subgroups was statistically investigated. RESULTS The mean AHDs on radiograph were 6.93 and 9.11 mm and on MRI were 5.94 and 7.46 mm in the patient and control groups, respectively. The mean AHDs were 6.47, 6.03, and 4.95 mm in Patte I, II, and III, respectively. The difference between the subgroups was statistically significant. According to the sagittal plane topography, the mean AHDs (mm) were 6.39, 6.44, 5.8, and 4.6 mm in the superiorly, anterosuperiorly, posterosuperiorly, and anteroposterosuperiorly localized lesions, respectively. The relationship between S and AS was not statistically significant, and those between S and PS, AS and PS, S and APS, and PS and APS were significant. CONCLUSIONS In patients with unilateral full-thickness rotator cuff tear, AHD narrowing was observed on the törnekler side after evaluating the bilateral acromiohumeral distance on MRI and radiograph. AHD was significantly reduced by increasing the degree of supraspinatus tendon retraction in the coronal plane MRI and by the posterosuperior and anteroposterosuperior location of the rotator cuff tear in the sagittal plane MRI.
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Martín-San Agustín R, Cuerda-Del Pino A, Moreno-Segura N, Escriche-Escuder A, Sánchez-Barbadora M. Influence of rigid taping on the acromiohumeral distance in healthy recreational weightlifters. PeerJ 2021; 9:e12093. [PMID: 34527448 PMCID: PMC8403474 DOI: 10.7717/peerj.12093] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background Subacromial pain syndrome is one of the most frequent injuries in overhead athletes, and it takes place when the acromiohumeral distance (AHD) is narrowed. Conservative treatment is the first approach to this syndrome, being shoulder taping one of the most used techniques. Although there are quite a few studies that analyse the effect of taping on the AHD, most of them do not include sham tapings. This study aimed to examine if the Relocation of the humeral head (RHH) taping produced an increase in the AHD in healthy recreationally weightlifter males, quantifying the change that may be due to a placebo effect. Methods The design of this study was a two-group pretest-posttest, in which eighteen healthy recreationally weightlifter males were measured. in a laboratory of the University of Valencia. RHH using rigid or sham taping was randomly applied to the participants. The AHD was measured and registered before and after the application of the taping for both groups by a blinded examiner using ultrasound. Results There were no significant differences between pre and post measures in the sham group (p = 0.51). The experimental group showed a significant AHD increase of 9.2% (10.75 ± 1.89 vs 11.74 ± 1.82, respectively, with p < 0.001). Significant differences in the effects of each taping on the AHD were found between groups (p < 0.001). The results of this study indicate that the RHH rigid taping increases the AHD in the shoulders of recreationally weightlifters, dismissing the possibility of a placebo effect of the taping.
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Jeon YD, Yoon JY, Jeong HJ, Nam GW, Heo K, Kim JU, Oh JH. Significance of the acromiohumeral distance on stress radiography for predicting healing and function after arthroscopic repair of massive rotator cuff tears. J Shoulder Elbow Surg 2021; 30:e471-81. [PMID: 33271320 DOI: 10.1016/j.jse.2020.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A decreased acromiohumeral distance (AHD) is commonly detected in patients with massive rotator cuff tears (mRCTs). Most studies evaluating fixed humeral elevation have used preoperative or postoperative standardized radiography and not stress radiography. This study aimed to evaluate the predictive role of the preoperative AHD measured using stress radiography (AHD_stress) in rotator cuff healing and function after arthroscopic repair of mRCTs. METHODS The data of 113 patients who underwent arthroscopic repair of mRCTs were analyzed. Postoperative cuff integrity was evaluated using magnetic resonance imaging at 1 year, and shoulder function was evaluated at a mean of 34.9 ± 17.8 months (range, 24-92 months) postoperatively. Forty-seven patients showed healing failure. Propensity score matching (1-1) was performed between the healed group and healing failure group. Thirty-eight patients in each group were matched in the final analysis. The AHD and AHD_stress were defined as the shortest distances from the inferior acromion to the superior humerus on standard anteroposterior radiography and stress radiography (5.4-kg weight applied inferiorly in a neutral position), respectively. The AHD difference (AHD_diff) was defined as the difference between the AHD and AHD_stress values. Receiver operating characteristic curve analysis was performed to determine cutoff values for significant variables. RESULTS No difference in the mean preoperative AHD was found between the healed group (7.5 ± 2.0 mm) and healing failure group (6.9 ± 2.2 mm, P = .234). The AHD_diff value was significantly higher in the healed group (4.4 ± 2.1 mm) than in the healing failure group (3.0 ± 2.0 mm, P = .002; cutoff, 3.2 mm). Patients with an AHD_diff value ≥ 3.2 mm showed a lower healing failure rate (28.9% vs. 71.1%, P < .001) and higher functional scores than patients with an AHD_diff value < 3.2 mm. The AHD_diff value was higher in patients with an American Shoulder and Elbow Surgeons (ASES) score ≥ 80 (4.9 ± 1.9 mm) than in those with an ASES score < 80 (3.1 ± 2.1 mm, P = .024). Among patients with healing failure, only the postoperative AHD showed a significant difference between those with an ASES score ≥ 80 (7.0 ± 2.5 mm) and those with an ASES score < 80 (4.8 ± 2.1 mm, P = .009; cutoff, 4.8 mm). CONCLUSION A reducible AHD, which increased by ≥ 3.2 mm under stress radiography, can be a favorable predictor of rotator cuff healing and function after arthroscopic repair of mRCTs. Our findings suggest that this new and simple radiologic parameter should be considered preoperatively and would be helpful to determine appropriate treatment strategies.
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Hufeland M, Brusis C, Kubo H, Grassmann J, Latz D, Patzer T. The acromiohumeral distance in the MRI should not be used as a decision criterion to assess subacromial space width in shoulders with an intact rotator cuff. Knee Surg Sports Traumatol Arthrosc 2021; 29:2085-2089. [PMID: 32524165 DOI: 10.1007/s00167-020-06090-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/03/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The acromiohumeral distance is in practice often evaluated on MRI by radiologists and a reduction diagnosed as subacromial impingement. However, the acromiohumeral distance as indicator for a decentered glenohumeral joint is defined on a true AP radiograph with the patient standing or sitting. The present study therefore evaluated the influence of the patient position by comparing the acromiohumeral distance in both modalities in shoulders with an intact rotator cuff. METHODS On MRI images and true AP radiographs of patients > 20 and < 80 years with an intact rotator cuff the acromiohumeral distance was measured. The maximum cranio-caudal size of the glenoid was measured as a reference to allow a direct comparison of both modalities. RESULTS Two-hundred and thirty-four shoulders (mean patients age 45.8 ± 14.3 years) were included. The mean acromiohumeral distance/glenoid size ratio of all shoulders was significantly larger (P < 0.0001) on the MRI with 4.6 ± 1.0 in comparison to 4.1 ± 0.9 in the radiographs indicating a smaller acromiohumeral distance on the MRI. In absolute values, a mean acromiohumeral distance of 9.2 mm ± 1.8 on MRI in comparison to 10.4 mm ± 2.4 on the radiographs was calculated. Herewith, the acromiohumeral distance in the MRI was in the average 1.2 mm ± 2.1 (13%) smaller than the in corresponding radiographs (P < 0.0001). CONCLUSION The acromiohumeral distance is significantly smaller in the MRI in comparison to AP radiographs in shoulders with an intact rotator cuff and should not be used as a decision criterion on MRI to assess glenohumeral centering or subacromial space width. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Martin Hufeland
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Christina Brusis
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Hannes Kubo
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Jan Grassmann
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - David Latz
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Thilo Patzer
- Department of Orthopaedics and Trauma Surgery, Schoenklinik Düsseldorf, Am Heerdter Krankenhaus 2, 40549, Düsseldorf, Germany
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Turan K, Çabuk H, Köroğlu C, Öztürk Ç. Increased acromiohumeral distance in a double-row arthroscopic rotator cuff surgery compared to a single-row surgery after 12 months. J Orthop Surg Res 2021; 16:385. [PMID: 34134739 PMCID: PMC8207657 DOI: 10.1186/s13018-021-02523-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background Arthroscopic rotator cuff surgery is an effective treatment for rotator cuff tears with the considered use of double-row repair techniques becoming popular in the last decade. We aim to compare the effects of double- and single-row arthroscopic rotator cuff repairs (ARCR) on repair integrity (RI) and acromiohumeral distance (AHD). Methods In this observational study, we retrospectively identified 98 patients with degenerative rotator cuff tear treated with arthroscopic rotator cuff repair between 2016 and 2019. We excluded 22 patients with partial-thickness tears, 15 with associated subscapularis or SLAP tears, 13 with massive tears, and 5 patients lost to follow-up; we included 43 patients who had ARCR for full-thickness cuff tear and clinical, radiologic follow-up. Of these 43 patients, 23 are grouped as double-row repair group (DRG) and 20 as single-row repair group (SRG). A minimum of 12 months after the surgery, bilateral shoulder MRIs were obtained. Contralateral shoulders without asymptomatic rotator cuff tears served as a control group (CG). The operating surgeon and two other surgeons experienced in arthroscopy blindly measured the AHD and determined the RI at the control MRIs in all groups. Functional assessments relied on UCLA and qDASH Scores. Results The mean age was 57.89 (45–78) years, and the mean follow-up time was 28,65 (21–43) months. The mean AHD of the CG was 9.7 ± 0.96 mm, the preoperative AHD of DRG was 8.62 ± 1.45 mm, and SRG was 9.71 ± 0.95 mm. The postoperative mean AHD of DRG 9.61 ± 1.83 mm and SRG was 10.21 ± 1.97 mm. AHD differences between the preoperative and postoperative groups were significant (P=0.009). The increase of the AHD in the double-row group was significantly higher than the single-row group (P=0.004). There was a high correlation between the RI and DASH scores (P=0.005). RI did not correlate with the repair method (P=0.580). Conclusion Although double-row repairs can maintain greater AHD than single-row repairs in the clinical setting, this difference did not affect functional results. Regardless of the surgical intervention, functional results are favourable if RI is achieved. Level of evidence Level III, Retrospective Cohort Study
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Affiliation(s)
- Kaya Turan
- Department of Orthopedics and Traumatology, Medicine Faculty of Istinye University, Aşık Veysel Mah. No:1 Istinye University Liv Hospital Esenyurt, İstanbul, Turkey.
| | - Haluk Çabuk
- Department of Orthopedics and Traumatology, Medicine Faculty of Istinye University, Aşık Veysel Mah. No:1 Istinye University Liv Hospital Esenyurt, İstanbul, Turkey
| | - Cenk Köroğlu
- Department of Orthopaedics and Traumatology, Tekirdag Ismail Fehmi Cumalıoglu City Hospital, Eski Cami Mah, Hastane Sk. No:1 Suleymanpasa, Tekirdağ, Turkey
| | - Çağatay Öztürk
- Department of Orthopedics and Traumatology, Medicine Faculty of Istinye University, Aşık Veysel Mah. No:1 Istinye University Liv Hospital Esenyurt, İstanbul, Turkey
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Seo JB, Kwak KY, Park B, Yoo JS. Anterior cable reconstruction using the proximal biceps tendon for reinforcement of arthroscopic rotator cuff repair prevent retear and increase acromiohumeral distance. J Orthop 2021; 23:246-249. [PMID: 33664556 DOI: 10.1016/j.jor.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Anterior cable reconstruction (ACR) using the long head of the biceps tendon (LHBT) was developed to place at the native superior capsule attachment site for large to massive rotator cuff tears (LMRCTs) with anterior cable disruption. In this study, we investigated whether ACR for reinforcement before ARCR prevented retear after arthroscopic rotator cuff repair (ARCR), especially in cases of LMRCTs with anterior cable disruption. A total of 125 patients who underwent arthroscopic rotator cuff repair (ARCR) for LMRCTs were retrospectively enrolled. To assess the benefit of ACR with LHBT, all data were compared with those after ARCR alone. As a result, ACR with LHBT showed satisfactory clinical and radiologic outcomes in comparison with conventional ARCR only technique. ACR with LHBT prevented retear after ARCR and improved the AHD, although There was no difference of clinical outcomes between two groups.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Kwon-Young Kwak
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Byeonghun Park
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae-Sung Yoo
- Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, South Korea
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Kajita Y, Iwahori Y, Harada Y, Takahashi R, Deie M. Morphological characteristics of the acromion in Fosbury flop tears and their clinical outcomes after arthroscopic rotator cuff repair. J Orthop 2020; 22:548-552. [PMID: 33214742 DOI: 10.1016/j.jor.2020.11.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background Rotator cuff tears that have flipped upon itself and adhered medially have been recently described as Fosbury flop tears (FFT). However, there are no reports on the cause and clinical outcomes of FFT. We investigated the preoperative anatomical factors and clinical outcomes related to the occurrence of FFT. Methods Among patients with more than two years of follow-up, 33 patients with FFT who underwent arthroscopic rotator cuff repair (ARCR) for a small-to-medium sized tear of the supraspinatus tendon alone (Group F: mean age, 63.4 ± 8.9 years) and 52 patients without FFT who underwent ARCR (Group C: mean age, 62.1 ± 7.0 years) were included. Presence of diabetes mellitus, critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral distance (AHD), sagittal and coronal morphologies of the acromion, JOA score, and rate of rotator cuff re-tear were evaluated. Results There were significantly more males in Group F (P = 0.017). There were no significant differences in age or rate of diabetic complications. The mean CSA, LAA, and AHD in the Groups F and C were respectively as follows: CSA, 33.7 ± 4.0° and 34.5 ± 3.4°; LAA, 82.1 ± 9.9° and 82.1 ± 6.9°; AHD, 10.2 ± 1.4 mm and 9.8 ± 1.4 mm. There were no significant differences between groups. The acromial morphology showed no significant difference in the sagittal plane; however, significantly more double-floor type acromia were found in the coronal plane (P < 0.001). Although the JOA score significantly improved in both groups, there was no significant difference between groups. The re-rupture rate was significantly higher in Group F than Group C (15.2% versus 1.9%; P = 0.02). Conclusions Double-floor type acromia in the coronal plane was common in Group F. The location of osteophytes on the inferior surface of the acromion was believed to be associated with the occurrence of FFT. Furthermore, a high re-tear rate was observed in group F.
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Affiliation(s)
- Yukihiro Kajita
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | | | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
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Yoshida Y, Matsumura N, Yamada Y, Yamada M, Yokoyama Y, Matsumoto M, Nakamura M, Nagura T, Jinzaki M. Evaluation of three-dimensional acromiohumeral distance in the standing position and comparison with its conventional measuring methods. J Orthop Surg Res 2020; 15:436. [PMID: 32967710 PMCID: PMC7510276 DOI: 10.1186/s13018-020-01935-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background Narrowing of the acromiohumeral distance (AHD) implies a rotator cuff tear. However, conventional AHD measurements using two-dimensional (2D) imaging or with the patient in the supine position might differ from that while standing during daily activity. This study aimed to evaluate the three-dimensional (3D) actual distance between the acromion and humeral head in the standing position and compare the AHD values with those obtained using conventional measuring methods. Methods Computed tomography (CT) images of 166 shoulders from 83 healthy volunteers (31 male and 52 female; mean age 40.1 ± 5.8 years; age range, 30–49 years) were prospectively acquired in the supine and standing positions using conventional and upright CT scanners, respectively. The minimum distance between the acromion and humeral head on the 3D surface models was considered as the 3D AHD. We measured the 2D AHD on anteroposterior digitally reconstructed radiographs. The AHD values were compared between the supine and standing positions and between the 2D and 3D measurements. Results The mean values of 2D AHD were 8.8 ± 1.3 mm (range, 5.9–15.4 mm) in the standing position and 8.1 ± 1.2 mm (range, 5.3–14.3 mm) in the supine position. The mean values of 3D AHD were 7.3 ± 1.4 mm (range, 4.7–14.0 mm) in the standing position and 6.6 ± 1.2 mm (range, 4.4–13.7 mm) in the supine position. The values of 3D AHD were significantly lower than those of 2D AHDs in both the standing and supine positions (P < 0.001). The values of 2D and 3D AHDs were significantly lower in the supine position than in the standing position (P < 0.001). Conclusions This study evaluated the 3D AHD of normal shoulders in the standing position using an upright CT scanner. The present results indicated that assessments in the supine position can underestimate the value of the AHD compared with those made in the standing position and that assessments using 2D analysis can overestimate the value.
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Affiliation(s)
- Yuki Yoshida
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Mirzayan R, Donohoe S, Batech M, Suh BD, Acevedo DC, Singh A. Is there a difference in the acromiohumeral distances measured on radiographic and magnetic resonance images of the same shoulder with a massive rotator cuff tear? J Shoulder Elbow Surg 2020; 29:1145-1151. [PMID: 32035821 DOI: 10.1016/j.jse.2019.10.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of our study was to compare the acromiohumeral distance (AHD) between radiographic and magnetic resonance images (MRIs) of the same shoulder with massive rotator cuff tears (MRCTs). METHODS Thirty-four shoulders with MRCTs that had an MRI and radiograph of the same shoulder within an average of 40.3 days (range: 8-109 days) were identified. AHD was measured digitally on radiograph and MRI by 3 examiners. Shoulders were grouped into Hamada grades <3 (group 1) and Hamada grades ≥3 (group 2). RESULTS The mean age was 66.4 years (range: 51-89). There were 19 men (59%). The Kappa for inter-rater reliability was 0.982 (95% confidence interval [CI] 0.975, 0.988) for radiographs and 0.88 (95% CI 0.75, 0.94) for MRI. There was a significant difference in the mean AHD of group 1 on radiograph vs. MRI (7.9 mm vs. 2.5 mm, respectively; P < .0001), but no difference in group 2 (1.8 mm vs. 2.2 mm, respectively; P = .45). There was no difference in AHD in group 1 between shoulders with Goutallier stage <3 (8.1 ± 1.9 mm) and those with Goutallier stage ≥3 (7.3 ± 2.1 mm) (P = .3479). There was no difference in AHD in group 2 between shoulders with Goutallier stage <3 (3.0 ± 0.1 mm) and those with Goutallier stage ≥3 (1.5 ± 1.0 mm) (P = .079). CONCLUSION There is a significant difference in AHD measurements between radiograph and MRI of the same shoulder with MRCT in early Hamada grades. AHDs measured on radiograph and MRI should not be used interchangeably in early Hamada grades to assess outcomes of superior capsule reconstruction and similar procedures.
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Affiliation(s)
- Raffy Mirzayan
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA.
| | - Steven Donohoe
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Michael Batech
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Brian D Suh
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Daniel C Acevedo
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Anshuman Singh
- Department of Orthopaedic Surgery, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
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Nodehi Moghadam A, Sarabadani Tafreshi E, Abdollahi S, Bakhshi E. The comparison of acromiohumeral distance and scapular dyskinesis prevalence in females with and without rounded shoulder posture. Med J Islam Repub Iran 2020; 34:19. [PMID: 32551308 PMCID: PMC7293807 DOI: 10.34171/mjiri.34.19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 11/05/2022] Open
Abstract
Background: Altered scapular kinematics in individuals with rounded shoulder posture (RSP) may affect acromiohumeral distance (AHD). The purpose of this study was to compare AHD and scapular dyskinesis prevalence in individuals with and without RSP. Methods: A total of 44 women (RSP, n=21; control, n=23) participated in the study. RSP was assessed by measuring acromion to table distance (ATD) in supine position and forward shoulder angle (FSA) using a camera and the AutoCAD software from the lateral side. According to these measurements, ATD more than 2.6 cm and FSA equal or more than 52° were considered as RSP. AHD was measured via ultrasonography with the arm at rest and 90 º of active elevation in scapular plane (scaption). Also, scapular dyskinesis was assessed by Uhl yes/no rating system. Independent and paired t tests were used to compare AHD between and within groups' comparisons, respectively. Chi-square test was used to compare the scapular dyskinesis prevalence in individuals with or without RSP. The data were analyzed using the SPSS statistical software version 17. Significance level was set at 0.05 Results: There were no statistically significant differences in participants' AHD in rest position (dominant side, p=0.187, nondominant side, p=0.144) and 90° scaption (dominant side, p=0.144, nondominant side, p=0.182) in each side between the 2 groups. Also, the results of chi-square test showed that there were not any significant differences in the prevalence of scapular dyskinesis during shoulder flexion (dominant side, p=0.653, nondominant side, p=0.541) and shoulder abduction (dominant side, p=0.141, nondominant side, p=0.277) in individuals with and without rounded shoulder postures. Conclusion: According to our results, RSD cannot lead to reduced AHD and higher prevalence of scapular dyskinesis.
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Affiliation(s)
- Afsun Nodehi Moghadam
- 1Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,Corresponding author: Dr Afsun Nodehi Moghadam, ; ;
| | - Elham Sarabadani Tafreshi
- 1Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Enayatollah Bakhshi
- 3Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Xu M, Li Z, Zhou Y, Ji B, Tian S, Chen G. Correlation between acromiohumeral distance and the severity of supraspinatus tendon tear by ultrasound imaging in a Chinese population. BMC Musculoskelet Disord 2020; 21:106. [PMID: 32066419 PMCID: PMC7027353 DOI: 10.1186/s12891-020-3109-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 02/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was twofold: (i) to investigate the intrarater reliability of acromiohumeral distance measurement; (ii) to assess the level of association between acromiohumeral distance measured by ultrasonography, and the degree of supraspinatus tendon tear, in patients suffering from chronic shoulder pain. Methods A cross-sectional, case-control study was carried out. A convenience sample comprising 59 patients with a unilateral supraspinatus tendon tear was assessed. Both shoulders of each patient were scanned by ultrasound, with the contralateral asymptomatic shoulders serving as the control group for comparison. Acromiohumeral distances of each shoulder were measured and analysed. Results Intrarater reliability was excellent for the ultrasound method of acromiohumeral distance measurement. The acromiohumeral distance of shoulders with full-thickness supraspinatus tendon tear was significantly smaller than that of joints with partial-thickness supraspinatus tendon tear and an intact supraspinatus tendon. There was a significant positive correlation between reduced acromiohumeral distance and the severity of a supraspinatus tendon tear. Conclusions Ultrasound is a reliable tool to measure acromiohumeral distance. A positive relationship was found between a narrowed acromiohumeral distance and the severity grading of a supraspinatus tendon tear. Reduced acromiohumeral distance can be considered a predictive parameter for a full-thickness supraspinatus tendon tear. Trial registration The study was prospectively registered with the Chinese Clinical Trial Registry. Registration number: ChiCTR-ROC-17013550. Date of registry: 26 November 2017.
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Affiliation(s)
- Mingmin Xu
- Department of Ultrasound, The First Affiliated Hospital of Jiaxing College, The First Hospital of Jiaxing City, Jiaxing City, China.,Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310016, China
| | - Zhenping Li
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310016, China.,Department of Anesthesiology, The First Affiliated Hospital of Jiaxing College, The First Hospital of Jiaxing City, Jiaxing City, China
| | - Youfa Zhou
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310016, China
| | - Bin Ji
- Department of Orthopedics, The First Affiliated Hospital of Jiaxing College, The First Hospital of Jiaxing City, Jiaxing City, China
| | - Suming Tian
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310016, China
| | - Gang Chen
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qingchun East Road, Hangzhou, 310016, China.
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Suh D, Ji JH, Tankshali K, Kim ES. Mid-term Clinical and Radiological Outcomes of Latissimus Dorsi Tendon Transfer in Massive Rotator Cuff Tears. Clin Shoulder Elb 2019; 22:220-226. [PMID: 33330223 PMCID: PMC7714307 DOI: 10.5397/cise.2019.22.4.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 11/28/2022] Open
Abstract
Background This retrospective study was undertaken to evaluate mid-term clinical and radiological outcomes of lattisimus dorsi (LD) tendon transfer in patients with irreparable massive rotator cuff tears (MRCT). We hypothesize that LD tendon transfer would provide safe and satisfactory clinical outcomes at mid-term follow-up. Methods From November 2008 to December 2016, 23 patients (57.5 ± 4.4 years; 20 male, 3 female) who underwent LD tendon transfer for massive tears, were enrolled. Inclusion criteria were irreparable MRCT. Exclusion criteria included full thickness subscapularis tear, rotator cuff arthropathy, anterosuperior rotator cuff tear, and osteoarthritis. Mean follow-up period was 4.7 ± 4.0 years (range, 2–12 years). Clinical assessment (American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], Simple Shoulder Test [SST]) and radiographic assessment (osteoarthritis [OA], acromiohumeral distance [AHI]) were evaluated. Results ASES, UCLA and SST scores, and range of motion (ROM), except internal rotation, improved significantly at the last follow-up (p<0.05). Also, AHI was significantly improved at the last follow-up, from 6.6 mm to 8.2 mm (p=0.008). At the final follow-up, the radiologic stages of the glenohumeral osteoarthritis were determined as stage 1 in 9 patients, stage 2 in 10 patients, stage 3 in 2 patients, and stage 4 in 2 patients. Complications were observed in 21.7% cases: 3 re-tears and 2 infections were noted in our study. Conclusions LD tendon transfer for irreparable MRCT provides satisfactory clinical outcomes at mid-term follow-up. Mild degenerative osteoarthritis (stage 1, 2) of the shoulder joint are common at the mid-term follow-up. Also, complications such as tear, infection should be considered.
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Affiliation(s)
- Dongwhan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Kirtan Tankshali
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Eung-Sic Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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21
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Vanderstukken F, Maenhout A, Spanhove V, Jansen N, Mertens T, Cools AM. Quantifying acromiohumeral distance in elite male field hockey players compared to a non-athletic population. Braz J Phys Ther 2019; 24:273-279. [PMID: 31076255 DOI: 10.1016/j.bjpt.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/08/2019] [Accepted: 04/16/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Shoulders of elite field hockey players are loaded continuously during play. Frequent high shoulder loading is known to influence certain shoulder variables, such as acromiohumeral distance. However, the influence of elite field hockey play on acromiohumeral distance is not examined yet. OBJECTIVE To examine the acromiohumeral distance in elite male field hockey players compared to a non-athletic control group. DESIGN Cross-sectional study. METHODS Fifty male participants were included; 25 elite field hockey players (age: 24.0±2.72 years; weight: 77.2±5.29kg; height; 180.5±5.37cm) and 25 age- and gender matched non-athletes (23.0±2.29 years; weight: 75.7±9.53kg; height: 181.8±5.52cm). A Telemed-Colormaster-128 EXT-IZ device was used to bilaterally obtain ultrasound acromiohumeral distance images at 3 different angles of shoulder abduction in the frontal plane. RESULTS Field hockey players showed a bilateral larger acromiohumeral distance at 45° (mean difference: 1.46mm [95% CI 0.46; 2.46]; p=0.005) and 60° (mean difference: 1.07mm [95% CI 0.21; 1.93]; p=0.016) compared to controls. In both groups, a significant but clinically less relevant, side difference was established for the acromiohumeral distance at 60° (mean difference: 0.79mm [95% CI 0.21; 1.34]; p=0.009). CONCLUSION With active shoulder abduction, elite field hockey players show a larger acromiohumeral distance in comparison to non-athletic participants. This may be a protective sport-specific adaptation, to better guard the shoulder from injury. Thus, acromiohumeral distance measurement may help physical therapists/coaches decide which athletes could benefit from specific, additional exercises aimed at enlarging the subacromial space.
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Affiliation(s)
- Fran Vanderstukken
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Annelies Maenhout
- Occupational Therapy Department, Artevelde University College, Ghent, Belgium
| | - Valentien Spanhove
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | | | | | - Ann Marcelle Cools
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Desroches G, Desmeules F, Gagnon DH. Characterization of humeral head displacements during dynamic glenohumeral neuromuscular control exercises using quantitative ultrasound imaging: A feasibility study. Musculoskelet Sci Pract 2017; 29:150-154. [PMID: 28715302 DOI: 10.1016/j.msksp.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
The objectives of the present study were to test the feasibility of measuring humeral head displacements using quantitative ultrasound imaging during the performance of two different dynamic glenohumeral neuromuscular control exercises and to investigate the influence of these exercises on the acromiohumeral distance (AHD) and anterior-posterior distance (APD). Ten individuals who have no history of shoulder injury at the non-dominant shoulder completed three repetitions of an active humeral head lowering exercise and three repetitions of a posteriorisation exercise in a random order in a seated position. The AHD and the APD of the humeral head relative to the glenoid cavity were measured continuously using an ultrasound imaging system during each exercise. Variations in AHD and APD, defined as the difference between the distance obtained before the exercise and the maximal distance reached during the exercise, were compared for each exercises. The active humeral head lowering exercise significantly increased the AHD by 0.94 ± 0.28 mm (relative: + 11.4%), but had no significant effect on the APD. The active humeral head posteriorisation exercise significantly increased the AHD by 0.65 ± 0.41 mm (relative: + 6.3%) and the APD by 1.51 ± 0.51 mm (relative: + 13.8%). The use of quantitative ultrasound imaging allows physiotherapists to quantify inferior and posterior humeral head displacements during dynamic glenohumeral neuromuscular control exercises. These measures, confirming favourable inferior and posterior humeral head displacements at the shoulder, may become useful when studying the effectiveness of rehabilitation programs incorporating dynamic glenohumeral neuromuscular control exercises.
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Affiliation(s)
- Guillaume Desroches
- School of Rehabilitation, Université de Montréal, Montreal, Canada; Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Installation Institut de réadaptation Gingras-Lindsay-de-Montréal, Montreal, Canada
| | - François Desmeules
- School of Rehabilitation, Université de Montréal, Montreal, Canada; Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Canada; Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Installation Institut de réadaptation Gingras-Lindsay-de-Montréal, Montreal, Canada.
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Akkaya N, Akkaya S, Gungor HR, Yaşar G, Atalay NS, Sahin F. Effects of weighted and un-weighted pendulum exercises on ultrasonographic acromiohumeral distance in patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil 2017; 30:221-228. [PMID: 27472856 DOI: 10.3233/bmr-160737] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). OBJECTIVE To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. METHODS Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N= 18) or un-weighted (free of weight, N= 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. RESULTS Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p < 0.05). There was no significant difference for pre and post-treatment AHD measurements at 0°, 30°, and 60° shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°-30°, and 0°-60°) between groups (p > 0.05). CONCLUSION While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups.
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Affiliation(s)
- Nuray Akkaya
- Department of Physical and Rehabilitation Medicine, Pamukkale University, Denizli, Turkey
| | - Semih Akkaya
- Department of Orthopedics and Traumatology, Pamukkale University, Denizli, Turkey
| | - Harun R Gungor
- Department of Orthopedics and Traumatology, Pamukkale University, Denizli, Turkey
| | - Gokce Yaşar
- Department of Physical and Rehabilitation Medicine, Pamukkale University, Denizli, Turkey
| | - Nilgun Simsir Atalay
- Department of Physical and Rehabilitation Medicine, Pamukkale University, Denizli, Turkey
| | - Fusun Sahin
- Department of Physical and Rehabilitation Medicine, Pamukkale University, Denizli, Turkey
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Scheyerer MJ, Brunner FE, Gerber C. The acromiohumeral distance and the subacromial clearance are correlated to the glenoid version. Orthop Traumatol Surg Res 2016; 102:305-9. [PMID: 26952173 DOI: 10.1016/j.otsr.2015.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/20/2015] [Accepted: 12/23/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The acromiohumeral distance (ACHD) is a radiographic parameter for evaluating the presence of a rotator cuff rupture. Previous investigations have demonstrated that several factors may influence the magnitude of the acromiohumeral distance, but glenoid version has not yet been considered. HYPOTHESIS Our hypothesis was that there is a direct correlation between glenoid version and acromiohumeral distance as well as subacromial clearance. METHODS Four right glenohumeral joints from adult fresh cadavers were anatomically dissected to the level of the rotator cuff. After fixation to a board and positioning of the humeral head in neutral position, an osteotomy of the glenoid neck was carried out and the version was altered in steps of 5°. The ACHD as well as the subacromial clearance (SAC) were measured for every degree of glenoid version. RESULTS The ACHD increased with increased anteversion and consistently decreased with increased retroversion of the glenoid. The SAC also depended on glenoid version. Neutral version was associated with a minimal clearance under the anterior third of the acromion, retroversion transferred the minimal SAC posteriorly and anteversion transferred minimal SAC under the coracoacromial ligament. CONCLUSION Our results indicate that glenoid version correlates directly with the magnitude of ACHD and SAC. Therefore, variations of glenoid version can lead to false interpretations of cuff integrity. TYPE OF STUDY Biomechanical investigation. LEVEL OF EVIDENCE Not possible to define.
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Affiliation(s)
- M J Scheyerer
- Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
| | - F E Brunner
- Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - C Gerber
- Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Dal Maso F, Blache Y, Raison M, Arndt A, Begon M. Distance between rotator cuff footprints and the acromion, coracoacromial ligament, and coracoid process during dynamic arm elevations: Preliminary observations. ACTA ACUST UNITED AC 2016; 25:94-9. [PMID: 27039161 DOI: 10.1016/j.math.2016.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/28/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this study was to provide preliminary measures of the distance between the supraspinatus, infraspinatus, and subscapularis footprints and the acromion, coracoacromial ligament, and coracoid process, during dynamic arm elevations through the entire range-of-motion. METHODS Two healthy men performed maximum adduction, flexion, abduction, and extension with the arm internally, neutrally, and externally rotated. The distance between each rotator cuff footprint and the acromion, coracoacromial ligament, and coracoid process was measured from glenohumeral kinematics obtained from markers fitted to intracortical pins combined with the scapular and humeral 3D geometry obtained from CT-scan. RESULTS All footprints moved to be less than 10 mm to the acromion, coracoacromial ligament and coracoid process. They got closer to the acromion than to the other parts of the coracoacromial arch. The acromion-supraspinatus and acromion-infraspinatus distances were minimal during abduction and flexion. The acromion-subscapularis distance was minimal when the arm was in external and neutral rotation during both adduction and flexion. CONCLUSIONS The present study provides benchmark results of the distance between the rotator cuff footprints and the coracoacromial arch that may guide future clinical research. Pressure transducers should be positioned throughout the coracoacromial arch to provide comprehensive assessment of the compression undergone by the rotator cuff tendons. Common shoulder examination tests, that require flexion and internal rotation movements, may be refined since the supraspinatus footprint was the closest to the coracoacromial arch during abduction. Larger scale investigations may be needed to identify more accurate shoulder examination tests.
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Affiliation(s)
- Fabien Dal Maso
- Département de kinésiologie, Université de Montréal, 2100, boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; Centre de recherché du CHU Ste Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C4, Canada.
| | - Yoann Blache
- Département de kinésiologie, Université de Montréal, 2100, boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; Centre de recherché du CHU Ste Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C4, Canada
| | - Maxime Raison
- Centre de recherché du CHU Ste Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C4, Canada; Ecole Polytechnique de Montréal, 2900 boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada
| | - Anton Arndt
- Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden; The Swedish School of Sport and Health Sciences, Lidingövägen 1, 114 33 Stockholm, Sweden
| | - Mickaël Begon
- Département de kinésiologie, Université de Montréal, 2100, boul. Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada; Centre de recherché du CHU Ste Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C4, Canada
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Mackenzie TA, Herrington L, Horlsey I, Cools A. An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: Is it important and what influences it? Clin Biomech (Bristol, Avon) 2015; 30:641-8. [PMID: 26071974 DOI: 10.1016/j.clinbiomech.2015.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reduction of the subacromial space as a mechanism in the etiology of shoulder impingement syndromes is debated. Although a reduction in this space is associated with shoulder impingement syndromes, it is unclear if this observation is cause or consequence. METHOD The purposes of this descriptive review are to provide a broad perspective on the current perceptions with regard to the pathology and pathomechanics of subacromial and internal impingement syndromes, consider the role of the subacromial space in impingement syndromes, describe the intrinsic and extrinsic mechanisms considered to influence the subacromial space, and critique the level of evidence supporting these concepts. FINDING Based on the current evidence, the hypothesis that a reduction in subacromial space is an extrinsic cause of impingement syndromes is not conclusively established and the evidence permits no conclusion. INTERPRETATION If maintenance of the subacromial space is important in impingement syndromes regardless of whether it is a cause or consequence, research exploring the correlation between biomechanical factors and the subacromial space, using the later as the outcome measure, would be beneficial.
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Affiliation(s)
- Tanya Anne Mackenzie
- Salford University, Health, Sports and Rehabilitation Sciences, Manchester, United Kingdom/M5 4WT.
| | - Lee Herrington
- Salford University, School of Sport, Exercise and Physiotherapy, Salford, Manchester, United Kingdom.
| | | | - Ann Cools
- Ghent University Dept of Rehabilitation Science and Physiotherapy, Ghent, Belgium.
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McCreesh K, Adusumilli P, Evans T, Riley S, Davies A, Lewis J. Validation of ultrasound measurement of the subacromial space using a novel shoulder phantom model. Ultrasound Med Biol 2014; 40:1729-1733. [PMID: 24613213 DOI: 10.1016/j.ultrasmedbio.2013.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 11/27/2013] [Accepted: 12/06/2013] [Indexed: 06/03/2023]
Abstract
Ultrasound has a high degree of diagnostic accuracy in the assessment of rotator cuff tendons. Increasingly, ultrasound is being used to measure other parameters of rotator cuff pathology, including the size of the subacromial space, or acromiohumeral distance (AHD). Although this measure has been found to be clinically reliable, no assessment of its validity has been carried out. This technical study reports on the development of a novel ultrasound phantom of the shoulder and its use in validation of ultrasound measurement of AHD. There was a close agreement between AHD measures using ultrasound and the true subacromial space of the phantom model, providing support for the construct validity of this measurement. The phantom model has good potential for further development as a training tool for shoulder ultrasound and guided injections.
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Affiliation(s)
- Karen McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Pratik Adusumilli
- Division of Medical Physics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Tony Evans
- Division of Medical Physics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Sara Riley
- Academic Unit of Diagnostic Imaging, School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Andrew Davies
- Division of Medical Physics, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Jeremy Lewis
- Central London Community Healthcare NHS Trust, London, United Kingdom; Department of Allied Health Professions and Midwifery, School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom
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Kim H, Kim B, Shim J, Kwon H, Jung J. Comparative analysis of acromiohumeral distances according to the locations of the arms and humeral rotation. J Phys Ther Sci 2014; 26:97-100. [PMID: 24567684 PMCID: PMC3927051 DOI: 10.1589/jpts.26.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/12/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the potential effects of resistance exercise according to the positions of the arms and the rotation of the humerus on the subhumeral acromial space. [Subjects] The study subjects were 34 subjects without shoulder pain. [Methods] Ultrasonographic measurements of the acromiohumeral distance of the subjects were made at three shoulder positions: 90° flexion, scaption at 90° abduction, and 90° abduction in an upright sitting position. The subjects were instructed to vertically push against a table to the maximum level with the humerus in internal, neutral, and external rotation. The measurements were made three times in each position. [Results] There was a significant difference in acromiohuneral distance between neutral and internal rotation of the humerus, and between external rotation and internal rotation of the humerus. In the scaption position, there was a significant difference between neutral and internal rotation of the humerus, and between external rotation and internal rotation of the humerus. In the 90° flexion position, there was a significant difference between neutral and internal rotation, and between neutral and external rotation. There was a significant difference between the flexion position and the abduction position, and between the flexion position and the scaption position. In terms of the internal rotation of the humerus, there was a significant difference between 90° flexion and 90° abduction. [Conclusion] These findings can be applied in exercises prescribed to increase the acromiohumeral distance and to aid the treatment and evaluation of shoulder dysfunctions.
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Affiliation(s)
- Haroo Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Boin Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Jemyung Shim
- Department of Physical Therapy, College of Health and Sciences, Kangwon National University, Republic of Korea
| | - Haeyeon Kwon
- Department of Physical Therapy, Graduate School, Catholic University of Pusan, Republic of Korea
| | - Juhyeon Jung
- Department of Physical Therapy, Rehabilitation Center, Gimhae Good morning Hospital
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