Effects of tendon-regulating and stretching manipulation combined with JIN's three-needle therapy for the shoulder on pain and shoulder joint function in subacromial impingement syndrome / 针灸推拿医学（英文版）

Objective: To observe the effects of tendon-regulating and stretching manipulation plus JIN's three-needle therapy for the shoulder on pain and shoulder joint function in subacromial impingement syndrome (SIS). Methods: Eighty patients with SIS were recruited and divided into a control group and a treatment group by the random number table method, with 40 cases in each group. The control group was given JIN's three-needle therapy for the shoulder, and the treatment group received additional tendon-regulating and stretching manipulation. The visual analog scale (VAS) score and constant-Murley score (CMS) were observed before and after the intervention, and the total effective rate was also observed. Results: The total effective rate was 92.5％ in the treatment group versus 70.0％ in the control group, and the difference was statistically significant (P<0.05). The VAS score and CMS changed notably after treatment in both groups (P<0.05), and the improvements were markedly greater in the treatment group than in the control group (P<0.05). Conclusion: Tendon-regulating and stretching manipulation plus JIN's three-needle therapy for the shoulder can facilitate the relief of pain and the improvement of shoulder joint function in SIS patients.

Comparison of the application value of X-ray and MRI in the diagnosis of subacromial impingement syndrome / 中国医师进修杂志

Objective:To compare and analyze the value of X-ray examination and MRI in the diagnosis of subacromial impingement syndrome.Methods:Sixty patients with shoulder pain and weakness in Beijing Tiantan Hospital, Capital Medical University from January 2019 to May 2021 were selected. All patients underwent X-ray and MRI. Taking clinical diagnosis as the gold standard, the diagnostic efficacy of X-ray and MRI in subacromial impact syndrome was compared and analyzed.Results:The consistency between MRI and gold standard was good ( Kappa = 0.769, P<0.01), and the consistency between X-ray and gold standard was general ( Kappa = 0.464, P<0.01); there was no significant difference between X-ray examination and MRI examination of acromion morphological classification, subacromial space classification ( P>0.05); The sensitivity of MRI was higher than that of X-ray, and the difference was statistically significant ( χ2 = 4.00, P<0.05). There was no difference between MRI and X-ray, and the difference was not statistically significant ( χ2 = 0.25, P>0.05). Conclusions:X-ray and MRI are complementary to each other in the diagnosis of subacromial impingement syndrome. X-ray examination should be carried out first, and MRI should be carried out when necessary.

Reliability of Bigliani’s Classification using Magnetic Resonance Imaging for Determination of Acromial Morphology

@#Introduction: Bigliani classification is used for determination of acromial morphology, but poor interobserver reliability has been reported on conventional radiographs. This study aims to assess inter- and intraobserver reliability using magnetic resonance imaging (MRI). Materials and methods: Forty consecutive patients diagnosed with subacromial impingement syndrome were included to study. All subjects underwent standard shoulder MRI scan and acromial shape was evaluated by nine observers of different level of expertise (three attending surgeons, three senior orthopaedic residents and three radiologists). A second set of evaluation was performed in order to assess intra-observer reproducibility. Kappa (κ) coefficient analyses both for interobserver reliability and intra-observer reproducibility were then performed. Results: Overall inter-observer agreement among nine observers was fair (κ=0.323). κ values for all 4 individual types ranged from 0.234 to 0.720 with highest agreement for type 4 and lowest agreement for type 3. Second evaluation did not result with an increase of inter-observer agreement (κ=0.338, fair). The κ coefficients for intra-observer reproducibility of nine observers ranged from 0.496 to 0.867. Overall intra-observer reproducibility was substantial. Comparison of inter- and intra-observer reliability among three groups showed no significant difference (p=0.92 and 0.22, respectively). Conclusion: Results showed that MRI did not show superior reliability compared to conventional radiographs. Moreover, inter- and intra-observer agreement did not differ between observers of different level of expertise. Findings of present study suggest that despite a sophisticated imaging modality like MRI, Bigliani’s classification apparently lacks accuracy and additional criteria, or different assessment methods are required to assess acromial morphology for clinical guidance.

Acromial type in Brazilian young adults: a radiological study / Tipo acromial em adultos jovens brasileiros: um estudo radiológico

Introduction: curved and hooked acromia play a key role in shoulder impingement syndrome. Little is known about acromial type in the Brazilian population. Aim: To describe the acromial profile of Brazilian young adults; to evaluate its correlation with gender and handedness and the occurrence of symmetry between the genders. Methodology: forty acromia in 20 Brazilian adults of both genders, aged 21-25 years, were studied. The acromial type was classified through the Bigliani/Epstein method using radiographs in supraspinatus outlet view. Results: as there was no gender difference in occurrences of acromial type, we considered the male and female groups together. Thus, among the 20 right acromia, we found 5 type I (25%), 8 type II (40%) and 7 type III (35%). Among the 20 left acromia, we found 4 type I (20%), 11 type II (55%) and 5 type III (25%). The only left-handed volunteer (100%) presented acromial type III in both the right and the left shoulder. Among the 19 right-handed volunteers, 5 (26.3%) presented right acromion type I, 8 (42.1%) had type II and 6 (31.6%) had type III; for the left acromion, 4 (21.1%) presented type I, 11 (57.9%) had type II and 4 (21.1%) had type III. Acromial symmetry occurred in 60% of females and 70% of males. Conclusion: type II acromion was predominant, in both the right and the left shoulder in Brazilian young adults. There was no correlation between acromial type and gender. It was not possible to analyze the correlation between acromial type and handedness. Acromial type tended to be symmetrical in our sample.

Introdução: o acrômio curvo e gancho desempenham um papel fundamental na Síndrome do impacto do ombro. Pouco se sabe sobre o tipo acromial na população brasileira. Objetivo: descrever o perfil do tipo acromial em adultos jovens brasileiros e avaliar sua correlação com o gênero e a lateralidade e a ocorrência de simetria entre os sexos. Metodologia: foram estudados 40 acrômios de 20 adultos brasileiros, de ambos os sexos, com idade entre 21 e 25 anos. O tipo acromial foi classificado pelo método de Bigliani/ Epstein nas radiografias de perfil de escápula. Resultados: como não houve diferença na ocorrência do tipo acromial quanto ao gênero, consideramos os grupos masculino e feminino juntos. Assim, dos 20 acrômios direitos, foram encontrados 5 (25%) do tipo I, 8 (40%) do tipo II e 7 (35%) do tipo III, enquanto que dos 20 acrômios esquerdos, foram encontrados 4 (20%) tipo I, 11 (55%) tipo II e 5 (25%) tipo III. O único voluntário canhoto (100%) apresentou para o ombro direito e esquerdo o tipo acromial III. Dos 19 voluntários destros, 5 (26,3%) apresentavam acrômio direito tipo I, 8 (42,1%) tipo II e 6 (31,6%) tipo III; para o acrômio esquerdo, 4 (21,1%) apresentavam tipo I, 11 (57,9%) tipo II e 4 (21,1%) tipo III. A simetria acromial ocorreu nos grupos feminino (60%) e masculino (70%). Conclusão: o acrômio tipo II foi o mais predominante para os ombros direito e esquerdo em adultos jovens brasileiros. Não houve correlação entre o tipo de acromial e o gênero. Não foi possível analisar a correlação entre o tipo acromial e a lateralidade. O tipo acromial tende a ser simétrico em na amostra estudada.

Diminutive Incision Acromioplasty Assisted with Arthroscopy in the Treatment of Chinese Patients with Subacromial Impingement Syndrome / Acromioplastia de Incisión Diminuta Asistida con Artroscopia en el Tratamiento de Pacientes Chinos con Síndrome de Pinzamiento Subacromial

ABSTRACT Background: Many causes can lead to shoulder pain and subacromial impingement syndrome (SIS) is the most frequently recorded disorders. The aim of this study was to evaluate the clinical effects of diminutive incision acromioplasty assisted with arthroscopy for the treatment of Chinese patients with subacromial impingement syndrome. Subject and Methods: Twenty-two patients with 24-painful shoulders subacromial impingement syndrome were enrolled. All painful shoulders were in Grades II (8) and III (16) according to Neer's classification. Detailed physical examination was performed. Conventional radiography and subsequent magnetic resonance imaging (MRI) of the shoulder region of all patients were done. The University of California at Los Angeles Shoulder (UCLA) score system was used for all patients to evaluate their satisfaction after surgery. The preoperative recordings of the UCLA scores were collected and all enrolled cases including 24-painful shoulders were available for follow-up in 1, 3, 6, 12 months after surgery. Results: According to the UCLA scoring system, the symptom of all painful shoulders were improved after one year postoperatively. The average score before surgery from 15.4 points increased to 31.2 points postoperatively, showing a statistical difference (p < 0.05). Conclusions: A diminutive incision acromioplasty assisted with arthroscopy is a reliable approach to treat Chinese patients with subacromial impingement syndrome. All painful shoulders were obviously improved in one year after surgery.

ABSTRACT Antecedentes: Muchas causas pueden provocar dolor de hombro y síndrome de compresión subacromial (SIS) es el trastorno más frecuentemente registrado. El objetivo de este estudio fue evaluar la clínica. Efectos de la acromioplastia con incisión diminuta asistida con artroscopia para el tratamiento de Pacientes chinos con síndrome de pinzamiento subacromial. Sujeto y métodos: Se incluyeron veintidós pacientes con síndrome de afectación subacromial de 24-hombros dolorosos. Todos los hombros dolorosos estaban en Grados II (8) y III (16) de acuerdo con la clasificación de Neer. Se realizó examen físico detallado. Se realizaron radiografías convencionales y, posteriormente, imágenes de resonancia magnética (IRM) de la región del hombro de todos los pacientes. El sistema de puntuación de la Universidad de California en Los Angeles Shoulder (UCLA) se utilizó para que todos los pacientes evaluaran su satisfacción después de la cirugía. Los registros preoperatorios de las puntuaciones de UCLA se recopilaron y todos los casos incluidos, incluidos 24-hombros dolorosos, estaban disponibles para el seguimiento en 1, 3, 6 y 12 meses después de la cirugía. Resultados: De acuerdo con el sistema de puntuación de UCLA, el síntoma de todos los hombros dolorosos mejoró después de un año después de la operación. La puntuación promedio antes de la cirugía de 15.4 puntos aumentó a 31.2 puntos después de la operación, mostrando una diferencia estadística (p < 0.05) Conclusiones: Una acromioplastia de incisión diminuta asistida con artroscopia es un enfoque confiable para tratar a pacientes chinos con síndrome de pinzamiento subacromial. Todas las lesiones dolorosas se mejoraron obviamente en un año después de la cirugía.

Effect Of Taping On Scapular Posture And Shoulder Range Of Motion In Subacromial Impingement Syndrome

Background: Alteration in upper body posture is associated with shoulder impingement due to changes in scapular orientation, increased thoracic kyphosis and concomitant imbalance of glenohumeral and scapulothoracic muscles. Mechanical correction of scaular and thoracic posture can reduce impingement. Recently use of kinesiotapes has been increasingly popular. There have been some studies reporting the effect of kinesiotapes on muscle activation and pain reduction in subacromial impingement syndrome. Kinesiotapes can also be used to correct scapular and thoracic posture in Subacromial Impingement Syndrome. Purpose of study: To study the effect of scapula and thoracic taping using kinesiotapes in addition of conventional treatment on scapular posture and shoulder range of motion in Subacromial Impingement Syndrome. Materials and Methods: 60 subjects with Subacromial Impingement Syndrome were randomly assigned to two groups. Experimental group received scapula and thoracic taping using kinesiotape for 24hrs along with conventional physiotherapy treatment. Control group received conventional physiotherapy. Subjects were assessed pre, immediate post intervention and 24hr post intervention for scapular posture, shoulder range of motion and pain. Results: Experimental group showed statistical significant improvement(p<0.001) in scapular posture, shoulder range of motion and pain (on medial rotation, and reaching the back) scores both immediately and 24hour post intervention compared to control group. Also greater improvement was seen in pain and range of motion post 24 hour as compared to immediate post intervention in experimental group. Conclusion: Taping as an adjunct to conventional treatment is much more effective for short term improvement in scapular postures, range of motion and reduction in pain as compared to only conventional treatment in subjects with Subacromial Impingement Syndrome.

Impact of Weight Relief Raise on Acromiohumeral Distance in Patients with Thoracolumbar Spinal Cord Injury / 中国康复理论与实践

Objective:To study the effect of weight relief raise on acromiohumeral distance in patients with thoracolumbar spinal cord injury. Methods:The acromiohumeral distance of 20 patients with thoracolumbar spinal cord injury was measured by ultrasonic diagnostic system, respectively in the resting position and the supporting decompression position. Results:The acromiohumeral distance was significantly larger in the resting position than in the supporting decompression position (t = 6.933, P < 0.001). Conclusion:Support could reduce the subacromial space in patients with spinal cord injury and become a potential factor for subacromial tissue injury.

Subacromial Impingement Syndrome of the Shoulder: A Musculoskeletal Disorder or a Medical Myth?

@#Subacromial impingement syndrome (SAIS) is a commonly diagnosed disorder of the shoulder. Though this disorder has been known for a long time, it remains a poorly understood entity. Over the years several hypotheses have been put forward to describe the pathogenesis of SAIS but no clear explanation has been found. Two mechanisms, the extrinsic and intrinsic mechanism, have been described for the impingement syndrome. The intrinsic mechanism theories which deny the existence of impingement are gaining popularity in recent years. The various shoulder tests used to diagnose SAIS have low specificity with an average of about 50%. Meta-analysis shows that neither the Neer sign nor the Hawkins sign has diagnostic utility for impingement syndrome. Several randomised controlled trials have shown that the outcome of treatment of SAIS by surgery is no better than conservative treatment. Physiotherapy alone can provide good outcome which is comparable to that achieved with surgery without the costs and complications associated with surgery. Since decompression with surgery does not provide any additional benefits as compared to conservative treatment for patients with SAIS, the impingement theory has become antiquated and surgical treatment should have no role in the treatment of such patients. There are calls by some practitioners to abandon the term impingement syndrome and rename it as anterolateral shoulder pain syndrome. It appears that SAIS is a medical myth. There are others who called SAIS as a clinical illusion.

Effect of a Specific Rehabilitation Program of Serratus Anterior and Lower Trapezius Muscles for Subacromial Impingement Syndrome on Subacromial Space and the Vascularity of Supraspinatus Tendon / 대한스포츠의학회지

PURPOSE: This study was designed to assess the effects of a rehabilitation program on clinical symptoms, subacromial space parameters and the supraspinatus vascularity in individuals with subacromial impingement syndrome (SIS). METHODS: Thirty-five participants (exercise group with SIS [EG]=11, non-exercise group with SIS [NEG]=10, control group [CG]=14) took part in this study. Only EG participated in 6-week rehabilitation program. Outcomes were evaluated at baseline, 6 weeks, and 10 weeks. Changes in symptoms and functional limitations were assessed using Shoulder Pain and Disability Index (SPADI) questionnaire. Changes in acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT)/AHD were assessed using ultrasonographic measures. Quantitative analysis of tendon blood flow was performed by determining four regions of interest with power Doppler quantification and analysis software to normalize data for interpretation of the mean ratio of colored pixel to the region of interest (vascularization index [VI]) and the intensity per pixel (flow index [FI]). RESULTS: Following the rehabilitation program, the scores on SPADI were significantly improved (p < 0.05). However, AHD, STT/AHD, VI, and FI indicated no significant difference within groups or interactions of time and group in between groups. CONCLUSION: The rehabilitation program yielded improvements in symptoms, but not in subacromial parameters and the vascularity of supraspinatus in participants with SIS.

Exploration into quantitative MR diagnostic criteria of subacromial impingement syndrome / 实用放射学杂志

Objective To investigate the relationships of MR indexes such as acromio humeral intervals (AHI),lateral extension of the acromion (LEA) and inclination angle of the acromion with the subacromial impingement syndrome (SIS).Methods 151 patients underwent MRI examination of shoulder joints,they were grouped according to age,gender and location of acromion.The differences in age,gender and MR indexes were compared between SIS group and non SIS group.The distribution statuses of SIS in different groups were compared at the same time,the relationships of various MR indexes with SIS were investigated and analyzed.Results There were no statistical differences in age,location distribution,the average shortest AHI value and the thickness of the subacromial bursal effusion between SIS group and non SIS group (P ＞ 0.05).There showed statistical difference in gender between the two groups (P =0.000),and there were more males than females in both groups.The acromion exactly covered the supraspinatus tendon in 79 patients,the average value of LEA in the SIS group was greater than that in the non SIS group,and there showed statistically significant difference between the two groups (P =0.002),the Youden index of LEA was 0.40,the sensitivity was 61％ and the specificity was 79％.The inclination angle of the acromion in the SIS group was smaller than that in the non SIS group,and there was a statistically significant difference between the two groups (P =0.019),the Youden index of the inclination angle of the acromion was 0.18,the sensitivity was 62％ and the specificity was 56％.47 patients in the SIS group had subacromial bursal effusion,51 patients in the non SIS group had subacromial bursal effusion.The thickness of the subacromial bursal effusion in the SIS group was greater than the non SIS group,and there showed statistically significant difference between the two groups (P =0.002),the Youden index of the thickness of the subacromial bursal effusion was 0.34,the sensitivity was 78 ％ and the specificity was 56 ％.Conclusion LEA,the inclination angle of the acromion and the thickness of the subacromial bursal effusion can be used as quantitative MR diagnostic criteria of SIS.The LEA measured by cardiothoracic ratio is simple and easy to use.

Clinical results of needle Dao for the treatment of subacromial impingement syndrome / 中国骨伤

<p><b>OBJECTIVE</b>To study the clinical results of needle Dao for the treatment of subacromial impingement syndrome.</p><p><b>METHODS</b>From September 2013 to August 2014, 90 patients with subacromial impingement syndrome were treated, including 61 females and 29 males, with the average age of (55.21±8.30) years old(ranged, 45 to 65 years old), and mean course of disease (3.49±2.98) months (ranged, 4 weeks to 7 months). Twenty-six patients had pains in left shoulder, and 64 patients had pains in right shoulder. Under local anesthesia, needle Dao was performed to release the pain point at the lower edge of the acromion and the subacromial adhesion. By observing the abduction of shoulder joint, anterior flexion and lifting, internal rotation and external rotation, shoulder pain score, the number of cases cured, markedly effective, effective and ineffective after treatment were counted, and the curative effect of needle Dao for the treatment of subacromial impingement syndrome was evaluated.</p><p><b>RESULTS</b>All the patients completed the treatment successfully without obvious adverse reactions. All the patients were followed up for more than 12 months. The visual analogue scale(VAS) decreased from preoperative 7.72±5.42 to postoperative 1.35±0.78(=15.89, <0.01). The Constant score at the 12th month after operation increased from preoperative 58.89±15.63 to 83.17±19.11(=28.48, <0.01). Overall efficacy evaluation was that, 46 cases were cured, 33 cases were markedly effective, 11 cases were effective, and 0 cases were invalid.</p><p><b>CONCLUSIONS</b>The advantage of needle Dao in the treatment of subacromial impingement syndrome is the minimally invasive treatment of the underlying lesions. The disadvantage is that it can not deal with the impact caused by bone abnormalities.</p>

A curative efficacy study of functional training focusing on muscle group around shoulder for subacromial impingement syndrome / 中国康复医学杂志

Objective:To study the curative efficacy of functional training focusing on muscle group around shoulder for subacromial impingement syndrome.Method:Forty five patients with subacromial impingement syndrome (SIS) were randomly grouped into three groups (fifteen patients for each group).Patients in Group Ⅰ were trained only on muscles around scapula.Patients in Group Ⅱ were treated on rotator cuff muscles.While patients in Group Ⅲ were treated on both.The training goes every 2 days and last for 4 weeks.The indexes for evaluating curative efficacy included:the Neer-test,the Hawkins-test and the Peen Shoulder Score.These indexes were measured immediately and three months after the four week treatment.Result:After treatment of the functional training focusing on muscle group around shoulder,Neer-tests and Hawkins-tests of all of patients were changed from positive to negative,the degree of pain compared with pain before the treatment declined apparently(P＜0.01),at the same time,the degree of satisfaction and the function went up remarkablely(P＜0.01).Compared with group Ⅰ and group Ⅱ,it dropped the most notably on the degree of pain in the group Ⅲ(P＜0.01),however,the degree of satisfaction and the function rose most apparently (P＜0.01) Conclusion:The curative efficacy of functional training focusing on muscle group around shoulder for sub-acromial impingement syndrome was effective apparently.But the efficacy of treated focusing on both muscles around scapula and rotator cuff was the most remarkably.

Advances in researches of subacromial impingement syndrome / 临床外科杂志

Subacromial impingement is an important cause of shoulder pain,which is common in orthopedic diseases. Clinicians have different views on the diagnosis and therapies. This article summarizes research advances of subacromial impingement syndrome in pathogenesis,types,clinical manifestation,ima-ging findings and treatment,hoping to standardize the diagnosis and treatment.

Research on the correlation between subacromial impingement syndrome and the relative position of acromion and humeral head / 中国矫形外科杂志

[Objective]To evluate the influence of subacromial space caused by the relative position of acromion and humeral head,and to provide theoretical guidance for diagnosis,prevention and treatment of subacromial impingement syndrome.[Method]From October 2006 to March 2007,31 shoulders(13 men and 18 women with average age of 54.3)with subacromial impingement syndrome,from our department,were selected to form the patient group,An age and gender-matched of 40 asymptomatic shoulders(18 men and 22 women with average age of 52.8)formed the control group.The acromion index was measured on the Grashey view.The distance from the glenoid plane to the lateral border of the acromion was divided by the distance from the glenoid plane to the lateral aspect of the humeral head to calculate the acromion index.[Result]The average acromion index(and standard deviation)was(0.72?0.05),in patient group,(0.61?0.04)in the asymptomatic,normal shoulders.The difference between the index in the shoulders with subacromial impingement syndrome and the index in normal shoulder was highly significantly(P

Study for Acromial Type, Acromial Tilt and Subacromial Distances in Subacromial Impingement Syndrome

OBJECTIVE: To study the acromial type, acromial angle, acromial tilt and subacromial distances which known as extrinsic factors of subacromial impingement syndrome in groups of subacromial impingement syndrome and normal control. METHOD: The radiography of shoulder named shoulder series composed of AP view, arch view and impingement view was performed in thirty patients with subacromial impingement syndrome and ninety persons with normal adult and we measured the acromial type, acromial angle, acromial tilt, subacromial distances and subacromial spur. RESULTS: Mean subacromial distances of impingement group were 11.3+/-2.4 mm in AP view, 11.1+/-2.5 mm in arch view and those of normal control group were 11.1+/-2.2 mm in AP view, 10.4+/-1.9 mm in arch view. Incidences of acromial type I,II,III in impingement group were 15 (50%), 10 (33.3%), 5 (16.7%) respectively and those in normal control group were 20 (22.2%), 46 (51.1%), 24 (26.7%) respectively. Incidence of subacromial spur was 19 (63.3%) in impingement group and 52 (57.8%) in normal control group. Mean subacromial spur size was 10.0+/-5.4 mm in impingement group and 12.4+/-4.5 mm in normal control group. Mean acromial angle was 27.1+/-8.3 degree in impingement group and 29.1+/-8.7 degree in normal control group. Mean acromial tilt was 28.0+/-6.39 degree in impingement group and 31.8+/-3.4 degree in normal control group. CONCLUSION: No significant statistical difference between subacromial impingement syndrome group and normal control group in acromial type, acromial angle, acromial tilt and subacromial distance known as extinsic factors of subacromial impingement syndrome.