MRI is a Reliable Method for Measurement of Critical Shoulder Angle and Acromial Index / A ressonância magnética é um método confiável para medida do ângulo crítico do ombro e do índice acromial

Abstract Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power (p< 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. Level of Evidence II, Diagnostic Study.

Resumo Objetivo Os objetivos deste estudo foram comparar os valores absolutos do índice acromial (IA) e do ângulo crítico do ombro (ACO) obtidos em radiografias e ressonâncias magnéticas (RM) do ombro e comparar a concordância interobservador e intraobservador dos valores de IA e ACO medidos nessas modalidades de imagem. Métodos Pacientes com indicação médica de investigação de doenças dos ombros por meio de radiografias e RM foram incluídos no estudo. As imagens foram levadas para dois cirurgiões de ombro treinados que realizaram medidas de IA e ACO em radiografias e RM. Doze semanas após a primeira avaliação, uma segunda avaliação foi realizada. A confiabilidade inter e intraobservador foi apresentada como coeficiente de correlação intraclasse (CCI) e a concordância foi classificada segundo os critérios de Landis e Koch. As diferenças entre duas medidas foram avaliadas por meio de gráficos de Bland-Altman. Resultados Cento e trinta e quatro ombros de 124 indivíduos foram incluídos no estudo. O CCI intraobservador médio para ACO em radiografias e RM foi 0,936 e 0,940, respectivamente; para IA, foi 0,908 e 0,022. O CCI interobservador médio para ACO foi 0,892 e 0,752 em radiografias e RM, respectivamente; para IA, os valores de CCI foram 0,849 e 0,685. Todas as análises individuais apresentaram poder estatístico (p < 0,001). A diferença média dos valores de IA em radiografias e RM foi 0,01 e 0,03 para os observadores 1 e 2, respectivamente. A diferença média dos valores de ACO em radiografias e RM foi 0,16 e 0,58 para os observadores 1 e 2, respectivamente. Conclusão Tanto a RM quanto as radiografias tiveram alta concordância intra e interobservador para medida de IA e ACO. Os valores absolutos de IA e ACO foram altamente correlacionados em ambas as modalidades de imagem. Esses achados sugerem que a RM é um método adequado para determinação de IA e ACO. Nível de Evidência II, Estudo Diagnóstico.

Correlations between subacromial impingement syndrome and acromial morphology and subacromial intervals after surgery of proximal humerus fracture / 中华创伤骨科杂志

Objective:To investigate the correlations between subacromial impingement syndrome (SIS) and acromial morphology and subacromial intervals after surgery of proximal humerus fracture.Methods:A retrospective study was conducted of the 62 patients with proximal humerus fracture who had been treated by internal fixation with a locking titanium plate from December 2014 to December 2019 at Department of Orthopedics, People's Hospital of Gaoming District. They were 40 men and 22 women, with an average age of 53.5 years (from 35 to 71 years). By the Neer classification, there were 38 three-part and 24 four-part fractures. The incidence of SIS was determined by Nikolaus's diagnostic criteria. The patients were divided into a SIS group and a non-SIS group. The acromial morphology was observed and the subacromial intervals [acromio-greater tuberosity of humerus interval (AGI) and acromio-plate interval (API)] were measured on postoperative X-ray films. The correlations were analyzed between them and SIS.Results:All patients completed treatments and follow-ups from 3 to 15 months (average, 10 months). There was no incision infection or internal fixation failure. There were 18 cases in the SIS group and 44 ones in the non-SIS group. In the SIS group, 3 cases had type Ⅰ acromion while 15 ones type Ⅱ or type Ⅲ acromion; in the non-SIS group, 20 cases had type Ⅰ acromion while 24 ones type Ⅱ or type Ⅲ acromion. The proportion of patients with type Ⅱ or type Ⅲ acromion in the SIS group was significantly higher than that in the non-SIS group ( P<0.05). AGI and API in the SIS group were (11.6±2.1) mm and (14.2±2.4) mm, significantly shorter than those in the non-SIS group [(15.7±2.8) mm and (18.5±3.2) mm] ( P<0.05). Conclusions:SIS is a common complication after surgery of proximal humerus fracture. Abnormal acromial morphology (type Ⅱ or type Ⅲ acromion), poor fracture reduction (reduced AGI), and high placement of a titanium plate (reduced API) may be all important factors leading to SIS.

Effect of the acromial inferolateral tilt on subacromial impingement syndrome: a retrospective magnetic resonance imaging assessment / A contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial: uma avaliação retrospectiva por ressonância magnética

Abstract Objective: To evaluate the effect of acromial inferolateral tilt on subacromial impingement syndrome. Materials and Methods: The acromial inferolateral tilt was retrospectively quantified by two researchers on 346 shoulder magnetic resonance images using the glenoacromial (between the inferior proximal acromial surface and the glenoidal face) and acromioclavicular (between the axis of the proximal acromion and distal clavicle) angles. Results: The glenoacromial angle was associated with subacromial impingement syndrome (p < 0.001) and complete supraspinatus tendon rupture (p < 0.001), and the acromioclavicular angle was associated with partial or complete supraspinatus tendon rupture (p = 0.003). The area under the receiver operating characteristic curve (AUC), best cut-off angle, and odds ratio (OR) of the glenoacromial angle for impingement syndrome were 0.579 (95% confidence interval [CI]: 0.508-0.649; p = 0.032), 72°, and 2.1 (95% CI: 1.136-4.053), respectively. For complete supraspinatus tendon rupture, the AUC, best cut-off angle, and OR of the glenoacromial angle were 0.731 (95% CI: 0.626-0.837; p = 0.001), 69°, and 8.496 (95% CI: 2.883-28.33), respectively. For partial or complete supraspinatus tendon rupture, the AUC, best cut-off angle and OR of the acromioclavicular angle were 0.617 (95% CI: 0.539-0.694; p = 0.002), 17°, and 3.288 (95% CI: 1.886-5.768), respectively. Interobserver agreement found for the glenoacromial and acromioclavicular angles were 0.737 (95% CI: 0.676-0.787; p < 0.001) and 0.507 (95% CI: 0.391-0.601; p = 0.001), respectively. Conclusion: Inferolateral acromial tilt may have some impact on subacromial impingement syndrome; however, the best quantification method identified (glenoacromial angle) showed a moderate interobserver agreement and a fair performance to assess the risk of complete supraspinatus tendon rupture.

Resumo Objetivo: Avaliar a contribuição da inclinação inferolateral do acrômio na síndrome do impacto subacromial. Materiais e Métodos: A inclinação inferolateral do acrômio foi quantificada retrospectivamente por dois pesquisadores em 346 ressonâncias magnéticas de ombro por meio dos ângulos glenoacromial (entre a superfície inferior proximal do acrômio e a face glenoidal no plano coronal) e acromioclavicular (entre o eixo do acrômio proximal e o eixo da clavícula distal no plano coronal). Resultados: Houve associação entre ângulo glenoacromial e síndrome do impacto subacromial (p < 0,001) e ruptura completa do tendão supraespinal (p < 0,001). Ângulo acromioclavicular associou-se a ruptura parcial ou completa do tendão supraespinal (p = 0,003). A área sob a curva (area under the curve - AUC) característica de operação do receptor, o melhor ângulo de corte e a razão de chances (odds ratio - OR) do ângulo glenoacromial para a síndrome do impacto foram, respectivamente: 0,579 (intervalo de confiança [IC] 95%: 0,508-0,649; p = 0,032), 72° e 2,1 (IC 95%: 1,136-4,053). Para ruptura completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo glenoacromial foram, respectivamente: 0,731 (IC 95%: 0,626-0,837; p = 0.001), 69° e 8,496 (IC 95%: 2,883-28,33). Para ruptura parcial ou completa do tendão supraespinal, a AUC, o melhor ângulo de corte e a OR do ângulo acromioclavicular foram, respectivamente: 0,617 (IC 95%: 0,539-0,694; p = 0,002), 17° e 3,288 (IC 95%: 1,886-5,768). As concordâncias interobservador encontradas para os ângulos glenoacromial e acromioclavicular foram, respectivamente: 0,737 (IC 95%: 0,676-0,787; p < 0,001) e 0,507 (IC 95%: 0,391-0,601; p = 0,001). Conclusão: Inclinação inferolateral do acrômio pode determinar alguma influência sobre a síndrome do impacto subacromial, entretanto, o melhor método de quantificação identificado (o ângulo glenoacromial) apresentou moderada concordância interobservador e desempenho moderado para estratificar o risco de ruptura completa do tendão supraespinal.

Comparison of isometric muscle strength between painful and non-painful shoulders in patients with symptoms of subacromial impingement / Comparação da força da musculatura isométrica entre ombro doloroso e não doloroso em pacientes com sintomas de impacto subacromial

ABSTRACT BACKGROUND AND OBJECTIVES: The subacromial impingement syndrome is a dysfunction of the glenohumeral joint which can cause pain, functional disability, dependence, and low quality of life. The aim of this study was to compare the muscle strength between painful and non-painful shoulders and to verify the relationship between shoulder pain and disability and isometric muscle strength of the upper limb and kinesiophobia level in individuals with symptoms of subacromial impingement syndrome. METHODS: Twenty volunteers with symptoms of subacromial impingement syndrome participated in the study. The evaluation was carried out by means of an evaluation form, the Shoulder Pain and Disability Index questionnaire (SPADI - BRAZIL) to assess disability and shoulder pain and the TAMPA questionnaire to analyze the level of kinesiophobia. The evaluation of shoulder isometric muscle strength was performed using the Manual Hand-Held Dynamometer stabilized by a rigid band in the movements of flexion, extension, abduction and internal and external rotation of the shoulder. RESULTS: In the comparison of muscle strength between symptomatic and asymptomatic side, evidence of significant difference (p<0.05) was verified for all movements evaluated. There was a significant negative relationship between shoulder pain and disability index and isometric muscle strength of flexion and internal rotation, and a significant positive relationship with the level of kinesiophobia. CONCLUSION: Individuals with symptoms of subacromial impingement syndrome showed a significant reduction in muscle strength of the symptomatic shoulder. The shoulder pain and disability index is related to the isometric muscle strength of the shoulder and to the level of kinesiophobia.

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome do impacto subacromial é uma disfunção da articulação glenoumeral, podendo gerar dor, incapacidade funcional, dependência e baixa qualidade de vida. O objetivo deste estudo foi comparar a força muscular isométrica entre ombro doloroso e não doloroso e verificar a relação entre dor e incapacidade no ombro e força muscular isométrica do ombro e nível de cinesiofobia em indivíduos com sintomas de síndrome do impacto subacromial. MÉTODOS: Participaram do estudo 20 voluntários com sintomas de síndrome do impacto subacromial. A avaliação foi realizada por meio de ficha de avaliação, questionário Shoulder Pain and Disability Index (SPADI - BRASIL) para avaliação da incapacidade e dor no ombro e questionário TAMPA para analisar o nível de cinesiofobia. A avaliação da força muscular isométrica do ombro foi realizada utilizando o instrumento Manual Hand-Held Dynamometer estabilizado por faixa rígida nos movimentos de flexão, extensão, abdução, rotação interna e externa do ombro. RESULTADOS: Na comparação de força muscular isométrica entre lado sintomático e assintomático foi verificada evidência de diferença significativa (p<0,05) para todos os movimentos avaliados. Houve relação negativa significativa entre índice de dor e incapacidade no ombro e força muscular isométrica no movimento de flexão e rotação interna, além de relação positiva significativa com nível de cinesiofobia. CONCLUSÃO: Indivíduos com sintomas de síndrome do impacto subacromial apresentaram redução significativa da força muscular isométrica do ombro sintomático. O índice de dor e incapacidade no ombro está relacionado com força muscular isométrica do ombro e com nível de cinesiofobia.

Platelet-Rich Plasma and Corticosteroid in the Treatment of Rotator Cuff Impingement Syndrome: Randomized Clinical Trial / Plasma rico em plaquetas e corticoide no tratamento da síndrome de impacto do manguito rotador: Ensaio Clínico randomizado

Abstract Objective This research aims to study the effectiveness of platelet-rich plasma (PRP) in the treatment of patients with rotator cuff impingement syndrome compared with the treatment with subacromial injection of corticosteroids. Methods This is a double-blind, randomized, comparative clinical trial. The patients were clinically evaluated with the use of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, University of California Los Angeles (UCLA) shoulder rating scale and Constant-Murley shoulder outcome score (CMS) on the day of application, and then again after 1, 3 and 6 months. Results No statistically significant differences were found (p < 0.05) when comparing the results of the DASH outcome measure, UCLA shoulder rating scale and CMS of the two groups at baseline and after 1, 3, and 6 months of treatment with subacromial injection. After the treatment, both groups showed a significant improvement in the DASH and UCLA scores (p < 0.05) when compared with the baseline. However, the CMS at 6 months after treatment with steroids was lower than the baseline. Concusions These findings suggest that PRP is a safe treatment and can be a useful tool in the therapeutic arsenal against of the rotator cuff diseases, for there was no significant difference between the subacromial use of PRP and corticosteroids.

Resumo Objetivo Analisar a eficácia do uso de plasma rico em plaquetas (PRP) no tratamento de pacientes portadores de síndrome de impacto do manguito rotador em comparação ao tratamento com injeção subacromial de corticosteroides. Métodos O estudo é de caráter comparativo, longitudinal, duplo cego e randomizado. A evolução clínica dos pacientes foi quantificada pelas escalas The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure, University of California Los Angeles (UCLA) shoulder rating scale e Constant-Murley shoulder outcome score (CMS) no dia da aplicação, e novamente após 1, 3, e 6 meses. Resultados Não foram encontradas diferenças etsatisticamente significativas (p< 0.05) ao comparar os resultados do DASH outcome measure, UCLA shoulder rating scale, e CMS dos dois grupos na admissão. Após o tratamento, ambos os grupos apresentaram melhora significativa tanto do DASH, quanto do UCLA (p< 0,05). Entretanto, o escore do CMS referente ao tratamento com corticoide mostrou-se pior no 6° mês em comparação com o escore à admissão. Conclusão Esses achados sugerem que o PRP é um tratamento seguro e que pode ser uma ferramenta útil no arsenal terapêutico contra doenças do manguito rotador, uma vez que não foram encontradas diferenças significativas entre os grupos que receberam PRP e injeção subacromial de corticosteroides.

Comparison Of Kinesio Taping And Manual Therapy With Supervised Exercise Therapy For The Treatment Of Shoulder Impingement Syndrome

Background: Shoulder Impingement Syndrome (SIS) is a major contributing factor for shoulder pain. Although many therapists use Kinesio Taping (KT) and Manual Therapy (MT) for SIS, no such studies in combination with Supervised Exercise Therapy (SET) have been conducted in the context of Saudi Arabia. Thus, the purpose of this study is to compare the effectiveness of KT and MT with SET in patients with SIS. Methods: Randomized controlled trial. Thirty-two subjects were assigned into two groups (KT with SET and MT with SET). The following outcome measures were measured at baseline, three weeks and six weeks. The outcome measurements are pain intensity by a numerical pain rating scale (NPRS), Active range of motion in the shoulder (AROM) by goniometry, and the functions of the shoulder measured through Shoulder Pain and Disability Index (SPADI). A simple descriptive statistical analysis was adopted to describe the patient-specific demographic characteristics with respect to outcome parameters. Within-group and between groups comparison were analyzed using ANOVA, and Scheffes’ posthoc tests by using SPSS 21.0. Results: Sixteen subjects completed treatment in each group. No differences were identified between groups at baseline. In ANOVA, it was shown that both groups significantly (p<0.05) decreased pain intensity, improved function and increased shoulder AROM in the 3rd week, and 6th week. However, post hoc analysis results suggested that the KT, in conjunction with SET, had a higher proportion of change on 3rd week, of the pain intensity, SPADI, and AROM. Conclusion: KT with SET has been found to be more effective than the MT with SET in the 3rd week and had the same effect in the 6th week of the treatment. When an immediate effect is expected, KT may be a better choice of treatment in the management of SIS.

Risk factors for recurrence of subacromial impingement syndrome treated with ultrasound-guided interventional therapy / 中国医学影像技术

Objective: To investigate the risks factors of recurrence of subacromial impingement type Ⅱ syndrome (SIS) in patients treated with ultrasound-guided interventional therapy. Methods: Data of 71 patients with type Ⅱ SIS diagnosed clinically were analyzed retrospectively. According to treatment methods, the patients were divided into simple injection group (n=16, ultrasound-guided subacromial-subdeltoid bursa injection) and combined treatment group (n=55, ultrasound-guided rotator cuff fenestration+subacromial-subdeltoid bursa injection). The factors affecting recurrence after treatment were analyzed by Logistic multivariate regression analysis. Results: The recurrence rate at 1, 3, 6 months after treatment in combined treatment group were significantly lower than those in simple injection (all P<0.001). Multivariate regression analysis showed that age, sex and course of disease had no relationship with recurrence, but treatment method was an independent risk factor for recurrence of patients with type Ⅱ SIS after treatment. Conclusion: Ultrasound-guided rotator cuff fenestration+subacromial-subdeltoid bursa injection can reduce the risk of recurrence in patients with type Ⅱ SIS.

The decompressive effect of chock-block technique used for acromioplasty: an anatomical study / 中华创伤骨科杂志

Objective To provide anatomic evidence for chock-block technique used for acromioplasty.Methods Thirty cadaveric specimens of intact shoulder fixed by formaldehyde solution were used for this anatomic study.They were chosen from 15 males and 15 females and from 17 left and 13 right sides.First the specimens were dissected for observation of general morphology of the acromion.According to the Bigliani's classification,the acromions were sorted in morphology as type Ⅰ (flat),type Ⅱ (curved) and type Ⅲ (hooked).The shortest distance from the acromion to the humeral head (A-H) was measured.Then the location of subacromial impingement was observed and the thickness of the anterolateral angle was measured preoperatively.At last,acromioplasty using the chock-block technique was performed in the acromions of types Ⅱ and Ⅲ.Postoperatively,the distance A-H and the thickness of the anterolateral angle were measured again for comparison with the preoperative values.Results According to the Bigliani's classification,7 acromions were type Ⅰ,13 type Ⅱ and 10 type Ⅲ.Subacromial impact occurred only in the anterior acromions of types Ⅱ and Ⅲ.The distance A-H was 0.670 ± 0.035 cm in type Ⅰ acromions,significantly longer than the preoperative values of type Ⅱ (0.506 ±0.029 cm) and type Ⅲ (0.334 ±0.023 cm) (P ＜ 0.05),but showed no significant differences from the postoperative values of type Ⅱ (0.692 ±0.025 cm) and type Ⅲ (0.699 ±0.024 cm) (P ＞ 0.05).The anterolateral angular thickness of type Ⅰ acromions was O.413 ± 0.015 cm,significantly thinner than the preoperative values of type Ⅱ (0.607 ±0.014 cm) and type Ⅲ (0.623 ±0.025 cm) (P ＜ 0.05),but showed no significant differences from the postoperative values of type Ⅱ (0.414±0.035 cm) and type Ⅲ (0.412±0.033 cm) (P＞ 0.05).Conclusion The chock-block technique used for acromioplasty is effective because it can enlarge the supraspinatus outlet and deter impingement.

Efectividad de un programa de rehabilitación autoadministrado en el tratamiento del síndrome de hombro doloroso en atención primaria de salud: un estudio clínico aleatorizado, simple ciego / Effectiveness of a self-administered rehabilitation program for shoulder pain syndrome in primary health care

Background: Shoulder pain syndrome (SPS) is frequent and management in primary care is precarious, with a high rate of referral without adequate treatment, overloading rehabilitation and orthopedic services. Aim: To assess the effectiveness of a self-administered rehabilitation program in adults with shoulder pain syndrome in primary care. Patients and Methods: A randomized, single-blind clinical trial (evaluators) with an experimental group (self-administered rehabilitation) and a control group (standard physical therapy) was carried out in 271 adult patients aged 18 or older with unilateral shoulder pain lasting more than six weeks and less than three months. The primary outcome was the recovery perceived by the patient. Constant score for function, quality of life using SF-36, simple shoulder test (SST) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were also calculated at six, 12 and 24 weeks of follow-up. Results: The self-administered rehabilitation program showed an adjusted effectiveness of 51% at the end of treatment compared to 54% of the standard physical therapy (p > 0.05). No differences in the evolution of the other scores assessed were observed between groups. Conclusions: A self-administered rehabilitation program for painful shoulder was non-inferior than usual physical therapy.

Osteochondroma of the Distal Clavicle: A Rare Cause of Impingement and Biceps Tear of the Shoulder

Hereditary multiple exostosis (HME) is an autosomal dominant disorder manifested by the presence of multiple osteochondromas. Although the lesions are benign in nature, exostoses are often associated with characteristic progressive skeletal deformity and displaying clinical symptoms such as mechanical irritation or impingement. We present the successful arthroscopic resection in a 24-year-old HME male with impingement syndrome and long head tendon tear of the biceps caused by osteochondroma arising from the distal clavicle.

Clinical efficacy of ultrasound-guided subacromial drug injection in the treatment of subacromial impingement syndrome / 中华外科杂志

Objective@#To evaluate the clinical effects of ultrasound-guided subacromial injection of two drugs in treatment of subacromial impingement syndrome.@*Methods@#This was a randomized controlled trial study, prospective collection of patients′ data who were diagnosed as subacromial impingement syndrome at Orthopedic of Tianjin Fifth Central Hospital from January 2015 to August 2017. To ensure the randomness of the study, patients were randomized into two groups using a random number table. Pain(visual analogue scale(VAS)) and shoulder function (University of California Shoulder Score System(UCLA) and shoulder abduction) were performed before and after each injection.For continuous endings with multiple points in time, firstly, the normality, the homogeneity of variance, and the sphericity test of Mauchly were performed. After the condition was satisfied, the variance analysis of the two-factor repeated measurement data was performed.@*Results@#Fifty-two patients completed the injection within 5 minutes and 41 patients got the final follow-up. Twenty-two patients in the corticosteroid group, 14 males and 8 females, aged (44.7±9.5) years old(range: 35-68 years old). The lesion involved 13 cases of superior shoulder, more than 1 time injection in 4 cases. There were 19 patients in the NSAID group, 7 males and 12 females, aged (37.2±10.1) years old(range: 27-63 years old), 10 cases with lesions involving superior shoulders, and 1 case with more than one injection. (1)VAS score: compared with pre-injection(Corticosteroid group 5.0(4.0-6.0)and NSAIDS group 5.0(4.0-6.0)), both groups showed significant pain relief at 60 minutes(1.0(1.0-2.0)and 1.0(1.0-2.0)) and 6 weeks(1.5(1.0-2.0)and 1.0(1.0-2.0)) after injection(χ2=47.293, 41.173, 45.174, 40.113; P<0.01). (2)UCLA score: compared with pre-injection(30.2±2.5 and 30.5±3.0), UCLA scores improved significantly in both groups at the 6-week after injection(Corticosteroid group: MD=9.727, t=19.218, P<0.001; NSAID Group: MD=9.579, t=11.467, P<0.01). The UCLA score improvement between the two groups was no statistical difference(all P>0.05). (3)shoulder abduction degree: compared with pre-injection(92.7±9.4 and 93.2±11.6), the abduction degree was significantly improved in both groups at 60 minutes(131.8±9.6 and 127.4±16.6) and 6 weeks(115.9±9. 1 and 127.9±14.4) after the injection, but the improvement in each time point has no statistical correlation(MD=4.450, t=1.069, P=0.292). NSAID group had better improvement of shoulder abduction degree than corticosteroid group at the 6 weeks after the injection(MD=-11.986, t=-3.238, P=0.002).@*Conclusions@#Ultrasound-guided subacromial injection can reduce pain in patients with subacromial impingement syndrome.The effect of injection of NSAID drugs is the same as corticosteroid drugs, it can avoid hormone-induced complications and reduce the repeat of the punctures.

Comparison of diagnostic value of 1.5T nuclear magnetic resonance imaging and multi-slice spiral CT for subacromial impingement syndrome / 中国医学装备

Objective:To investigate the diagnostic value of 1.5T magnetic resonance imaging(MRI) and multi-slice spiral CT (MSCT) for subacromial impingement syndrome(SIS).Methods: The clinical data of 60 patients with SIS were researched by using retrospective analysis. All of patients were detected by using MRI and CT, respectively. And the diagnosis value of the two methods were compared.Results: The differences of sensitivity and Youden index between MRI and MSCT were significant, respectively (x2=12.987,x2=12.987,P<0.05), and the diagnostic sensitivity of MRI was higher than that of MSCT. While the diagnostic specificities of the two method were 100％. The differences of detectable rate for Bigliani I and Bigliani II between MRI and MSCT were no significant (x2=2.492,x2=2.031, P>0.05), respectively. The detectable rate of MRI for Bigliani III was significantly higher than that of MSCT (x2=9.087, P<0.05).Conclusion: The diagnostic sensitivity of MRI for SIS is higher than that of MSCT, and the main reason is that MRI has higher resolution ratio for soft tissue. Besides, it has no radiation. Therefore, it is appropriate to the diagnosis of SIS.

Risco de lesões de ombro em cortadores de cana-de-açúcar: análise baseada na simulação dos movimentos / Risk of shoulder injuries in sugarcane workers: analysis based on the simulation of the movements

OBJETIVOS: Avaliar se os ângulos de amplitude da flexão e abdução de ombro, nos movimentos realizados durante uma simulação da tarefa do corte de cana-de-açúcar, ultrapassam os limites considerados seguros MÉTODOS: Foram realizadas simulações controladas não randomizadas do movimento do corte de cana-de-açúcar em voluntários recrutados entre estudantes universitários. Os critérios de inclusão foram (a) sexo masculino; (b) idade entre 21 e 40 anos; (c) destro; (d) sem alterações ortopédicas e/ou neurológicas; (e) características físicas e histórico de atividades laborais semelhantes às dos cortadores de cana; (f) atividade física aeróbica pelo menos três vezes por semana nos últimos seis meses. Os critérios de exclusão foram (a) presença de dor durante os testes; e (b) incapacidade de realizar o movimento. O estudo foi realizado no laboratório de biomecânica ocupacional do Núcleo de Estudo e Pesquisa em Ergonomia da Faculdade de Ciências e Tecnologia da Universidade Estadual Paulista. Os dados cinemáticos foram coletados pelo Sistema de Análise de Movimento Tridimensional Vicon®. As aberturas em flexão e abdução do ombro direito foram medidas e classificadas. Os parâmetros utilizados para avaliar os resultados tiveram como referência o documento do Ministério da Saúde que sintetiza os limites seguros de amplitude desses movimentos. RESULTADOS: Foram avaliados 10 sujeitos, com média de idade de 24,5±4,78 anos. Foram analisadas 39 coletas obtidas com repetições dos movimentos durante um período médio de 30 segundos. O ângulo de abertura do ombro em flexão permaneceu acima de 30 graus por 98,18% do tempo de execução da tarefa, acima de 45 graus por 88,84%, acima de 60 graus por 42,19% e acima de 90 graus por 7,72% do tempo. O ângulo de abdução permaneceu acima de 60 graus por 100% e acima de 90 graus por 57,59% do tempo. Nos picos de amplitude de movimento observaram-se aberturas em abdução com ângulos superiores a 100 graus. CONCLUSÕES: Durante a maior parte do tempo dos experimentos que simularam o movimento de corte de cana-de-açúcar, os ângulos de flexão e abdução do ombro estiveram acima dos considerados seguros, indicando que a atividade realizada por cortadores de cana-de-açúcar possui um forte potencial para causar danos à articulação dos ombros.

AIMS: To evaluate whether the amplitude angles of shoulder flexion and abduction, in the movements performed during a simulation of the sugarcane cutting task, exceed the limits considered safe. METHODS: Non-randomized controlled simulations of the movement of sugarcane cutting were performed in volunteers recruited among university students. Inclusion criteria were (a) male sex; (b) age between 21 and 40 years; (c) right handed; (d) without orthopedic and/or neurological impairment; (e) physical characteristics and a history of work activities similar to that of sugarcane cutters; (f) performing aerobic physical activity at least three times a week in the last six months. The exclusion criteria were (a) presence of pain during the tests; and (b) inability to perform the movement. The study was carried out in the laboratory of occupational biomechanics of the Center for Study and Research in Ergonomics of the School of Science and Technology of the State University of São Paulo. The kinematic data were collected by the Vicon® Three-Dimensional Movement Analysis System. The movements of flexion and abduction of the right shoulder were measured and classified. The parameters used as reference to evaluate the results were those published by the Ministry of Health of Brazil, which synthesizes the safe limits of amplitude of these movements. RESULTS: Ten subjects were evaluated, with a mean age of 24.5±4.78 years. A total of 39 samples obtained with the movement repetitions were analyzed during an average period of 30 seconds. The angle of shoulder in flexion remained above 30 degrees during 98.18% of the task execution time, above 45 degrees during 88.84%, above 60 degrees during 42.19% and above 90 degrees during 7.72% of the time. The abduction angle remained above 60 degrees throughout all the time and above 90 degrees during 57.59% of the time. In the amplitude of movement spikes, abduction apertures with angles greater than 100 degrees were observed. CONCLUSIONS: During most of the time of the experiments that simulated the movement of sugarcane cutting, the flexion and abduction angles of the shoulder were above those considered safe, indicating that the activity performed by sugarcane cutters has a strong potential to cause damage to the shoulder joint.

Disorders of the long head of the biceps: tenotomy versus tenodesis / Lesões do cabo longo do bíceps: tenotomia versus tenodese

ABSTRACT Disorders of the long head of biceps tendon are common in clinical practice. Their causes could be degenerative, inflammatory, instability (subluxation or luxation) or traumatic. They are generally associated to other diseases of the shoulder, mainly rotator cuff injuries. Currently, there is controversy in the literature regarding the indications for surgical treatment and the choice of the best technique for each case, due to the possibility of esthetic deformity, loss of muscle strength, and residual pain. The objective of this study was to identify the indications for surgical treatment, the best surgical technique, and the advantages and disadvantages of each technique described in the orthopedic literature for the treatment of long head of biceps tendon injuries. A revision of the orthopedic medical literature on the following databases: Biblioteca Regional de Medicina (BIREME), Medline, PubMed, Cochrane Library and Google Scholar, comprising articles published in the period from 1991 to 2015.

RESUMO As lesões da cabeça longa do tendão bicipital (CLB) são comuns na prática clínica e podem ter causas degenerativas, inflamatórias, instabilidades (subluxação ou luxação) ou traumáticas. Geralmente, elas estão associadas a outras doenças do ombro, principalmente a lesões do manguito rotador. Atualmente, existem controvérsias quanto às indicações dos tratamentos cirúrgicos e à escolha da melhor técnica para cada caso, devido à possibilidade de deformidade estética, perda da força muscular e dor residual. O objetivo deste estudo foi identificar as indicações do tratamento cirúrgico, a melhor técnica cirúrgica e as vantagens e desvantagens de cada técnica descritas na literatura médica ortopédica no tratamento das lesões da CLB. Foi realizada revisão da literatura médica ortopédica disponível na base de dados da Biblioteca Regional de Medicina (BIREME), Medline, PubMed, Cochrane Library e Google Scholar, incluindo artigos publicados no período de 1991 a 2015.

The clinical relevance of abnormal upper trunk posture for predicting shoulder impingement syndrome among stroke survivors / 中华物理医学与康复杂志

Objective To explore the relevance of abnormal posture to the development of shoulder pain among stroke survivors.Methods A total of 102 stroke survivors were studied.Those with shoulder impingement syndrome or shoulder pain formed a shoulder pain group,while those without shoulder pain served as controls.The upper trunk sagittal sitting postures of all of the subjects were quantified using the thoracic and craniovertebral angles measured from photographs.Results The average craniovertebral angle of the shoulder pain group was significantly smaller than that of the control group,while the average thoracic angle of the former was significantly larger.The craniovertebral angles were negatively correlated with shoulder pain,while a large thoracic angle was positively correlated.Conclusion Thoracic and craniovertebral angles can be used as a predictor of shoulder impingement syndrome among stroke survivors.Stroke patients with thoracic kyphosis and forward head posture should undergo active rehabilitation.

The clinical relevance of abnormal upper trunk posture for predicting shoulder impingement syndrome among stroke survivors / 中华物理医学与康复杂志

Objective To explore the relevance of abnormal posture to the development of shoulder pain among stroke survivors.Methods A total of 102 stroke survivors were studied.Those with shoulder impingement syndrome or shoulder pain formed a shoulder pain group,while those without shoulder pain served as controls.The upper trunk sagittal sitting postures of all of the subjects were quantified using the thoracic and craniovertebral angles measured from photographs.Results The average craniovertebral angle of the shoulder pain group was significantly smaller than that of the control group,while the average thoracic angle of the former was significantly larger.The craniovertebral angles were negatively correlated with shoulder pain,while a large thoracic angle was positively correlated.Conclusion Thoracic and craniovertebral angles can be used as a predictor of shoulder impingement syndrome among stroke survivors.Stroke patients with thoracic kyphosis and forward head posture should undergo active rehabilitation.

Impingement Syndrome and Labral Tear in Athletes: Differences in Diagnosis and Management with General Population / 대한스포츠의학회지

The pathophysiology of impingement syndrome and labral tear was variable and not clear. In general populations, lesions occur mainly in acute cases. But in athletes, lesions are caused by repetitive exposure to excessive force, resulting in different patterns. For diagnosis, thorough physical examinations and radiologic findings should be combined. In athletes, conservative treatment including posterior capsular stretching and periscapular muscle strengthening is recommended as the first choice of treatment considering chronic progression and adaptive change. When choosing surgical treatment because of failure of conservative treatment, careful attention should be paid to the choice of repair or debridement of the rotator cuff partial tear, and the choice of the labral repair or biceps tenodesis.

Early Clinical Outcomes after Subacromial Injection of Ketorolac in Patients with Shoulder Impingement Syndrome: A Comparison with Steroid Injection / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical results between the subacromial injection of the ketorolac and that of the corticosteroid in patients with subacromial shoulder impingement syndrome. MATERIALS AND METHODS: Twenty patients with shoulder impingement syndrome received an injection of 60 mg ketorolac and were evaluated in terms of visual analogue scale (VAS), range of motion (ROM) and Constant-Murley score. The outcomes are compared with the data of patients treated by 40 mg triamcinolone injection, retrospectively. RESULTS: There was no significant difference in the demographics, VAS, ROM, and Constan-Murley score between the two groups before the injection. At the 4 weeks follow-up, pain improvement was significantly greater in the corticosteroid group (2.7±1.53) than in the ketorolac group (4.9±2.08; p=0.001). However 12 weeks after the injection, there was no significant difference in pain improvement between the two groups (ketorolac: 2.9±2.32, corticosteroid: 2.6±1.82; p=0.707). The Constant-Murley score at the final follow-up improved from 33.5 to 52.1 in the corticosteroid group, and from 39.0 to 56.6 in the ketorolac group (p=0.677). ROM was increased in both groups, and external rotation was significantly greater in the ketorolac group than in the corticosteroid group at the final follow-up (ketorolac: 29.3°±9.90°, corticosteroid: 20.8°±7.99°; p=0.005). CONCLUSION: In this study, ketolorac provided an effect equivalent to triamcinolone in the treatment of subacromial shoulder impingement syndrome at 12 weeks after the injection. This result could offer better opportunities to manage patients with diabetes or local and systemic side effects of repetitive use of corticosteroids.

Descompresión subacromial por vía artroscópica / Arthroscopic subacromial decompression

Fundamento: la compresión subacromial constituye la causa más frecuente de dolor en el hombro, su tratamiento puede variar del conservador al quirúrgico, sin embargo, en relación al tratamiento quirúrgico, el realizado por la vía artroscópica es superior en resultados estéticos y funcionales. Objetivo: profundizar en la compresión subacromial y la importancia de la descompresión de este compartimiento mediante la vía artroscópica. Métodos: se realizó una revisión bibliográfica acerca del tema de un total de 570 artículos publicados en las bases de datos Pubmed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 56 citas seleccionadas para realizar la revisión, 53 de ellas de los últimos cinco años donde se incluyeron tres libros. La búsqueda de la información se realizó en un período de dos meses del 1ro de febrero al 31 de marzo de 2016. Se emplearon las siguientes palabras: subacromial compression y arthroscopic subacromial decompression. Desarrollo: se abordan los factores participantes en la compresión subacromial divididos en intrínsecos, extrínsecos y secundarios. Se hace referencia al cuadro clínico de estos enfermos con especial énfasis en las maniobras más empleadas. En relación al tratamiento quirúrgico se describen las dos variedades de tratamiento por la vía artroscópica, así como las complicaciones más frecuentes. Conclusiones: la descompresión subacromial por la vía artroscópica es efectiva en pacientes con compresión subacromial, es un método factible con un mínimo de complicaciones.

Background: subacromial compression is the most common cause of shoulder pain. Its treatment varies from conservative to surgical. However, surgical treatment by arthroscopy is better in regards to functional and cosmetic points of view. Objective: to deepen into the importance of subacromial decompression by arthroscopy in patients with subacromial compression. Methods: a search in the databases Pubmed, Hinari, SciELO and Medline was carried out through the management information software EndNote by using the words subacromial compression and arthroscopic subacromial decompression, resulting in a total of 570 articles, in which 56 of them were selected for review, 53 of them in the last five years, including three books. Development: important aspects related to subacromial compression causes were described and divided in intrinsic, extrinsic, and secondary. Specific maneuvers and clinical presentation were pointed. In regards to surgical treatment, a couple of arthroscopic surgical modalities were described as well as complications. Conclusions: arthroscopic subacromial decompression is an effective surgical modality in patients suffering from subacromial compression; it’s a safe procedure with few complications.

Eficacia de la magnetoterapia en pacientes ecuatorianos con síndrome de pinzamiento del hombro / Effectiveness of the magnetotherapy in Ecuadorian patients with shoulder impingement syndrome

Se realizó un estudio cuasiexperimental, longitudinal y prospectivo, en 60 pacientes con síndrome de pinzamiento del hombro, atendidos en la consulta de Rehabilitación del Hospital "José María Velasco Ibarra", en la ciudad de Tena, Ecuador, desde agosto del 2014 a marzo del 2015, con vistas a determinar la eficacia de la magnetoterapia en ellos. El funcionamiento del hombro fue evaluado con el test de Constant-Murley, que se aplicó antes y después del tratamiento, y en el procesamiento estadístico de la información los resultados obtenidos mediante el cálculo porcentual se compararon a través de la prueba de homogeneidad marginal de Stuart-Maxwell, con 95 % de confiabilidad. En la serie predominaron el sexo femenino (63,3 %), el grupo etario de 60 y más años (41,8 %) y la bursitis subacromial (46,6 %) como principal causa de la afección. La rápida evolución de los pacientes demostró la eficacia de la magnetoterapia, por lo que se recomienda su empleo en estos casos.

A quasi-experiment, longitudinal and prospective study, in 60 patients with shoulder impingement syndrome, assisted in the Rehabilitation Service of "José María Velasco Ibarra" Hospital, in Tena city, Ecuador, was carried out from August, 2014 to March, 2015, aimed at determining the effectiveness of magnetotherapy in them. The shoulder performance was evaluated with the Constant-Murley test that was applied before and after the treatment, and in the statistical processing of the information the results obtained by means of the percentage calculation were compared through the Stuart-Maxwell marginal homogeneity test, with 95% of confidence. In the series the female sex (63.3%), the age group of 60 years and over (41.8%) and the subacromial bursal synovitis (46.6%) prevailed as main cause of the disorder. The quick clinical course of the patients demonstrated the effectiveness of the magnetotherapy, reason why its use is recommended in these cases.