Utilizing Scapula Retraction Exercises With or Without Glenohumeral Rotational Exercises With a Gradual Progression for Subacromial Pain Syndrome.

BACKGROUND: Although exercise interventions are recommended in the management of subacromial pain syndrome (SPS), there is a lack of data regarding the exercises focusing on the principal biomechanical deficiencies that cause symptoms. HYPOTHESIS: Utilizing progressive scapula retraction exercises (SRE) and glenohumeral rotation exercises (GRE) in the scapula stabilization program may lead to more reduction in symptoms and greater acromiohumeral distance (AHD) values. STUDY DESIGN: A double-blind, randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 33 patients were assigned randomly to either SRE or SRE+GRE. Both groups received a 12-week supervised rehabilitation program, including manual therapy and exercises (stretching and progressive scapula stabilization exercises). In addition, the SRE+GRE group performed GRE exercises at gradual elevation angles. From 12 to 24 weeks, patients performed exercise programs less frequently (3 times per week). Disability (shoulder pain and disability index [SPADI]), AHD (at 5 active abduction angles), pain intensity (visual analogue scale [VAS]), and patient satisfaction were recorded at baseline, 12 weeks, and 24 weeks. A total of 16 healthy individuals were recruited as a control group to compare AHD values. Data were analyzed using mixed model analyses of variance. RESULTS: A statistically significant group-by-time interaction was found for AHD values (F4,92 = 6.38; P = 0.001), a significant group-by-time interaction for SPADI-disability (F1,33 = 5.148; P = 0.01), SPADI-total (F1,32 = 4.172; P = 0.03), and for pain during activity (F2,62 = 3.204; P = 0.05). However, no significant group-by-time interaction for SPADI-pain (F1,33 = 0.533; P = 0.48), for pain at rest (F1,31 < 0.001; P = 0.99), and at night (F1,32 = 2.166; P = 0.15). Yet, a significant time effect was observed. CONCLUSION: Progressive SRE and GRE in the scapula stabilization program lessens symptoms and improves AHD values in patients with SPS. Moreover, this program could preserve outcomes and further increase AHD when applied less frequently. CLINICAL RELEVANCE: Utilizing SRE and GRE in the scapula stabilization program at gradual shoulder abduction angles provides better rehabilitation outcomes.

Acromiohumeral distance quantification during a variety of shoulder external and internal rotational exercises in recreationally overhead athletes.

To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead athletes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (active-hold) and during ER and IR exercises (isometric and concentric) at five different shoulder-abduction angles (0°, 30°, 45°, 60°, and 90° of abduction). A two-way ANOVA was used to analyze AHD values. Shoulder abduction angle × exercise interaction for AHD was found (F16,304 = 10.92; p < .001; η2 = 0.37). For both isometric and concentric conditions, AHD increased during IR exercises (p < .05) yet decreased during ER exercises (p < .05) when compared with each active-hold positions. Shoulder ER and IR exercises influence the AHD in recreational overhead athletes. A larger AHD was observed during shoulder IR exercises, whereas ER exercises failed to maintain the AHD.

Excessive z-axis scan coverage in body CT: frequency and causes.

OBJECTIVES: The aim of this study was to determine the frequency and causing factors of excessive z-axis coverage in body CT examinations. METHODS: A total of 2032 body CT examinations performed between 1 March and 1 April 2018 in 1531 patients were included in this study. The over-scanned length values in the z-axis for each CT examination on each patient were determined by calculating the difference between the actual scanned length and optimal scan length in the z-axis. Over-scanning and over-scanning ratios were interrogated in terms of potential underlying factors that can be affected by patient demography, time, the throughput of CT, and the experience of technologists. RESULTS: Over-scanned CTs in z-axis were 66% of all CTs performed. CT scans were over-scanned in the cranial side in 18.4% and caudal side in 48.5% of patients. Over-scanning was found to be more frequent in 55-64-year-old age group (74%), thorax CTs (89.2%), patients with consciousness change (88.9%), patients with misleading findings related to lung apex or diaphragm on the scout images (76.6%), CTs performed in day shift (66.8 %), in CT with low daily scan (72.4%), and CT scans performed by less-experienced technologists (75.9%). CONCLUSIONS: Over-scanning in z-axis in body CT examinations is not infrequently encountered in routine practice. Awareness of causes of over-scanning in z-axis can be helpful to prevent over-scanning in CT and unnecessary ionizing radiation exposure in patients. KEY POINTS: • Over-scanning in z-axis frequently occurs in body CT. • The frequency of over-scanning in caudal side is higher than cranial side. • Chest CT and any CT performed in following situation were more prone to over-scanning: older patients, patients with consciousness change, presence of misleading findings on the scout images related to lung apex or diaphragm, day shift, CT with low daily scan, less-experienced technologist.