Acromioclavicular Joint Degeneration Research Articles

The association between ultrasonographic findings and pain, physical function, and symptoms in patients with shoulder pain.

Shoulder ultrasonography (US) is commonly employed to differentiate the causes of shoulder pain. However, the correlation between ultrasonographic findings and the individual's functional disability and daily activities remains unexplored. To investigate the relationship between shoulder US findings and physical function, disability, and pain. The study investigated patients with shoulder pain. Tendons of supraspinatus, infraspinatus, subscapularis, and long head of biceps brachii, acromiohumeral distance, and acromioclavicular joint (ACJ) degeneration were evaluated using US. The QuickDASH questionnaire was employed to evaluate physical function, symptoms, and disability, while the visual analog scale (VAS) was utilized to assess pain levels. The study included 84 patients (69 [82.1%] women, mean age = 55.7 ± 11.9 years). Ultrasonographic examination revealed ACJ degeneration in 61 (21.4%) patients and biceps tendinitis in 21 (25%) patients. In addition, supraspinatus tendinosis was identified in 51 (61%) patients, while 28 (33%) exhibited a supraspinatus tear. The patients demonstrated a mean VAS score of 7.03 ± 1.49 and mean QuickDASH score of 45.6 ± 15.3. Individuals with a supraspinatus tear exhibited higher VAS (P = 0.008) and QuickDASH (P = 0.016) scores. Patients presenting with ACJ degeneration demonstrated increased VAS scores (P = 0.014), whereas those with biceps tendinopathy showed higher QuickDASH scores (P = 0.035). The results obtained from our research demonstrate significant correlations between ultrasonographic data and pain, disability, and physical manifestations. The findings of this study indicate that shoulder US provides valuable information regarding the difficulties individuals face in their daily tasks and the degree of pain they endure.

Exploring shoulder joint pain: a comparative analysis of dynamic ultrasonography and magnetic resonance imaging

BACKGROUND: To evaluate shoulder joint pain, the study concentrated on evaluating the diagnostic accuracy of ultrasonography and magnetic resonance imaging. AIM: By comparing the results from both modalities within the same patient group, the study aimed to identify potential challenges in image interpretation, underscoring the limitations of ultrasonography and magnetic resonance imaging. MATERIALS AND METHODS: Patients with shoulder joint pain were included through purposive sampling. These patients underwent ultrasonography and magnetic resonance imaging, and the results were correlated. Various shoulder pathologies, including tendon tears, bursitis, degenerative changes, calcifications, and impingement, were analyzed. RESULTS: The study comprised 35 patients who underwent ultrasonography and magnetic resonance imaging detecting pathologies such as subscapularis and supraspinatus tendon injuries, partial and full-thickness tears, peribicipital tendon fluid, subcoracoid and subacromial-subdeltoid bursitis, acromioclavicular joint degeneration, tendon calcification, and impingement. Comparative analysis showed varying sensitivities, specificities, positive predictive values, negative predictive values, and accuracy for different pathologies. CONCLUSION: Compared with ultrasonography, magnetic resonance imaging demonstrated greater sensitivity and specificity in identifying conditions causing shoulder pain. Ultrasonography’s affordability, real-time capabilities, and ability to compare results with the unaffected side make it a useful first diagnostic step for shoulder pain. Ultrasonography, although a quick and cost-effective initial diagnostic tool, has limitations, including operator dependence and lower sensitivity in certain conditions. In contrast, magnetic resonance imaging is employed as a confirming measure or in instances where diagnosis is challenging. The study emphasized the complementary roles of ultrasonography and magnetic resonance imaging in the diagnosis of shoulder joint pain, with magnetic resonance imaging as the more accurate and complete imaging modality.

Pattern of Radiographic and Sonographic Findings of Adult Patients Presented with Shoulder Pain at Tikur Anbessa Hospital, Addis Ababa, Ethiopia.

Shoulder pain is one of the most common presentations in the orthopedic clinic. Multiple factors have been found to cause shoulder pain. Radiographs and ultrasound are widely available, relatively cheap modalities in assessing shoulder pain. The aim of this study is to assess the radiographic and sonographic imaging patterns of shoulder pain. A descriptive prospective cross-sectional hospital-based study was conducted at the Department of Radiology of Tikur Anbessa Specialized Hospital among patients with shoulder pain that came for imaging from August 2021-January 2022. Of the 73 patients with shoulder pain included in the study, 67% were females while 33% males. The mean age was 51.7 years. Radiographs found pathology in 53% of the cases. Acromioclavicular joint osteoarthritis, greater tuberosity degenerative changes, rotator cuff calcification were common radiographic findings. Ultrasound detected pathologies in 87% of the cases. The common pathologies were rotator cuff pathologies, biceps tendon pathologies, acromioclavicular joint degeneration, greater tuberosity degenerative changes, subacromial subdeltoid bursitis, and adhesive capsulitis. There was a significant association between greater tuberocity degenerative changes and supraspinatous pathologies with age, greater tuberocity degenerative changes with supraspinatous pathologies, acromiohumeral distance of <7mm with supraspinatous pathology. Radiographs and ultrasound are valuable imaging modalities for shoulder pain. Low acromiohumeral interval, greater tuberosity degenerative changes, and acromioclavicular joint osteoarthritis are associated with rotator cuff tears. Rotator cuff pathologies are the most common pathologies observed in ultrasound. We recommend ultrasound to be second step after radiograph due to its low cost and wide availability.

The usefulness of ultrasound in predicting outcomes in patients with shoulder pain: a prospective observational study.

Shoulder pain is common but current clinical classification has limited utility. We aimed to determine whether groups of ultrasound-based shoulder pathologies exist and to evaluate outcomes according to identified groups and individual pathologies. This was a prospective study of a community-based cohort with shoulder pain referred for their first ultrasound scan at a single radiology unit, with subsequent routine clinical care. Patient-reported outcomes were collected at baseline, 2 weeks and 6 months; standardized ultrasound reporting was employed. Latent class analysis (LCA) identified ultrasound pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and Shoulder Pain and Disability Index (SPADI). Short-term response to corticosteroid injections was investigated. Of 500 participants (mean age 53.6 years; 52% female), 330 completed follow-up. LCA identified four groups: bursitis with (33%) or without (27%) acromioclavicular joint degeneration, rotator cuff tear (21%) and no bursitis/tear (19%). Total SPADI was higher at baseline for cuff tears (mean 55.1 vs 49.7-51.3; overall P = 0.005), but accounting for this, groups did not differ at 6 months (43.5 vs 38.5-40.5; P = 0.379). Baseline SPADI was the only predictor of 6-month SPADI retained by penalized modelling; neither LCA-derived ultrasound groups nor individual pathologies were selected. Response to baseline injection at week 2 did not differ between groups (mean SPADI 40.1-43.8; P = 0.423). Ultrasound-based classification (groups or individual pathologies) of shoulder pain did not predict medium-term outcomes using current treatments. The role of routine diagnostic ultrasound for shoulder pain needs consideration; it may be useful to establish evidence-based therapies for specific pathologies.

Bony Regrowth and New Spur Formation as Possible Causes of Failed Distal Clavicle Excision-Mid-Term Outcomes after Revision Surgery in a Matched-Pair Analysis.

Despite high rates of successful outcomes after open and arthroscopic distal clavicle excision (DCE) for symptomatic acromioclavicular joint (ACJ) degeneration, some patients present with persistent symptoms and disabilities after surgical intervention. This study aims to compare radiological, functional, and subjective outcomes of open revision surgery after failed arthroscopic DCE to primary successful arthroscopic DCE. In this retrospective case-control study, 10 patients who underwent open DCE revision were age- and gender-matched with 10 patients who did not require revision surgery after DCE. Radiographic evaluation included presence of acromioclavicular spurs and acromioclavicular joint distance. Functional and subjective outcomes were assessed using the CS, SSV, SST, VAS for pain, patient's satisfaction, ASES and quick DASH score. At the latest postoperative follow-up (case: 57.3 ± 19.2 months; control: 63.5 ± 16.3 months), spur formation was detected in twice as many cases in the revision group, while acromioclavicular distance showed no significant difference. However, a significant bony regrowth was noticed in the revision group between revision surgery and latest follow-up, with a decrease of the acromioclavicular distance from 9.2 ± 1.6 mm to 5.9 ± 4.6 mm (p = 0.026) and a development of new spur formations in 30% of cases. There were no significant differences in overall CS between the revision and control group (p = 0.174) at final follow-up, but the control group scored significantly higher in the CS subgroups pain (p = 0.012) and internal rotation (p = 0.016). Mean SSV was significantly lower in the revision (65.5 ± 22.3%) compared to the control group (85.9 ± 16.4%; p = 0.031). Bony regrowth at the distal clavicle presenting as postoperative AC-distance narrowing and new spur formation was observed more distinctly in the revision group. Despite a slight increase in postoperative outcomes after revision surgery, subjective satisfaction and recalcitrant pain remain a concern. Therapeutic Level III, retrospective case-control study.

Relationship Between Preoperative Shoulder Osteoarthritis Severity Score and Postoperative PROMIS-UE Score After Rotator Cuff Repair

Mild to moderate glenohumeral joint osteoarthritis is a common finding among patients who are evaluated for rotator cuff tears. However, the impact of preoperative shoulder joint degeneration on patient-reported outcomes after rotator cuff repair (RCR) is not well-established. To apply the magnetic resonance imaging (MRI)-based Shoulder Osteoarthritis Severity (SOAS) score to the evaluation of patients undergoing RCR and determine the relationship between preoperative shoulder pathology present on MRI and postoperative Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE) scores. Case-control study; Level of evidence, 3. Seventy-one MRI scans corresponding to 71 patients were analyzed by 2 independent reviewers and scored using the SOAS criteria. Intraclass correlation coefficients were calculated for total SOAS score as well as for each subscore. Spearman correlations were calculated between averaged SOAS scores, patient characteristics, and PROMIS-UE scores. Linear regression analysis was performed between the independent variables of patient age, sex, body mass index, and significant SOAS score components determined by univariate analysis with the dependent variable of PROMIS-UE score. Significance was defined as P < .05 for univariate analyses and < .0125 for multivariate analyses using the Bonferroni correction. The mean PROMIS-UE score of this cohort was 51.5 ± 7.4, while the mean total SOAS score was 21.5 ± 8.4. There was a negative correlation between total SOAS score and postoperative PROMIS-UE score (r = -0.24; P = .040). Both cartilage wear (r = -0.33; P = .0045) and acromioclavicular joint degeneration (r = -0.24; P = .048) individually demonstrated negative correlations with PROMIS-UE score. When a multivariate linear regression with Bonferroni correction was applied to the significant variables identified in univariate analysis along with patient characteristics, none were independently correlated with PROMIS-UE score. In this cohort of patients undergoing RCR, increasing preoperative total SOAS score was predictive of lower postoperative PROMIS-UE scores. SOAS subscores with the strongest negative correlations with PROMIS-UE scores included cartilage wear and acromioclavicular joint degeneration. The cartilage subscore was negatively correlated with PROMIS-UE scores independent of patient factors in multivariate analysis.

A Modified Endoscopic Technique with Three Incisions for Rockwood Types III and V Acromioclavicular Joint Dislocation

Acromioclavicular joint dislocation is one of the most common shoulder injuries in young men. With the advancement of minimally invasive technology, arthroscopy of acromioclavicular joint dislocation has been recognized for its good curative effect. This study aimed to explore the technical details and clinical efficacy of a modified minimally invasive endoscopic treatment for acromioclavicular joint dislocation. Clinical data of patients receiving the three-incision endoscopic treatment were retrospectively reviewed between July 2013 and July 2019. A total of 72 patients with acromioclavicular joint dislocation of Rockwood type III (n=42) and type V (n=30) were included in this study. Postoperative routine radiography was performed to evaluate acromioclavicular joint reduction and fixation. In addition, functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores. Differences between the preoperative and postoperative data were compared using paired t-tests. All patients underwent loop plate elastic fixation under endoscopy during 24 to 48months of follow-up. Postoperative radiography showed that the acromioclavicular joint achieved anatomical reduction. The ASES score (91.1 ± 4.2) was significantly improved compared to the preoperative ASES score (62.4 ± 3.1) (t=46.65, P < 0.0001). The Constant-Murley score (93.1 ± 4.6) was also significantly higher than that before the operation (40.7 ± 6.4) (t=56.41, P < 0.0001). No postoperative complications occurred. During follow-up, four patients had mild acromioclavicular joint degeneration but no obvious pain symptoms. The modified three-incision endoscopic technique optimizes the surgical incision, reduces trauma, is minimally invasive, and provides rapid rehabilitation with satisfactory clinical outcomes.

Anatomic reconstruction for acromioclavicular joint injuries: a pilot study of a cost-effective new technique.

BackgroundThe treatment for acromioclavicular joint injuries (ACJI) ranges from a conservative approach to extensive surgical reconstruction, and the decision on how to manage these injuries depends on the grade of acromioclavicular (AC) joint separation, resources, and skill availability. After a thorough review of the literature, the researchers adopted a simple cost-effective technique of AC joint reconstruction for acute ACJI requiring surgery.MethodsThis was a prospective single-center study conducted between April 2017 and April 2018. For patients with acute ACJI more than Rockwood grade 3, the researchers performed open coracoclavicular ligament reconstruction using synthetic sutures along with an Endobutton and a figure of 8 button plate. This was followed by AC ligament repair augmenting it with temporary percutaneous AC K-wires. Clinical outcomes were evaluated using the Constant Murley shoulder score.ResultsSeventeen patients underwent surgery. The immediate postoperative radiograph showed an anatomical reduction of the AC joint dislocation in all patients. During follow-up, one patient developed subluxation but was asymptomatic. The mean follow-up period was 30 months (range, 24–35 months). The mean Constant score at 24 months was 95. No AC joint degeneration was noted in follow-up X-rays. The follow-up X-rays showed significant infra-clavicular calcification in 11 of the 17 patients, which was an evidence of a healed coracoclavicular ligament post-surgery.ConclusionsThis study presents a simple cost-effective technique with a short learning curve for anatomic reconstruction of acute ACJI. The preliminary results have been very encouraging.

Relationship between shoulder ultrasound findings and disease activity in patients with rheumatoid arthritis: A pilot study.

Objectives The aim of this study was to investigate whether shoulder ultrasound (US) findings were associated with disease activity and pain level in rheumatoid arthritis (RA) patients.Patients and methods Between April 2019 and November 2019, a total of 60 shoulders of 30 female patients with RA (mean age: 53.8±12.0 years; range, 30 to 65 years) were included. The patients were questioned about shoulder pain and their Disease Activity Score-28 (DAS28) was estimated. After clinical examination with shoulder impingement tests, both shoulders were evaluated by US.Results Of 60 shoulders examined by shoulder US, the most common shoulder pathology was supraspinatus tendinopathy (n=33, 55%). The prevalence of subdeltoid bursitis on US was significantly higher in the group with moderate disease activity, compared to the group with low disease activity (p<0.05). There were no significant differences in the physical examination findings of patients with low and moderate disease activity. In terms of US findings, subscapularis tendinopathy, glenohumeral joint and acromioclavicular joint degeneration, and subacromial bursitis were more common in shoulders with a history of pain, compared to non-painful shoulders.Conclusion Shoulder US may be useful for demonstrating shoulder involvement in patients with RA, independent of the presence of shoulder pain.

Factors Affecting Prolonged Postoperative Pain and Analgesic Use After Arthroscopic Full-Thickness Rotator Cuff Repair.

Background:Postoperative pain and analgesic use after arthroscopic rotator cuff repair remain important issues that affect rehabilitation and overall outcomes.Purpose:To evaluate the pre- and intraoperative factors that may cause prolonged duration of postoperative pain and analgesic use.Study Design:Case-control study; Level of evidence, 3.Methods:We included 443 patients who underwent arthroscopic rotator cuff repair and subacromial decompression. Visual analog scale (VAS) scores for pain were obtained preoperatively and at 30 and 90 days postoperatively. Patients were divided into a group who had prolonged postoperative pain (duration ≥1 and <3 months; n = 86 patients) and a group with nonprolonged pain (duration <1 month; n = 357 patients). The following factors were compared between groups: age, sex, body mass index, repair technique, tear size, retraction amount, repair tension, tendon degeneration, preoperative pseudoparesis, symptom duration, application of microfracture to the rotator cuff footprint for marrow stimulation, smoking, degree of fatty degeneration, preoperative narcotic analgesic use, diabetes, acromioclavicular joint degeneration, and preoperative Douleur Neuropathique 4 (DN4) and American Shoulder and Elbow Society (ASES) scores.Results:Significant differences were seen between the prolonged and nonprolonged groups regarding the median duration of pain (54 vs 27 days, respectively; P < .001) and analgesic use (42 vs 28 days, respectively; P < .001). Significant differences were noted between the groups for symptom duration (P = .007), smoking status (P = .001), degree of fatty degeneration (P = .009), preoperative narcotic analgesic use (P < .001), preoperative DN4 and ASES scores, 30-day VAS score (P < .001), duration of opioid and nonopioid analgesic use (P < .001), tear size (P = .026), and retraction stage (P = .032). Tear size (P = .009), retraction amount (P = .005), preoperative narcotic analgesic use (P < .001), degree of fatty degeneration (P < .001), and preoperative DN4 score (P = .024) were factors independently associated with prolonged postoperative pain and analgesic use.Conclusion:Patients with larger size tears, retracted tendons, preoperative use of narcotic analgesics, higher tensioned tendon after repair, and Goutallier grade 3 or 4 fatty degeneration faced an increased risk of prolonged postoperative pain and analgesic use after arthroscopic rotator cuff repair. These factors might be mitigated by psychosocial support; gentle, controlled, and individualized postoperative rehabilitation approaches; detailed preoperative evaluation; and closer follow-up of patients who are treated operatively.

POS1269 THE UTILITY OF ULTRASOUND TO PREDICT PATIENT OUTCOMES IN SHOULDER PAIN: A PROSPECTIVE OBSERVATIONAL STUDY OF 500 PATIENTS

Background:Shoulder pain is common and persistent, with a large socioeconomic burden. Ultrasound (US) scans are used for diagnosing and managing shoulder pain, but the extent to which it informs management and improves outcomes is unknown. A recent retrospective study identified groups with different patterns of US pathologies.Objectives:To confirm the existence of US-based groups of shoulder pain and determine if US-detected pathology (grouped or individual) predicts outcomes in the context of usual care. Response to local steroid injection was also evaluated.Methods:This was a 6 month, prospective, single centred, community based, observational cohort study. Inclusion: shoulder pain, ≥18 years, first shoulder US. Exclusion: shoulder surgery, inflammatory arthritis, steroid/physiotherapy in prior 6 weeks. Standardised reporting for 10 US pathologies was employed. Latent class analysis (LCA) identified pathology-based groups. Multiple linear regression analysis explored associations between baseline pathologies, subsequent treatment and 6-month Shoulder Pain and Disability Index (SPADI). Growth mixture modelling (GMM) identified groups with common trajectories of change.Results:Of 500 patients (mean age 53.6; 52% female), 330 completed follow-up. LCA identified 4 groups: bursitis without acromioclavicular joint degeneration (ACJD) (group 1), bursitis with ACJD (group 2), rotator cuff tear (group 3), no bursitis/tear (group 4). SPADI was higher at baseline for tears (55.1 vs. 49.7-51.3) (overall p=0.005), but groups did not differ at 6 months (p=0.379) (Table 1). No individual pathologies predicted 6-month outcomes. Response to baseline injection at week 2 did not differ between groups (p=0.423). GMM found 4 trajectories; the majority of patients followed trajectory 1 (little change), irrespective of US pathology group (79%, 77%, 87%, 70% of US groups 1-4 respectively) (Figure 1).Conclusion:This is the largest prospective study involving US of symptomatic shoulders, and the first to investigate groups with distinct patterns of US pathologies in predicting outcome. US-based classification of pathology (as groups or individually) did not predict 6-month outcomes with current treatments and there were no differences in short-term response to steroids between groups. The role of routine diagnostic US for shoulder pain needs consideration; it may be useful if evidence-based therapies for specific pathologies are established.Table 1.Predictors of SPADI score at 6 monthsBaseline characteristicCoefficient* (95% CI), p-valuePathology group:Bursitis w/o ACJ degeneration (group 1)ReferenceBursitis with ACJ degeneration (group 2)0.08 (-5.15, 5.32), p=0.975RC tear (group 3)5.01 (-1.48, 11.50), p=0.130No bursitis, no RC tear (group 4)1.98 (-4.00, 7.96), p=0.516Injection at scan4.87 (0.40, 9.34), p=0.033Age, years-0.01 (-0.17, 0.15), p=0.898Female-1.51 (-5.42, 2.40), p=0.448Symptom duration, months0.00 (-0.04, 0.05), p=0.879Uses arms to rise from chair2.65 (-1.50, 6.81), p=0.210Physiotherapy before baseline-0.23 (-4.78, 4.31), p=0.9201 injection before baseline2.35 (-2.87, 7.56), p=0.377≥2 injections before baseline6.53 (-2.50, 15.57), p=0.156Total SPADI0.62 (0.35, 0.89), p&lt;0.001Shoulder activity score-0.59 (-1.15, -0.04), p=0.037P-SEQ score-0.20 (-0.46, 0.07), p=0.141Brief IPQ score0.19 (-0.16, 0.54), p=0.298HADS score0.01 (-0.38, 0.41), p=0.947Constant**35.44 (29.50, 41.38), p&lt;0.001*Interpreted as unit difference in Rasch-transformed SPADI score per 1 additional unit of the independent variable **Estimated SPADI at 26 weeks in patients in the reference category for all categorical variables and with mean values for continuous covariates. ACJ=acromioclavicular joint; HADS=hospital anxiety and depression scale; IPQ=illness perception questionnaire; P-SEQ=pain self-efficacy questionnaire; RC=rotator cuff; SPADI=shoulder pain and disability indexFigure 1.Trajectories of total SPADI over time by the pathology groups found and response to injectionsAcknowledgements:This research was funded by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC) and by a NIHR Doctoral Research Fellowship (GT; DRF-2016-09-159). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This study was also part-funded through the Arthritis Research UK Leeds Experimental Osteoarthritis Treatment Centre (20083).Disclosure of Interests:None declared

Magnetic Resonance Arthrography in Rugby Players Undergoing Shoulder Stabilization for Glenohumeral Instability: Professionals Have Higher Frequencies of More Pathologies

PurposeTo quantify the magnetic resonance arthrography (MRA) findings in rugby players during preoperative workup for anterior surgical stabilization for glenohumeral instability.MethodsAll patients who underwent glenohumeral instability surgery in our institution between 2008 and 2018 were considered for inclusion. Rugby players were identified using the patient’s medical notes, with subsequent identification of all professional players. All rugby player’s preoperative MRA findings were recorded and analyzed.ResultsOverall, 267 rugby players were included, 261 of whom were male (97.8%), with a mean age of 22.7 years (range 13-55 years). There were 58 professional rugby players (21.7%). The mean number of pathologies in nonprofessional rugby players was 5.0 pathologies versus 6.2 pathologies in the professional rugby players, with a significant difference in nonprofessional rugby players with up to 3 pathologies versus professional rugby players (26.3% vs 10.3%, P = .01). Professional rugby players had a statistically significant increased incidence of bicipital tendon lesions (25.9% vs 13.9%, P = .009), acromioclavicular joint degeneration (60.3% vs 42.1%, P = .016), glenohumeral bone loss (87.9% vs 69.9%, P = .006), and degenerative changes (67.2% vs 44.0%, P = .002) on their MRAs.ConclusionsRugby players undergoing surgical stabilization for glenohumeral instability often have a significant number of pathologies identified on MRA at the time of surgery. Professional rugby players showed concerningly greater frequencies of early degenerative changes when compared with nonprofessional rugby players.Level of EvidenceIII; Retrospective Cohort Study

Impact of 30 years' high-level rock climbing on the shoulder: an magnetic resonance imaging study of 31 climbers.

Rock climbers are particularly susceptible to shoulder injuries due to repetitive upper-limb movements on vertical or overhanging terrain. However, the long-term effects of prolonged climbing on the shoulder joints are still unknown. The purpose of this study was to analyze the prevalence of pain and degenerative changes in the shoulder joints after high-level rock climbing over at least 25 years. We hypothesized that specific climber-associated patterns of degeneration would be found. Thirty-one adult male high-level rock climbers were compared to an age- and sex-matched control group of 31 nonclimbers. All participants underwent a detailed interview, standardized clinical examination, and bilateral (climbers) or unilateral (nonclimbers, dominant side) magnetic resonance imaging (MRI) scans. Clinical and MRI findings of the groups were compared. The lifetime prevalence of shoulder pain in the rock climbers was 77%. The rock climbers had significantly more abnormalities in the labrum (82% vs. 52%; P = .002), long biceps tendon (53% vs. 23%; P = .006), and cartilage (28% vs. 3%; P = .005). These increased changes positively correlated with climbing intensity. There were no differences between the 2 groups with respect to rotator cuff tendon pathology (68% vs. 58%; P = .331) and acromioclavicular joint degeneration (88% vs. 90%; P = .713). Despite the increased degenerative changes in the rock climbers, their Constant score (CS) was still better than that of the nonclimbers (CS 94, interquartile range [IQR] 92-97, vs. CS 93, IQR 91-95; P = .019). Prolonged high-level rock climbing leads to a high prevalence of shoulder pain and increased degenerative changes to the labrum, long biceps tendon, and cartilage. However, it is not related to any restriction in shoulder function.

The Ultrasonographic Features of Shoulder Pain Patients in a Tertiary Hospital in South China.

Methods Patients with shoulder pain were recruited in an outpatient rehabilitation clinic at the Third Affiliated Hospital of Sun Yat-Sen University from January 1, 2017, to June 30, 2018. These shoulder pain patients with or without limitation in joint movement can be included in the study. All of them received musculoskeletal ultrasound scanning. Demographic and imaging data including age, gender, duration of shoulder pain, pain side, and pathologies found by musculoskeletal ultrasound imaging were collected and analyzed. Patients were divided into three groups: <45 years (young group), between 45 and 60 years (middle-aged group), and >60 years (elderly group). The rates of various shoulder pathologies were evaluated and compared between the groups. Results This study recruited a total of 346 patients with shoulder pain. There were more female (62.1%) than male patients (37.9%), with the largest number of patients in the 45-60 years of age group (40.5%). Forty-eight percent of patients had shoulder pain within a period of 3 months. A total of 380 shoulders were assessed using musculoskeletal ultrasound imaging. The occurrence rate of subacromial disorder (83.8%) was the highest. The rate of supraspinatus tendinopathy, acromioclavicular joint degeneration, and adhesive shoulder capsulitis varied significantly between age groups (P < 0.05). The rate of acromioclavicular joint degeneration was the highest in the elderly group followed by the middle-aged and young groups (P < 0.0167). The rate of supraspinatus tendinopathy and adhesive capsulitis in the middle-aged and elderly groups was significantly higher than that in the young group (P < 0.0167). Conclusions Musculoskeletal ultrasound can be a useful imaging tool in making an accurate diagnosis of shoulder pain. The occurrence rates of different shoulder pain pathologies in all age groups were thoroughly calculated in this study. More female and more subcoracoid disorder patients than western countries are attributed to repetitive lifting in daily life and work in this study. Correlations between these pathologies and their associated images can be a solid foundation for the development of artificial intelligence in diagnosing the cause of shoulder pain.

Sonographic Predictors in Patients with Hemiplegic Shoulder Pain: A Cross-Sectional Study

ObjectivesTo evaluate the sonographic findings of soft tissues more comprehensively, to investigate the relationship between sonographic pathologies and clinical features, and to determine the predicted factors that may interfere with the most common sonographic findings in patients with hemplegic shoulder pain (HSP) . MethodsSixty-four consecutive stroke patients with HSP admitted to inpatient clinic were included in this cross-sectional study. Demographic, clinical, and sonographic findings were recorded. Patients were assigned to poor or good motor function groups according to the Brunnstrom motor recovery (BMR) stages. ResultsThere were abnormal sonographic findings in 63 patients (98.4%). A significant reverse correlation was found between the sonographic grading and functional independence measure (p=0.005) and a positive correlation with energy level (p=0.044). The main risk factors were age for acromioclavicular joint degeneration, BMR stage for glenohumeral joint subluxation, subacromial-subdeltoid bursitis for partial-thickness rotator cuff tear, and Pittsburgh Sleep Quality Index for long head of the biceps tenosynovitis. ConclusionAge, motor recovery, subacromial-subdeltoid bursitis, and sleep quality were the strongest predictors of different sonographic findings in HSP patients. Functional capacity and energy level are negatively affected by an increased number of abnormal sonographic findings. Therefore, sonographic evaluation of shoulder soft tissue lesions eventually might provide a more constructive rehabilitation approach to achieve optimal outcomes, particularly in elderly patients with poor motor function and sleep quality.

Do intra-articular pathologies accompanying symptomatic acromioclavicular joint degeneration vary across age groups?

This study aims to evaluate the accompanying intra-articular pathologies in patients who underwent arthroscopic distal clavicle resection (DCR) for symptomatic acromioclavicular (AC) joint degeneration based on age groups and to reveal which additional pathologies should be considered across different age groups during physical examination of patients suspected of AC joint degeneration. The study included 156 patients (55 males, 101 females; mean age 57.2±10.0 years; range, 35 to 80 years) who underwent arthroscopic DCR between January 2006 and December 2017 and had at least one clinical positive test for AC joint degeneration during the preoperative physical examination. The patients were divided into three groups as those aged <50 years (group 1), between 50-65 years (group 2), and >65 years (group 3). The concomitant intra-articular pathologies were evaluated across different age groups and compared between the groups. Concomitant intra-articular pathologies were detected in 117 (75%) of a total of 156 patients. Additional pathology rate increased with increasing age (p=0.002). More than one concomitant intra-articular pathologies were detected in 37 patients (23.7%). This rate increased with increasing age (p=0.002). The number of patients with superior labrum anterior posterior (SLAP) lesion as the only additional pathology was 33 (21.2%). This rate decreased with increasing age (p=0.015). In group 1, the rate of concomitant SLAP lesion was 44.1%. The high incidence of intra-articular pathologies accompanying symptomatic AC joint degeneration raises the importance of careful physical examination, detailed imaging, and arthroscopic surgery to obtain good results in patients scheduled for DCR. The frequency of AC joint degeneration and concomitant SLAP lesions, particularly in younger patients, should be considered during clinical examinations.

MRI on rotator cuff and shoulder joint pathologies

The shoulder joint is an elegant anatomic structure formed by the humerus, clavicle and the scapula; its range of motion exceeds all other joints, yet under most circumstances, it is stable. The shoulder complex comprises of three joints namely the sternoclavicular, acromioclavicular, and glenohumeral joints. The factors which aid on to this progress including age, occupation, trauma, acromion type, slope and position, acromioclavicular joint degeneration, proximal migration of the humeral head, bony spurs compressing on the tendons. The most commonly affected rotator cuff tendon being the supraspinatus. The tears are further classified as complete/full thickness and partial tears depending on the involvement of the whole or part of the tendon. Being one of the most important stabiliser of the shoulder joint, rotator cuff pathologies can cause major joint dysfunction, like stiffness, restricted/painful joint movements even to the extent of restricting daily activities our study aims to describe MRI characteristics of shoulder and rotator cuff pathologies. And to describe the distribution of rotator cuff pathologies in terms of age, gender, symptomatology and secondary changes/sequelae study, the rotator cuff abnormalities were common in the sixth and seventh decades of life. The incidence of predisposing factors for rotator cuff tears was also found to increase with age as seen in our study, type II and III acromions, acromioclavicular joint arthropathies, osteophytosis/spurs are common in the sixth and seventh decades of life. We noticed in our patients that pain followed by stiffness resulting in reduced range of movement across the shoulder joint is very common. MRI imaging was useful in effectively ruling out the other causes of shoulder pain, overall features conclude that magnetic resonance imaging is very useful in depicting rotator cuff disease diagnosis along with the predisposing factors like the acromion type and orientation, reduction in coracohumeral distance, reduced acromioclavicular distance and other associated features like effusion, bursitis and bone changes. Further research with a larger sample size for a longer study period is suggested to draw broader conclusions and to strengthen the findings of the present study.

Incidence of accompanying intraarticular lesions in patients treated with arthtroscopic surgery for acromioclavicular degeneration

Purpose:Acromioclavicular joint degeneration is a common disease that causes antero-superior shoulder pain. İn physical examination regional pain at acromioclavicular joint can occur with cross-body adduction or internal rotation. Surgery should be planned if the patient has not relieved with minimum 6 months of nonoperative treatment, and has no infection or instability. In this study, we aimed the incidence of accompanying intraarticular conditions in patients applied arthroscopic distal clavicula resection.Method:Documents and intraoperative videos of 128 patients undergone artroscopic distal clavicula resection between 2005-2014 has been analyzed restospectively. The incidence of other intraarticular conditions accompanying acromioclavicular arthritis.Results:The average of the age of the 128 patients was 56,9(18-70). 43 of them were male (%33,6) and 85 were female (66,4). 3 (%2,3) patients had anterior instability and treated with Bankart repairment. 50 patients had Superior Labrum Anterior Posterior (SLAP) lesion (39,1) (SLAP1:12, SLAP2:36, SLAP4:1, SLAP5:2). 37 of the were treated with SLAP repairment. Bufford complex had been spotted in one patient. 19 (%14,8) patients had accompanying biceps lesions. 2 patients had biceps brachii long head rupture. 10 patients had been treated with biceps tenotomy, 3 atients had been treated with biceps tenodesis. 7 (%5,5) patients had accompanying subscapularis lesion and treated with repairment. 58(%45,3) patients had accompanying rotator cuff tears (12 partial, 45 total, 1 massive) and48 treated with repairment. In conclusion; 100 (%78,1) 128 patients had accompanying intraarticular lesions needed surgical interventionOutcomes:The most common complication of distal clavicle resection is pain as a result of insufficient resection and instability due to aggressive resection. İndications sould be chosen carefully to avoid complications and for patient satisfaction. After evaluation of the accompanying lesions that require operative treatment, acromioclavicular lesion should be evaluated again. In our study accompanying lesions can be unnoticed using open surgery, as a consequence incomplete treatment and low patien satisfaction. In radographic imaging, if acromioclavicular arthritis is not compatible with clinical symptoms it is essential to evaluate accompanying lesions, on the other hand it should not be forgotten that acromioclavicular arthritis can imitate other lesions

Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

Background and purpose — Shoulder impingement syndrome is common, but treatment is controversial. Arthroscopic acromioplasty is popular even though its efficacy is unknown. In this study, we analyzed stage-II shoulder impingement patients in subgroups to identify those who would benefit from the operation.Patients and methods — In a previous randomized study, 140 patients were either treated with a supervised exercise program or with arthroscopic acromioplasty followed by a similar exercise program. The patients were followed up at 2 and 5 years after randomization. Self-reported pain was used as the primary outcome measure.Results — Both treatment groups had less pain at 2 and 5 years, and this was similar in both groups. Duration of symptoms, marital status (single), long periods of sick leave, and lack of professional education appeared to increase the risk of persistent pain despite the treatment. Patients with impingement with radiological acromioclavicular (AC) joint degeneration also had more pain. The patients in the exercise group who later wanted operative treatment and had it did not get better after the operation.Interpretation — The natural course probably plays a substantial role in the outcome. Based on our findings, it is difficult to recommend arthroscopic acromioplasty for any specific subgroup. Regarding operative treatment, however, a concomitant AC joint resection might be recommended if there are signs of AC joint degeneration. Even more challenging for the development of a treatment algorithm is the finding that patients who do not recover after nonoperative treatment should not be operated either.

Is sport practice a risk factor for shoulder injuries in tetraplegic individuals?

A retrospective cohort. To report the incidence rates of shoulder injuries diagnosed with magnetic resonance imaging (MRI) in tetraplegic athletes and sedentary tetraplegic individuals. To evaluate whether sport practice increases the risk of shoulder injuries in tetraplegic individuals. Campinas, Sao Paulo, Brazil. Ten tetraplegic athletes with traumatic spinal cord injury were selected among quad rugby athletes and had both the shoulders evaluated by MRI. They were compared with 10 sedentary tetraplegic individuals who were submitted to the same radiological protocol. All athletes were male with a mean age of 32.1 years (range 25-44 years, s.d.=6.44). Time since injury ranged from 6 to 17 years, with a mean value of 9.7 years and s.d. of 3.1 years. All sedentary individuals were male with a mean age of 35.9 years (range 22-47 years, s.d.=8.36). Statistical analysis showed a protective effect of sport in the development of shoulder injuries, with a weak correlation for infraspinatus and subscapularis tendinopathy (P=0.09 and P=0.08, respectively) and muscle atrophy (P=0.08). There was a strong correlation for acromioclavicular joint (ACJ) and labrum injuries (P=0.04), with sedentary individuals at a higher risk for these injuries. Tetraplegic athletes and sedentary individuals have a high incidence of supraspinatus tendinosis, bursitis and ACJ degeneration. Statistical analysis showed that there is a possible protective effect of sport in the development of shoulder injuries. Weak evidence was encountered for infraspinatus and subscapularis tendinopathy and muscle atrophy (P=0.09, P=0.08 and P=0.08, respectively). Strong evidence with P=0.04 suggests that sedentary tetraplegic individuals are at a greater risk for ACJ and labrum injuries.