Hawkins-Kennedy Test Research Articles

Biomechanical risk factors and subacromial pain provocation in healthy manufacturing workers

Objectives. Work-related musculoskeletal disorders (MSDs) of the shoulder may manifest subclinically. By combining risk assessment and clinical instruments, it may be advisable to recognize workers who may develop more complex MSDs early. This study aimed to evaluate the relationship between biomechanical risk factors and subacromial pain provocation in healthy manufacturing workers. Methods. A cross-sectional descriptive observational study was carried out with workers in the furniture manufacturing industry. The occupational repetitive action (OCRA) checklist was applied to detect risk factors and three clinical tests used to detect subacromial tissue reactivity: the supraspinatus test, the painful arc test and the Hawkins–Kennedy test. Results. The positivity of the clinical tests is higher in the supraspinatus test, followed by the Hawkins–Kennedy test, and lowest in the painful arc test, for both the right and left shoulders. No significant associations were found with the overall OCRA checklist index or specific biomechanical factors. Conclusion. The biomechanical risk factors and the provocation of subacromial pain reviewed in this study were not found to be related. Other physical tests that are more sensitive and adapted to workers at risk of developing musculoskeletal shoulder disorders should be explored.

Shoulder Impingement Syndrome, A Common Shoulder Disease: A Comprehensive Review

The shoulder joint is a flexible but unstable joint in the human body. Also, it has complex structures including coracoacromial arch, synovial bursa, head of femur and so on. Based on these traits, shoulder joints have a wide range of activity, but some lesions accompany with, especially some overhand motions like throwing baseball, swimming, lifting the weight above head repetitively. Diversification of pathogenic factors are significant traits of this kind of injury. In addition, lesions of shoulder impingement syndrome (SIS) can occur in multiple locations even happening at same time. Under normal conditions, this type of disease is often delimited by rotator cuff. Because of the complexity of this injury, different tests of diagnosis can be applied, including Hawkins-Kennedy test, Neer sign, Jobe test, Painful arc of motion. For treatment options, these can be divided into conservative treatment including conservative methods and surgical treatment like arthroscopic subacromial decompression (ASD). SIS causes shoulder pain to disrupt and reduce life’s quality of patients. Based on relevant research and literature, this article is designed to offer a general review of the above content.

Evaluation of Clinical Subacromial Impingement Test Positive Patients with Ultrasonographic Subacromial Impingement Test

Objective: Knowing which of the special clinical tests used in subacromial impingement syndrome is more successful in making the diagnosis is important for patient evaluation, determining if further examination is necessary, and arranging treatment. Utilizing sonographic impingement as a reference diagnostic technique, the study sought to evaluate how well clinical test results performed in diagnosing patients with subacromial impingement syndrome. Material and method: The study involved 42 patients with shoulder pain and at least one positive subacromial impingement test, including Neer, Hawkins, or Yocum tests. Dynamic sonographic compression of the tendon in the coracoacromial area was examined by abducting the shoulder. Dynamic sonographic compression findings were compared with clinical examination tests. Results: In 40.5% of the patients, the ultrasonographic impingement test was positive. Hawkins test was positive in 81% of patients, Neer test was positive in 69% of patients, and Yocum test was positive in 78.6% of patients. A significant relationship was found between the ultrasonographically evaluated subacromial impingement test and the Neer test, but no significant relationship was found with other special tests (Hawkins and Yocum test) (p = 0.02, p = 0.4, p = 0.12, respectively). Conclusion: We have demonstrated a significant relationship between the ultrasonographic finding of dynamic subacromial impingement and the Neer test, which is a non-invasive and device-independent physical examination test.

A cadaveric study of the posterior band of the inferior glenohumeral ligament of the shoulder and its dynamic behaviour in different arm positions.

The inferior glenohumeral ligament (IGHL) is composed of three parts: the anterior branch or band (AB), the axillary pouch and the posterior band (PB). The latter has rarely been studied. We aim to describe the PB of the IGHL and its dynamic behaviour in different arm positions. Twelve fresh cadaveric shoulders were used and the two bands (AB and PB) of the IGHL were dissected and isolated, taking away all muscle, ligaments and capsule. Characteristics of the bands were studied in five positions: maximum external rotation (ER1), abduction (ABD), internal rotation (IR), ABD external rotation (ER2) and anterior elevation-adduction-IR (Hawkins-Kennedy test position). Progressive and randomized sectioning of the bands and capsule with a scalpel was performed to study its impact on mobility and translation of the glenohumeral joint. The bands that tensioned first werein ER1, the AB at 97 ± 9° (80-110); in ER2, the AB at 81 ± 19° (30-100); in IR, the PB at 64 ± 9° (50-80); and in ABD, the PB at 87 ± 10° (70-105). Isolated sectioning of the AB had no effect on ABD, whilst isolated sectioning of the PB allowed greater ABD. In ER2, the AB limited anterior translation. After sectioning the AB, anterior translation remained limited by the PB, which wrapped around the humeral head and locked the joint by pressing the two joint surfaces tightly together. In Hawkins-Kennedy position anterior elevation-adduction-IR, the AB is the first constraint and the posterior translation was limited by the PB alone only in four cases. When the IGHL is isolated, ligament limitation of glenohumeral ABD seems to be uniquely dependent on the PB. In the Hawkins and Kennedy position, the AB is the first constraint. In the case of an isolated lesion to the AB, the PB participates in anterior stabilization of the shoulder by wrapping around the humeral head that cannot dislocate. These findings confirm the role of the PB in glenohumeral joint stability. Level IV.

Council of Experts: chronic shoulder pain as a multidisciplinary problem

Chronic shoulder pain (CSP) is a clinical syndrome associated with inflammatory and degenerative musculoskeletal changes, characterized by pain in the shoulder that persists for at least 3 months, arising or aggravated by functional activity in this area. The frequency of CSP in the modern population reaches 20–33%, it is one of the leading causes of severe suffering, disability and seeking for medical attention. The main causes of CSP are shoulder rotator impingement syndrome (subacromial impingement syndrome), calcific tendinitis, adhesive capsulitis, shoulder and acromioclavicular joint osteoarthritis. Accurate diagnosis of these diseases is necessary for the correct choice of treatment. Differential diagnosis is carried out using tests that evaluate the function of the shoulder joint and the rotator cuff muscles (Neer, Speed, Hawkins tests, etc.), as well as using instrumental methods (ultrasound, magnetic resonance tomography, X-ray). In CSP, it is necessary to exclude septic, oncological, visceral, systemic rheumatic and other diseases, as well as musculoskeletal pathology of the cervical spine, upper chest and back, which can cause pain in the shoulder region.Therapy for diseases that cause CSP should be personalized and complex, aimed at maximum pain control and restoration of function. For this purpose, non-steroidal anti-inflammatory drugs, local injection therapy with glucocorticoids, hyaluronic acid, and platelet-rich plasma are used. In some cases, muscle relaxants, antidepressants, anticonvulsants, local injections of botulinum toxin type A are indicated. Physiotherapy and medical rehabilitation methods play a fundamental role in the treatment of CSP.

A Modified Mason – Allen Suture Bridge for Musculotendinous Rotator Cuff Repair in Elderly Patient: A case report

Introduction: As geriatric patient remains active, high functional outcomes is expected, treating rotator cuff in geriatric patient is usual nowadays. But, compromised vascularity and healing potential of soft tissue in older patients contributes to high incidence of re-rupture. Factor could be improved for decreasing the possibility of re-rupture is the suture technique. Modified Mason-Allen technique provides better biomechanical strength which offer high fixation strength, minimal gap formation and tendon strangulation and mechanical stability until tendon healing. Case Presentation: A 62-year-old female evaluated for 1 year history of pain around her right shoulder with history of trauma 1 year prior. From the physical examination, she reported significant decrease passive and active range of movement of the shoulder, particularly on abduction which less than 90 degrees. Neer test was positive with positive on Job test and Hawkins test. MRI showed a picture of massive rotator cuff tear. Corticosteroid injection and physical therapy were performed but pain and functional limitation still persisted. We decided to perform arthroscopy. We found subscapularis longitudinal tear, LHBT tear, humeral head bone defect, subacromial bursitis and massive supraspinatus tear. We perform acromioplasty, bursectomy, subacromial decompression, subscapular repair, debridement of supraspinatus footprint and anchor placement as modified Mason-Allen suture bridge. Clinical Discussion: In order to prevent re-tears, tendon fixation to bone and footprint reconstruction are important. Trans osseous-equivalent (suture bridge) was giving better biomechanical properties for the repaired tendon. In Modified Mason- Allen techniques, combination of horizontal matrass as a rip stops and vertical simple sutures as main holding power. This suture bridge was giving a compressive mechanism for enthesis to footprint enhancing healing. Several advantages of Mason – Allen suture bridge are very strong tissue holding property, rip stop which prevent tendon pull-out and less possibility strangulation, impingement or irritation. Conclusion: Modified Mason – Allen technique provides better biomechanical strength and restoration of footprint which allow the repaired tendon to heal and decrease the incidence of re-rupture.

Diagnostic Value of Clinical Tests in Patients with Rotator Cuff Arthropathy

Relevance. There are a large number of clinical tests for the diagnosis of rotator cuff tendon injuries and their consequences. Timely collected anamnesis and a thorough clinical examination are the key to an accurate diagnosis and the choice of treatment tactics.
 Objective: to determine the diagnostic value of clinical tests in patients with rotator cuff arthropathy.
 Materials and Methods. Clinical examination and surgical treatment of 110 patients with pathology of the shoulder joint, who had limited or complete lack of movement in the shoulder joint. The study of clinical results was performed in 2 groups: group I (60 patients) with rotator cuff arthropathy and group II (50 patients) with osteonecrosis of the humeral head. All patients were examined according to a single standard (clinical, radiological, and MRI examination). The clinical examination was performed in the standard way with special tests: the Jobe test, the Neer test, the Full can test, the Patte test, the Lift-off test, and the Hawkins-Kennedy test.
 Results and Conclusions. As a result of the analysis of clinical research data in patients with rotator cuff arthropathy, it was established that the clinical picture was distinguished by the polymorphism of manifestations and was closely related to undiagnosed damage to the structures of the shoulder joint. In patients with rotator cuff arthropathy, the most informative tests were (1) the Lift-off test: sensitivity (95.45%), specificity (73.33%), accuracy (86.49%), positive predictive value (PVP) (84.00%) and negative predictive value (PVN) (91.67%), and (2) the Full can test: sensitivity (89.80%), specificity (72.50%), accuracy (82.02%), as well as PVP (80.00%) and PVN (85.29%). In patients with rotator cuff arthropathy, the pain syndrome remained in most cases, which increased the sensitivity of the Lift-off test to 95.45% and the Full can test to 89.80%. The least specific clinical tests in patients with rotator cuff arthropathy were the Patte test (63.83%) and the Hawkins-Kennedy test (58.82%). No clinical test is reliable enough to diagnose rotator cuff arthropathy or osteonecrosis.

The Applicability of Provocative Functional Tests in the Diagnosis of Rotator Cuff Muscle Injuries of the Best University Athletes.

Rotator cuff disease, external and internal impingement syndromes, low shoulder stability, various types of trauma, and overuse injuries are all related to sports activities. In order to check symptoms in patients with disability and shoulder pain, clinicians use different methods and diagnostic imaging assessment. The research is aimed at evaluating whether there is a difference between provocation function tests (PFT) and ultrasonographic (US) testing of muscles within the rotator cuff in elite collegiate athletes. Patients (n = 184) were recruited from university team sports selections and tested with a standardized US examination of the shoulder and five PFTs (Speed's test, Neer's test, Hawkins test, lift-off test, Yergason's test). Based on the VAS pain assessment scale, 60 subjects had some pain, which was taken for further processing in the work (124 subjects did not have the presence of pain and were excluded from further processing). The US examination was conducted using Voluson 730 apparatus, by a linear probe, with the frequency in the range of 6-12 MHz. The chi-square test showed significant differences between PFT and the occurrence of shoulder muscle tendinitis for the following variables: Speed's test and subscapularis tendinitis (p = 0.02) and Speed's test and infraspinatus tendinitis (p = 0.01); Neer test and biceps brachii caput longum tendinitis (p = 0.01), Neer test and supraspinatus tendinitis (p = 0.02) and Neer test and infraspinatus tendinitis (p = 0.01); lift-off test and subscapularis tendinitis (p = 0.05); and Yergason's test and biceps brachii caput longum tendinitis (p = 0.03) and Yergason's test and subscapitis tendinitis (p = 0.01). The greatest effect of differences was observed in Neer's test and biceps brachii caput longum tendinitis (φ = 0.60), while the other effects can be described as medium and small in most cases. It can be concluded that functional tests are good predictors of soft tissue changes in the muscles of the rotator cuff of the shoulder. Further monitoring and analysis are needed on a larger number of athletes.

Diagnostic Dilemma: Which Clinical Tests Are Most Accurate for Diagnosing Supraspinatus Muscle Tears and Tendinosis When Compared to Magnetic Resonance Imaging?

Background: The study aims to investigate the diagnostic accuracy of five clinical shoulder tests in the diagnosis of supraspinatus tears and tendinosis when compared to magnetic resonance imaging (MRI).Methods: A total of 116 shoulders of 106 consecutive patients who experienced shoulder pain were assessed for this cross-sectional diagnostic accuracy study. Patients were assessed with the most commonly used clinical shoulder tests, including the Jobe test (empty can), Neer test, drop arm test, Hawkins test, and full can test to identify supraspinatus tears and tendinosis. MRI examinations were performed on a 1.5 Tesla MRI system, and images were assessed by a blinded radiologist. The primary outcomes were to determine the sensitivity, specificity, and accuracy of the five clinical tests and to establish their correlation with MRI for supraspinatus tears and tendinosis.Results: The Hawkins test had a higher sensitivity and accuracy when diagnosing tears (sensitivity 89.66% [95% CI, 78.83-96.11] and accuracy 56.03% [95% CI, 46.51-65.23], respectively) and higher sensitivity in tendinosis (79.07% [95% CI, 63.96-89.96]). The drop arm test had a lower sensitivity but higher specificity in both tendinosis and tears (sensitivity 0% [95% CI, 0-8.22] and 12.07% [95% CI, 4.99-23.29], respectively, and specificity 87.67% [95% CI, 77.88-94.21] and 96.5% [95% CI, 88.09-99.58], respectively). The Neer test had a higher positive predictive value (PPV) of 37.21% in diagnosing tendinosis. When compared to the Hawkins test, the combination of the clinical tests had no statistically significant contribution to sensitivity and diagnostic accuracy.Conclusion: The Hawkins test had higher accuracy in diagnosing tears and was the most sensitive in diagnosing supraspinatus tendinosis and tears when compared to the MRI findings. The Neer test may also be another reliable tool for the diagnosis of tendinosis due to its higher PPV.

Diagnostic value of physical examination tests for supraspinatus tendon tears

To investigate the diagnostic value of 6 conventional physical examination tests for the diagnosis of supraspinatus tendon tears, and how well they could tell the difference between partial-and full-thickness tears. A total of 91 patients with different shoulder symptoms who received shoulder arthroscopic procedure were enrolled in the study from June 2017 to September 2020. The intraoperative findings were compared with the results of the preoperative physical examination of 6 clinical tests, including the Hug-up test, the Jobe test, the 0°abduction test, the drop arm test, the Neer test, and the Hawkins test, to determine the sensitivity, specificity, positive and negative predictive value, accuracy, positive and negative likelihood ratio of each test. By arthroscopy, a total of 44 full-thickness tears, 34 partial-thickness tears, and 13 intact supraspinatus tendons were found in all 91 cases. The Hug-up and the Jobe tests significantly correlated with the intraoperative findings. The sensitivity of the Hug-up test, the Jobe test, the 0° abduction test, the drop arm test, the Neer test, and the Hawkins test was 0.90, 0.79, 0.64, 0.42, 0.49, 0.24 respectively;the specificity was 0.61, 0.69, 0.54, 0.38, 0.31, 0.77;the positive predictive value was 0.93, 0.94, 0.89, 0.80, 0.81, 0.86;the negative predictive value was 0.50, 0.36, 0.20, 0.10, 0.09, 0.14;the accuracy was 0.86, 0.78, 0.63, 0.42, 0.46, 0.32;the positive likelihood ratio was 2.30, 2.58, 1.39, 0.69, 0.71, 1.06;and the negative likelihood ratio was 0.16, 0.30, 0.67, 1.50, 1.65, 0.98. The Jobe test and the Hug-up test are both effective at accurately diagnosing supraspinatus tendon tears, the Hug-up test detects supraspinatus tears with a high sensitivity, and similar specificity. The tests assessed in this study are not capable of distinguish between partial-and full thickness supraspinatus tendon tears.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

AAOS Appropriate Use Criteria: Management of Rotator Cuff Pathology.

Shoulder impingement syndrome in water polo players: muscle shortening manoeuvre controls pain intensity, recovers function and normalizes sonographic parameters.

To evaluate the effects of muscle shortening manoeuvre (MSM) by sonography (US) in professional water polo players with shoulder impingement syndrome (SIS). Twenty-four professional water polo players (mean age: 22.13 ± 3.34) with SIS were assigned to one of 2 different treatment interventions: Group (1) MSM: a series of fast accelerationsin the upward direction was applied to the upper limb that's connected to a spring through a metal plate with a ring. The ring was linked to a pulley system that was submitted to forces acting in the opposite direction (added mass). Group (2) Simple traction: the series of fast accelerations were performed without the springs. Pain intensity, Yocum and Hawkins tests for SIS, Neer's impingement sign, range of motion, muscle strength and shoulder US were assessed. The examination was performed before, immediately after and 30days after each treatment to study the US width of subacromial-subdeltoid bursa (SSB), thickness of supraspinatus (ST), long biceps tendons (LBT); hypoechoic halo of surrounding the long biceps (LBH) and subscapular tendons (STH); width of acromio-clavicular joint capsule (ACJ) and the distance between bone heads (ACD). Impingement sign (IS) was evaluated by dynamic examination. Immediately after treatment with MSM, pain was much reduced (p = 0.002); Yocum and Hawkins tests were decreased (p = 0.008, p = 0.031); Neer's impingement sign was negative; range of motion and muscle strength were increased. US showed that the following parameters were significantly reduced: SSB (p = 0.001), LBT (p = 0.014), LBH (p = 0.014), SSH (p = 0.002), ACJ (p = 0.004), ACD (p = 0.001). IS was no more detected. After 30days, the improvement of clinical and US findings was maintained. In the control group, after simple traction, no clinical amelioration of US parameters was found immediately after the procedure. These data show that MSM could be significantly and rapidly effective against pain and the loss of function due to shoulder impingement in water polo players.

Risk factors associated with subacromial pain in young athletes: A case control study.

Subacromial pain (SAP) is a common complaint of young athletes, independently of the sport engaged. The prevalence of SAP in some sports is up to 50%. The study was aimed to investigate some new factors possibly associated to subacromial pain in young athletes. The factors considered were the grade of tightness of the clavicular portion of the pectoralis major, dysfunction of the sternoclavicular joint, and serratus anterior and lower trapezius strength. This case-control study included 82 young athletes 9-15years, 41 with the symptoms of SAP and 41 controls. All participants self-reported whether they had subacromial pain. In addition, Hawkins-Kennedy Test was performed to all the participants to evaluate the subacromial pressure. Main outcome measures were the grade of tightness of the clavicular portion of the pectoralis major, dysfunction of the sternoclavicular joint, and serratus anterior and lower trapezius strength. The grade of tightness of the clavicular portion of the pectoralis major and the dysfunction of the sternoclavicular joint were measured with an inclinometer. Serratus anterior and lower trapezius strength were measured by a handheld dynamometer with external belt-fixation. The data were analyzed using t-test for independent samples, Mann-Whitney U test, contingency coefficients and a stepwise binary logistic regression. Significant statistical difference was observed in the grade of tightness of the clavicular portion of the pectoralis major and in the variable representing the physiological functioning of the sternoclavicular joint, between the cases and the controls. There was no significant difference in serratus anterior and lower trapezius strength between the cases and the controls. Logistic regressionanalysis showed that the variable representing the physiological functioning of the sternoclavicular joint and the grade of shortening of the clavicular portion of the pectoralis major were good predictors for presence of SAP. A strong association was determined between subacromial pain in young athletes, clavicular portion of pectoralis major tightness and the dysfunction of the sternoclavicular joint.

Supraspinatus tears: predictability of magnetic resonance imaging findings based on clinical examination

The shoulder physical examination is frequently performed to diagnose rotator cuff tears in clinical practice; however, there is insufficient evidence on which physical tests are efficient for shoulder impingements in primary care settings. The purposes of this study were (1) to analyze the accuracy of 8 clinical tests to diagnose supraspinatus tendon lesions and investigate whether the combination of these tests can improve the diagnostic values; (2) to assess which are the best positivity criteria for shoulder maneuvers-pain and/or weakness; and (3) to investigate the ability of these tests to distinguish between partial- and full-thickness tears. A total of 733 consecutive patients were prospectively evaluated by 4 shoulder surgeons in this multicenter diagnostic study from May 2017 to December 2018, and 8 clinical tests (empty-can, full-can test, drop arm, painful arc, Neer sign, Hawkins test, Patte test, and resisted external rotation) were compared with magnetic resonance imaging performed by blinded radiologists. We assessed the sensitivity, specificity, accuracy, positive and negative predictive values, and diagnostic odds ratio (DOR) for all tests. For overall supraspinatus tears, the empty-can test showed the highest sensitivity (0.81), the Patte test (positive for pain and weakness) and the drop-arm test showed the highest specificity (0.99 and 0.98, respectively), and the best combination was the Neer sign and the drop-arm test (DOR, 12.92). The positivity criteria for pain associated with weakness showed the highest performance, with DORs of 16.94 for the Patte test and 10.45 for the empty-can test. The Patte test and resisted external rotation, positive for pain and weakness, showed the highest ability to distinguish between full- and partial-thickness tears (DOR, 5.69 and 5.35, respectively). The shoulder maneuvers showed low negative predictive values; the highest value (0.58) was found with the empty-can test. (1) The clinical tests demonstrated excellent diagnostic values; the empty-can test had the highest sensitivity, whereas the drop-arm test and the Patte test had the highest specificity; and the best combination for detecting supraspinatus tears was the Neer sign and the drop-arm test. On the other hand, the physical examination findings showed limited values to rule out tears. (2) The best positivity criterion for shoulder maneuvers was pain associated with weakness. (3) The Patte test and resisted external rotation showed the highest ability to distinguish between full- and partial-thickness tears.

Is There Any Relationship between Frequency of Shoulder Impingement Steroid Injection and Diabetes Mellitus

Objective: Determine the relationship between frequency of steroid injections, duration between injections and diabetic status among shoulder impingement patients. Design: Retrospective. Setting: Outpatient. Participants: Charts of 412 patients presented with unilateral or bilateral shoulder pain diagnosed shoulder impingement syndrome and treated with steroid injections over a period of 01/2019-12/2020. Exclusion criteria: Those having manifestations suggesting of cervical radiculopathy, neuromuscular diseases, or shoulder trauma history. Interventions: Reviewing and collecting patient charts data; demographic data including occupation, body mass index, detailed medical history including DM history. Shoulder exam including impingement provocative tests; Hawkins test, Neer’s sign. Neck exam including Spurling test. Full neurological exam. Main outcome measures: Number of steroid injections received and duration between each injection over past 2 years. Laboratory results: Glycosylated hemoglobin (HgA1c), liver and kidney functions. MRI shoulder results if available. Results: Mean age 59.4 ± 11.123. All patients were right-handed, Male 37.1%, female 62.9%, Mean body mass index (BMI) 32.2 ± 8.2. Majority were manual workers (55.1%). significant relationship between shoulder impingement and sex and BMI. HgA1c <5.5 has the fewest patients (7.3%), highest number of patients with HgA1c 5.5-6.0. significant incidence of shoulder impingement with rising category of HgA1c with highest among HgA1c >7 (p=0.0001) with significant bilateral disease. Significant incidence of shoulder impingement (unilateral or bilateral among diabetics (HgA1c>6) compared to non- diabetics (p=0.011). Mean number of injections among diabetics 1.1756 ± 1.17283, non-diabetics 0.6391 ± 0.89051 (p=0.0001). No significant relation between DM and duration between injections (p=0.129). Conclusion: Steroid injection has proven efficacy in diabetic shoulder impingement patients. No studies discussed effect of DM on frequency of steroid injection. This study showed that presence of DM among shoulder impingement patients significantly increases the frequency of steroid injection but not affecting duration between injections.

Posterior Humeral Avulsion of the Glenohumeral Ligament: A Rare and Nonspecific Injury

Posterior Humeral Avulsion of the Glenohumeral Ligament: A Rare and Nonspecific Injury

Effectiveness and safety of fluoroscopy-guided acupuncture for subacromial impingement syndrome: A randomized, patient-assessor blind, parallel clinical trial

BackgroundSubacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain, and acupuncture treatment is widely used as treatment. However, no studies have examined image-guided acupuncture for SIS. This study evaluated the effectiveness and safety of low-dose X-ray guided acupuncture (LA) in patients with SIS. MethodsA total of 54 patients with SIS were randomly allocated to the LA group and the conventional acupuncture (CA) group. Two acupuncture treatment sessions were conducted for a week, and follow up was conducted after three weeks. The primary outcome was pain intensity measured by the visual analogue scale (VAS) during the Neer and Hawkins test. The incidence rate of shoulder impingement sign, the modified Constant-Murley score (CMS) and the Shoulder Pain and Disability Index (SPADI) were assessed as other outcomes. All indicators were assessed at baseline and after one week and three weeks. For safety evaluation, adverse events were monitored in both groups. ResultsThe change in pain during the Neer test after one week from baseline was more significant in the LA group than in the CA group (p=0.008). However, the Hawkins test did not show a difference between the two groups. The incidence rate of shoulder impingement sign and the changes in CMS and SPADI were not significantly different between the two groups at one week, but after three weeks, SPADI was more significantly improved in the LA group (p=0.024). No adverse events were related to this trial. ConclusionLA was more effective than CA in relieving pain and improving function in terms of VAS and SPADI. Trial registrationThis study was registered at the Clinical Research Information Service: KCT0002751.

Evaluation of the effectiveness of dexamethasone iontophoresis in patients with subacromial impingement syndrome

BackgroundSubacromial impingement syndrome is the most common shoulder disease in individuals. There is no study evaluating the effectiveness of steroid iontophoresis in subacromial impingement syndrome. We aimed to assess the effectiveness of dexamethasone iontophoresis as treatment for impingement syndrome with respect to pain and function. MethodsForty-six patients with subacromial impingement syndrome were recruited to the study and divided randomly into two groups (21 patients in iontophoresis group and 25 patients in control group). Demographic, clinical features and MRI findings of patients were recorded. Detailed physical examination of all patients were performed and Numerical rating scale (NRS) during rest and exercise, The Disabilities of the Arm, Shoulder and Hand (DASH) scores were recorded at baseline, week 2 and week 6. Both group received physiotherapy program for ten days. Additionally the patients in iontophoresis group recieved dexamethasone iontophoresis (1 mg dexamethasone per 1 g administered under the active electrode) with an intensity of 0.1–0.2 mA/cm2 galvanic current for ten days. ResultsNo significant difference was observed between the groups in terms of gender, job status, MRI findings, painful shoulder and pain duration. Baseline range of motion, Neer, Hawkins, Yocum and painful arc tests, numerical rating scale (NRS) and DASH scores were similar between groups. A significant improvement was found in terms of the NRS (resting and exercise) and DASH scores at week 2 and week 6 in both group (p < 0.001). A significant difference was found in terms of improvement NRS (resting) and DASH scores between baseline and week 6 in iontophoresis group (p = 0.007, p = 0.011 respectively). ConclusionsAdding dexamethasone iontophoresis to physiotherapy for patients with subacromial impingement syndrome seems to provide a better clinical and functional improvement.

Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests.

Clinical diagnosis of posterosuperior rotator cuff tears remains uncertain due to a lack of evidence-based consensus. This review aimed to compare the diagnostic accuracy of commonly used clinical tests for posterosuperior rotator cuff tears. The authors conducted an electronic literature search using Medline, Embase and the Cochrane library/Central, to identify original clinical studies reporting diagnostic accuracy of clinical tests to diagnose the presence of posterosuperior rotator cuff tears involving the infraspinatus, supraspinatus and/or teres minor. The electronic literature search returned 1981 records, of which 14 articles were eligible. Among 17 tests included in the systematic review, 6 tests were eligible for meta-analysis: drop arm sign, Jobe test, external rotation lag sign, Hawkins-Kennedy test, Neer test and painful arc abduction test. According to QUADAS-2 criteria, risk of bias was low in 1 study, moderate in 2 and high in 4. The highest pooled sensitivity was 0.77 (CI 0.67-0.85), for the Jobe test, while the lowest pooled sensitivity was 0.38 (CI 0.01-0.98), for the drop arm sign. The Jobe test had the best pooled sensitivity, while the drop arm sign had the best pooled specificity. As no single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option. More reliable clinical diagnosis of posterosuperior rotator cuff tears could reduce the reliance on magnetic resonance imaging or arthrography and their associated costs and waiting times. Level II.

Bilateral Shoulder Pain - Baseball

HISTORY: A 14-year-old right handed baseball player presents with two and a half years of insidious-onset bilateral shoulder pain. The pain is generalized in both shoulders, but worse anteriorly and in the right shoulder. He has continued to play year-round at an elite level, but he had to stop pitching due to pain. His shoulders “catch” and pain is exacerbated with rapid movements. PHYSICAL EXAM: Examination in clinic demonstrated tenderness of the anterior and posterior humeral head on the right and anterior humeral head on the left. Range of motion is limited in extension, internal rotation, and external rotation, and is full in flexion and abduction. Strength is full in all ranges of motion with pain in abduction, internal and external rotation. Hawkins, O’Brien’s, and Crank tests are positive for pain. He is distally neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1. Labral tear 2. Proximal Humeral Epiphysiolysis 3. Synovial Osteochondromatosis 4. Dysplasia Epiphysealis Hemimelica TEST AND RESULTS::Bilateral shoulder radiograph: Abnormal rounded ossific densities anterior to the right humeral head and metaphysis. Similar pattern of ossification anterior to the left humeral head,which is less well-defined than that seen in the right shoulder.Bilateral shoulder MR without contrast: Bilateral symmetric irregularly-shaped osteochondral fragments within the anterior glenohumeral joint spaces with evidence of erosions of the humeral head.Bilateral shoulder CT without contrast: Bony irregularity along the medial, proximal aspect of both humeri with clustered ossicles adjacent to the bony irregularity. No evidence of free intra-articular bodies. FINAL/WORKING DIAGNOSIS: Bilateral Synovial Osteochondromatosis of the Shoulders TREATMENT AND OUTCOMES: 1.Referred for a surgical consult, where non-operative treatment was recommended. 2.Started in physical therapy (PT). 3.Continued full participation in sports despite pain. 4.10-15% improvement after 3 months of PT. 5.Currently travelling for the winter baseball season and continuing PT at a distant site.