Secondary Impingement Syndrome Research Articles

Influence of Shoulder Position on Functional Control Ratio During Isokinetic Assessment.

One of the possible mechanisms leading to secondary impingement syndrome may be the strength imbalance of shoulder rotators which is known as functional control ratio (FCR). The FCR is a ratio dividing the eccentric peak torque of the external rotators by the concentric peak torque of the internal rotators. Previous studies have focused on the reproducibility and reliability of isokinetic assessment, but there is little information on the influence of variable shoulder positions on FCR. To compare shoulder FCR across 3 different shoulder abduction positions during isokinetic assessment. Cross-sectional study. Biomechanics laboratory. Thirty-one healthy young university students (age 22.35 [0.95]y, weight 60.52 [9.31]kg, height 168.23 [9.47]cm). The concentric peak torque of internal rotators and eccentric peak torque of external rotators of right shoulder were measured on an isokinetic dynamometer. Concentric peak torque of the internal rotators and eccentric peak torque of the external rotators, measured using an isokinetic dynamometer. The concentric peak torque of internal rotators was significantly lower at 120° shoulder abduction compared with other positions (P < .001). The FCR was significantly higher at 120° shoulder abduction than 90° (P = .002) or 60° (P < .001) shoulder abduction because of the lower concentric peak torque. No significant difference was found in the FCR between the other 2 shoulder positions (P = .14). Shoulder position variations may influence FCR because of weakness of the internal rotators. Rehabilitation and injury prevention training programs should specifically focus on strengthening the internal rotators at more elevated angles of shoulder abduction.

THE UTILIZATION OF MULLIGAN CONCEPT THORACIC SUSTAINED NATURAL APOPHYSEAL GLIDES ON PATIENTS CLASSIFIED WITH SECONDARY IMPINGEMENT SYNDROME: A MULTI-SITE CASE SERIES

Secondary impingement syndrome (SIS) is a common complaint in the sporting population particularly among athletes engaging in overhead activities. While symptoms may be present at the shoulder with patients complaining of SIS, spinal alignment or dysfunction can influence scapular positioning and overall shoulder girdle function. As an adjunct therapy to traditional interventions for SIS, thoracic high-velocity low-amplitude (HVLA) thrusts have been utilized and correlated with patient reported decreases in pain. Mulligan Concept (MC) thoracic sustained natural apophyseal glides (SNAGs) are an emerging treatment intervention utilized to treat patients with shoulder pain and dysfunction as the evidence supporting an interdependent relationship between the thoracic spine and the shoulder is growing. The purpose of this case series was to investigate the effects of one MC thoracic SNAG treatment session on subjects classified with SIS, while utilizing a classification-based treatment protocol. Seven subjects classified with SIS were treated utilizing a MC thoracic SNAG. The Numeric Rating Scale (NRS) was administered at initial evaluation, immediately following intervention, and at the 48-h follow-up to identify patient-reported pain during range of motion, manual strength testing, and special tests of the shoulder. Investigators collected the Shoulder Pain and Disability Index (SPADI) at initial evaluation and the 48-h follow-up to identify patient-reported dysfunction. Following one MC thoracic SNAG treatment (3 sets of 10 repetitions), minimal clinically important differences (MCIDs) were reported utilizing the NRS. A decrease in pain during active shoulder abduction (ABD) was detected immediately post-treatment, and the NRS change scores for resisted external rotation (RER) and active ABD were statistically different and clinically important at the 48-h follow-up. Based on the results of this case series, thoracic SNAGs may influence short-term pain levels and shoulder mobility in the included subjects with SIS and support the concept of regional interdependence (RI) between the thoracic spine and glenohumeral joint. Continued exploration into the proposed benefits of the MC thoracic SNAG treatment as an adjunct therapy when treating patients complaining of SIS is warranted. 4 (Case Series).

Longitudinal Supraspinatus Tear Associated with Antegrade Humeral Intramedullary Nailing: A Case Report and Literature Review with Focus Placed on Nail Entry Point

Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegr- ade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decom-pression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and ‘snapping’, especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a lon- gitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.(Clin Shoulder Elbow 2015;18(1):47-51)Key Words: Rotator cuff; Complications; Intramedullary nailing; Arthroscopy

Effects of diagonal shoulder training in a closed kinematic chain for secondary impingement syndrome: a case study.

[Purpose] This study examined the effects of diagonal shoulder training on an individual with secondary impingement due to scapular dyskinesis. [Subject] A 54 year-old female with secondary impingement participated in this study. [Methods] The patient performed diagonal shoulder training in 4-point kneeling, 3 times per day for 20 minutes over a period of 6 weeks. Evaluations of shoulder pain, range of motion, upper trapezius/lower serratus anterior ratio, and impingement were performed before training and at 2, 4, and 6 weeks. [Results] The patient’s parameters improved gradually. All parameters returned to normal ranges at 4 weeks. [Conclusion] Diagonal shoulder training is effective for improving dysfunction in individuals with secondary impingement. In addition, this training should be applied for more than 4 weeks.

Muscular activation patterns in swimmers with asymptomatic shoulder joint instability

PurposeThe aim of this study was to investigate the (electromyographic) EMG patterns of the shoulder muscles in asymptomatic swimmers with AGI – atraumatic glenohumeral instability. AGI, one of the most common shoulder disorders in athletes who perform overhead activities, occurs especially among swimmers. AGI usually provokes shoulder pain and secondary impingement syndrome, which might alter glenohumeral and scapular kinematics and change the activity of the shoulder muscles. Alternatively, pain or functional activities might affect EMG patterns in individuals with AGI.MethodsEight swimmers with AGI and eight healthy swimmers took part in this cross-sectional study. Bilateral and simultaneous shoulder elevations in the scapular plane toward three different target distances were investigated, and the shoulder kinematics and EMG activities of the glenohumeral and scapulothoracic muscles were also collected. Results. No differences in the EMG patterns were found between swimmers with and without AGI in terms of the rate of EMG rise and magnitude.ResultsNo differences in the EMG patterns were found between swimmers with and without AGI in terms of the rate of EMG rise and magnitude.ConclusionsShoulder instability does not necessarily affect the modulation of the shoulder muscles in swimmers with AGI. Others factors such as laxity in the capsular structures and ligaments may be one of the primary reasons for pain and instability in these athletes.

Supraspinatus tendon US morphology in basketball players: correlation with main pathologic models of secondary impingement syndrome in young overhead athletes. Preliminary report

The purpose of this study was to investigate supraspinatus tendon sonographic morphology in a population of young overhead athletes in correlation with main pathologic models of secondary shoulder impingement syndrome. Between April and May 2004, 20 subjects (ten professional basketball players and ten non-athlete controls of the same age, weight and height ranges) underwent bilateral, standardised, sonographic sholulder examination to evaluate supraspinatus echotexture, supraspinatus and subacromial bursa thickness, subacromial space width (cutoff of 7 mm) and dynamic anterior impingement beneath the acromial margin. All subjects were right handed. No symptomatic controls were found. Four players showed signs and symptoms of right atraumatic shoulder instability (two cases) or supraspinatus impingement with anterior pain (one right and one left shoulder). Subacromial space width was reduced in five right-dominant players' shoulders (three symptomatic and two asymptomatic) versus zero controls (p<0.05) and in eight players' shoulders versus zero controls on total shoulders (p<0.05). No other significant differences were observed between the two groups in sonographic parameters considered. Despite the study limitations, ultrasonography (US) is able to detect subacromial space narrowing in young overhead athletes as early shoulder impingement sign, according to the continuum impingement-instability pathologic model.

Application of tape at the shoulder joint: an effective therapeutic modality for the treatment of impingement syndrome?

Shoulder taping is commonly used in the clinical setting as an adjunct to other physiotherapy modalities when treating secondary impingement syndrome. However, the mechanisms by which tape may produce an effect at the shoulder are still under debate. The objectives of this review are to elucidate the effects of taping at the shoulder upon proprioception, muscle recruitment, pain and functional recovery at this joint. A search of the relevant databases was undertaken and six studies were identified as relevant. The heterogeneity of these studies and the conflicting outcomes obtained highlight the need for further research into the effectiveness of the use of tape as a treatment modality for secondary impingement syndrome at the shoulder.

Open capsular shift for multi directional shoulder instability.

We evaluated the outcome of open antero-inferior capsular shift in 17 patients with multidirectional instability of the shoulder who failed to respond to conservative treatment. Six shoulders presented with secondary impingement syndrome and 11 with involuntary instability. The mean duration of follow-up was 39 months (range 7-89 months). Based on the Rowe and Constant scores and the 12-item questionnaire of Dawson, the results were rated excellent in 14 patients, fair in 2 and poor in 1. All but 2 patients were satisfied with the results, although 6 patients experienced some residual pain, and 4 suffered minor instability. There were no neurovascular complications, infections or symptomatic posterior instability. Open antero-inferior capsular shift yields promising short-term to medium-term results in multidirectional, involuntary instability of the shoulder.

Anterior Femoroacetabular Impingement After Periacetabular Osteotomy

As experience with the Bernese periacetabular osteotomy has grown, an unexpected observation in a group of patients has alerted the authors to the risk of a secondary impingement syndrome that may occur some time after the periacetabular osteotomy. This possibly may explain residual pain and limited range of motion in a larger group of patients. The impingement is produced by abutment of the femoral head or head to neck junction on the anterior rim of the properly aligned acetabulum. The symptoms are those of restricted flexion, and limited or absent internal rotation in flexion, with variable groin pain. Magnetic resonance imaging studies may reveal acetabular labral disease and adjacent cartilage damage associated with the impingement. Lack of anterior or anterolateral offset between the femoral neck and head results in neck to rim contact when the hip is flexed and/or internally rotated. Before the periacetabular osteotomy this is compensated by the lack of anterior acetabular coverage, but after proper correction the mismatch becomes apparent. The authors recently have devised a routine during the periacetabular osteotomy procedure whereby after the acetabular fragment is corrected into the desired position, the joint is opened, visually inspected, and palpated for impingement with the hip flexed and internally rotated. When necessary, a resection osteoplasty of the femoral neck to head junction is performed to improve the head and neck offset and reduce the anterior contact. This, in the short term, has provided satisfactory prevention of postoperative impingement.