Subacromial Bursitis Research Articles

BAASIK technique: an innovative single needle technique of performing shoulder corticosteroid injections.

The novel BAASIK (B-Botchu,Bipin, A-Agrawal, A-Ankit, S- Sindhura, I-Iyengar, K- Kapil) technique is a combined ultrasound-guided injection into the subacromial-subdeltoid (SASD) bursa and the biceps tendon sheath to treat shoulder pain associated with biceps tendonitis/tendinopathy, subacromial bursitis, rotator cuff impingement or to determine the source of shoulder pain. This technique aims in reducing shoulder pain, improving functional activities and enhancing treatment delivery. A single-entry supine ultrasound-guided injection of the subacromial-subdeltoid (SASD) bursa and biceps tendon sheath involves using a single needle insertion point to access both structures for therapeutic injection. This technique could become a favoured alternative technique, rather than subjecting patients to two needlesticks and preparing twoseparate injections to address often concomitant pathologies.

A rare case report: Brucellosis as an extreme cause of shoulder subluxation and rotator cuff tendinopathy

Rationale: Shoulder subluxation and rotator cuff tendinopathy is commonly associated with degeneration or trauma, and brucellosis has been reported to be correlated with shoulder subacromial bursitis, arthritis. However, brucellosis as a cause of shoulder subluxation and rotator cuff tendinopathy has never been reported in the English medical literature. Patient concerns: A 46-year-old man complained of left shoulder weakness and limited movement ongoing for 1 month. He was primarily diagnosed with shoulder subluxation and rotator cuff tear based on magnetic resonance imaging, and was advised to undergo arthroscopic rotator cuff surgical repair. Diagnoses: Although rotator cuff tear was diagnosed in another hospital, some doubts remained. First, a tendon profile with a relative high signal in T2-weighted magnetic resonance images in the supraspinatus tear area still existed. The findings were clearly different from the usual full-thickness rotator cuff tear, and no tendon profile could be found in the tear area. Second, degenerative rotator cuff tear mainly occurs in the aged population and this patient was relatively young, without a history of trauma. His left shoulder was painless but the weakness and the limited movement were extreme and all of these factors did not support the diagnosis of rotator cuff tear. Some infectious disease was suspected to be the cause and relevant laboratory tests were conducted. This patient was eventually diagnosed as having brucellosis-associated shoulder subluxation and rotator cuff tendinopathy based on positive serum standard tube agglutination test and buffer plate agglutination test for brucellosis. Interventions: Oral drug therapy with rifampicin and doxycycline was used for 8 weeks. Outcomes: A complete response with normal shoulder strength and movement was achieved at 8 weeks. At the one-year follow-up no signs of recurrence were detected. Lessons: Brucellosis-associated shoulder subluxation and rotator cuff tendinopathy may be misdiagnosed as a rotator cuff tear in magnetic resonance imaging and be further managed with indeterminate arthroscopic repair. A comprehensive understanding of the patient’s previous medical history, imaging and laboratory data and a careful physical examination are of great clinic value for the accurate diagnosis of the condition and the subsequent prognosis of the patient.

Shoulder pathology on advanced imaging in asymptomatic non-athlete individuals: A narrative review.

The prevalence of asymptomatic shoulder pathology has been shown to be high on both ultrasound and magnetic resonance imaging (MRI). The most common shoulder pathologies identified in asymptomatic, non-athlete individuals include rotator cuff pathology, acromioclavicular (AC) joint pathology, labral tears, subacromial bursitis, and calcific tendinitis. The data in the current literature suggest that asymptomatic rotator cuff tears are diagnosed on ultrasound and MRI at high rates, suggesting that rotator cuff tears may be considered an age-related, normal, degenerative change. However, there are data to suggest that the presence of an asymptomatic rotator cuff tear on imaging may predispose a patient to shoulder pain in the future, although the data remain inconclusive. AC joint arthritic changes are also common in older individuals on advanced imaging. Recent studies have reported that labral tears are common in asymptomatic shoulders, although at less frequent rates than in athletes, but more research is required on this topic. In addition, the presence of subacromial bursitis on imaging has not been found to accurately differentiate between symptomatic and asymptomatic shoulders. Finally, calcific tendinitis has been diagnosed asymptomatically, with most individuals remaining asymptomatic. Individuals who did develop pain developed severe pain, although the risk factors for developing symptomatic calcific tendinitis are unclear. In summary, given the high prevalence of shoulder pathology diagnosed on imaging, it is important to not over diagnose or complete an unnecessary workup for an asymptomatic person who is otherwise healthy.

Ultrasound definition of subacromial chronic "fibro-adhesive" bursitis and its treatment via ultrasound guided hydrodilation: a prospective pilot study.

The shoulder pain is one of the main causes that lead the patient to medical evaluation. Today, the ultrasound (US) represents an essential tool in the orthopaedical, rheumatological and rehabilitative setting to address the musculoskeletal causes of pain. Amongst the commonest causes of shoulder complains lay the frequent subacromial chronic bursitis (SACB). In this condition, the thickening of the bursal walls and subsequent fusion of the two synovial sheets leads to the reciprocal loss of bursal walls gliding under the subacromial space and consequently pain. This condition represents a common cause of shoulder pain and may be easily addressed by musculoskeletal sonographers. The purpose of this paper will be to describe the US appearance of SACB and to evaluate the efficacy of US-guided hydrodilation in its treatment. We included patients with painful shoulder attending our outpatient clinic for shoulder complains with the diagnosis of SACB with a bursal wall > 1.5 mm. A group was treated via US-guided hydrodilation, while the control group was treated via a classical blind approach using triamcinolone acetonide. Both groups underwent the same rehabilitation program following the injections. The shoulder functionality was assessed via qDASH questionnaire at baseline, days 3, 7, 14, 30, 60, and 90. A p <0.05 was considered significant. Both groups displayed a significant reduction of pain; nevertheless, in the group treated with US-hydrodilation, there was no need for re-treatment. The US-guided hydrodilation for SACB should be the preferred technique to detach bursal walls and improve patient symptoms, since it requires fewer invasive maneuvers.

Musculoskeletal Pathologies Affecting Shoulder Girdle: A Systematic Review with Anatomical and Radiological Validation

Abstract Musculoskeletal pathologies affecting shoulder girdle joints, other than gleno-humeral joint such as acromioclavicular joint arthritis, tendonitis, subacromial bursitis, subdeltoid bursitis, and osteochondritis dissecans, are relatively rare. In Middle East and Asian countries, public health services are generally availed by a large number of patients in primary health centres, rural hospitals, and district hospitals, but the scarcity of specialist orthopaedic surgeons in such hospitals usually leads to misdiagnosis of rare musculoskeletal pathologies, which may result in complications and morbidity. The study aims to determine the presentation, progression, diagnostic evaluation, and treatment of musculoskeletal pathologies affecting the shoulder girdle and develop an algorithm to screen such pathologies. A systematic literature search of four medical databases (PubMed, Scopus, Web of Science and Google Scholar) was conducted, from 1st January 1950 to 31st December 2022. Studies (case reports, prospective studies, review articles) reporting pathological conditions affecting shoulder girdles, with a focus on clinical presentation, physical examination tests required for diagnostic evaluation, and management, were included. The relevant data was extracted from the selected studies and tabulated for analysis. Seventeen studies were included in the final analysis. Several case reports, case series and review articles showed that very few musculoskeletal conditions can be correctly diagnosed based on only physical examination tests. Radiological and anatomical basis of each of the cases were discussed. An algorithm was prepared to help diagnose shoulder girdle pathologies based on clinical presentation and examination findings.

Four Common Upper Body Injuries in Tennis Players: Prevention, Description, and Treatment

The average tennis player gets injured 2-3 times every two years. This may not seem relevant but when added over a lifetime career in tennis these numbers become significant. This is why it is important to be aware of the most common tennis injuries, as well as the best prevention and treatment methods for each injury. This literature review will discuss four of the most common tennis injuries, which include tennis elbow, tendonitis, shoulder bursitis, and a rotator cuff tear. This review covers how to prevent and treat them, with a focus on the elbow and shoulder as two of the most common places for injury in tennis players.

Tendinopathies Associated with Statin Therapy in Patients with Dyslipidemia: Case Study Article Sidebar

Statins are considered the initial and first-line treatment in cardiovascular and atherosclerotic diseases, characterized by inhibiting HMG-CoA reductase. Some adverse effects associated with these drugs are injuries to the tendon structure including tenosynovitis, tendon and tendon rupture. The aim of this article is to evaluate the tendon structure by musculoskeletal ultrasound and to raise the question of whether chronic statin consumption in this patient with dyslipidemia is related to the appearance of tendinopathies. Methodology A cross-sectional descriptive observational study was carried out, focused on the evaluation of the incidence of tendinopathies in patients who have been using statins chronically. A case study approach was used, analysing in detail a female patient selected according to the established inclusion and exclusion criteria. The sample consisted of a patient who met the inclusion criteria: age between 45-60 years, chronic use of statins for more than 12 months, presentation of symptoms suggestive of tendinopathy. Patients with a history of musculoskeletal diseases prior to the start of treatment were excluded, and anyone with arthritis, chronic septic inflammatory processes, athletes, young patients, and those who did not want to participate in the study and did not agree to give informed consent were excluded. For data collection, 7 patients were selected, of which 1 only met the inclusion and acceptance criteria for the study, a clinical history was taken with exhaustive clinical evaluations of the selected patients, focused on the identification of tendinopathy symptoms and other possible risk factors, at the end a musculoskeletal ultrasound was carried out where possible tendon injuries were identified and characterized. evaluating tendon structure and its relationship to statin use. This methodology provides a detailed and structured approach to conducting research on the incidence of tendinopathies associated with statin use. Results During the clinical evaluation of this patient, symptoms associated with tendinopathy of the long portion of the biceps brachii on the right side were identified. The results of the musculoskeletal ultrasound confirmed the alterations in the structure of the tendon, finding tenosynovitis, significant peritendinous effusion and microruptures of the long portion of the biceps brachii not only on the affected side, but also on the contralateral side, which was asymptomatic for tendon pathology. In addition, not only was the biceps tendon modified, micro ruptures in the supraspinatus tendon and subacromial bursitis were observed. This patient had been taking atorvastatin 20mg every 24 hours in the mornings for 9 years and was not attributed with any mechanism of overuse injury that triggered multiple tendinopathies at the rotator cuff level.

Ketorolac Injections for Musculoskeletal Conditions: A Narrative Review.

Musculoskeletal conditions of the upper and lower extremities are commonly treated with corticosteroid injections. Ketorolac, a parenteral nonsteroidal anti-inflammatory drug, represents an alternative injectant for common shoulder, hip, and knee conditions. A review of the current literature was conducted on the efficacy of ketorolac injection in musculoskeletal diseases. Several studies support the use and efficacy of ketorolac injection in subacromial bursitis, adhesive capsulitis, and hip and knee osteoarthritis. Given the systemic effects of glucocorticoid injections, ketorolac may be a safe and effective alternative in patients with musculoskeletal disease. However, more evidence is required to better understand the effects ketorolac has on the human body during inflammatory processes.

GLUTAMATE EXPRESSION IN SUBACROMIAL BURSA IS ASSOCIATED WITH ROTATOR CUFF TEAR AND WITH SHOULDER PAIN

Glutamate regulates the expression of apoptosis-related genes and triggers the apoptosis of fibroblasts in rotator cuff tendons. Subacromial bursitis is always accompanied by symptomatic rotator cuff tear (RCT). However, no study has been reported on the presence of glutamate in subacromial bursa and on its involvement of shoulder pain in patients who had RCT. The purposes of this study were to determine whether the glutamate expression in subacromial bursa is associated with the presence of RCT and with the severity of shoulder pain accompanying RCT.Subacromial bursal tissues were harvested from patients who underwent arthroscopic rotator cuff tendon repair or glenoid labral repair with intact rotator cuff tendon. Glutamate tissue concentrations were measured, using a glutamate assay kit. Expressions of glutamate and its receptors in subacromial bursae were histologically determined. The sizes of RCT were determined by arthroscopic findings, using the DeOrio and Cofield classification. The severity of shoulder pain was determined, using visual analog scale (VAS). Any associations between glutamate concentrations and the size of RCT were evaluated, using logistic regression analysis. The correlation between glutamate concentrations and the severity of pain was determined, using the Pearson correlation coefficient. Differences with a probability &lt;0.05 were considered statistically significant.Glutamate concentrations showed significant differences between the torn tendon group and the intact tendon group (P = 0.009). Concentrations of glutamate significantly increased according to increases in tear size (P &lt; 0.001). In histological studies, the expressions of glutamate and of its ionotropic and metabotropic receptors have been confirmed in subacromial bursa. Glutamate concentrations were significantly correlated with pain on VAS (Rho=0.56 and P =0.01).The expression of glutamate in subacromial bursa is significantly associated with the presence of RCT and significantly correlated with its accompanying shoulder pain.Acknowledgements: This research was supported by the Basic Science Research Program, through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A3A01018955 and 2017R1D1A1B03035232).

ВОЗМОЖНОСТЬ ПРИМЕНЕНИЯ ПРЕПАРАТОВ БИОРЕГУЛЯЦИОННОЙ МЕДИЦИНЫ В СОСТАВЕ КОМПЛЕКСНОЙ ТЕРАПИИ ПРИ ПЕРВИЧНОМ ОСТЕОАРТРИТЕ ПЛЕЧЕВОГО СУСТАВА

The presented clinical case examines the possibility of using bioregulatory medicine as part of complex therapy for primary osteoarthritis of the shoulder joint, trabecular edema in the area of the head of the humerus, minor synovitis, and calcifying subacromial bursitis. The use of complex therapy for the treatment of the above pathology of the shoulder joint, including the use of the drugs Zeel T and Traumeel S®, gave a pronounced analgesic, anti-inflammatory effect and a good, clinically significant result.

RISK FACTOR OF ROTATOR CUFF TENDINOPATHY: A SYSTEMATIC REVIEW

Background: Rotator cuff tendinopathy is an umbrella term that includes different shoulder conditions affecting subacromial structures, such as rotator cuff tendinitis/tendinosis, subacromial bursitis and shoulder impingement syndrome. Rotator cuff tendinopathy is refractory to treatments, results in impaired activities of daily living and has a significant socio-economic burden due to loss of work and treatment costs. The aim: This study aims to show risk factor for rotator cuff tendinopathy. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 75 articles, whereas the results of our search on SagePub brought up 151 articles. The results of the search conducted for the last year of 2013 yielded a total 58 articles for PubMed and 53 articles for SagePub. The result from title screening, a total 7 articles for PubMed and 18 articles for SagePub. In the end, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: The most well-established RCD risk factor is advanced age, with higher prevalence associated with age in multiple studies. Other important and potentially modifiable risk factors exist, such as occupational physical demands, but few epidemiologic studies have evaluated associations specific to RCD.

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.

Ultrasound Findings in Adult Patients with Chronic Shoulder Pain Having No History of Trauma

OBJECTIVE: To evaluate the frequency of non-traumatic chronic shoulder pain sonographically in the local population. METHODOLOGY: This cross-sectional study was conducted at the Department of Radiology, Combined Military Hospital Malir, from March to October 2020. A history of shoulder pain of more than one month duration was included. Patients with a History of shoulder dislocation, neurological, renal, hepatic and cardiac diseases were excluded. The sample size was 196. A non-probability consecutive sampling technique was employed. SPSS version 23 was used for statistical analysis. RESULTS: 196 patients (69.9% males and 30.1% females) with non-traumatic shoulder pain (56.4 % right side and 43.4% left) were scanned. The mean age was 42.80±11.20 years. Out of 196, 118(60.2%) were having complaints in dominant limbs (right 51.0% and left 9.2%); 78(39.8%) were having pain in non-dominant limbs (right 6.6% and left 33.2%). Significant findings were supraspinatus partial tear (46.9%), sub-acromial sub-deltoid bursitis(8.2%), and biceps tenosynovitis(6.1%), adhesive capsulitis, a complete tear of supraspinatus tendon, impingement syndrome, joint effusion, subscapularis tendon tear and tenosynovitis. 44(22.4%) patients had two pathologies, and 31 (15.8%) patients had three pathologies, respectively. Significant co-existent findings were biceps tenosynovitis (13.8%), Impingement syndrome (9.2%), bursitis (8.2%) and joint effusion (7.1%). Age and number of pathological were moderately positively correlated, r (194) = 0.46, p &lt; 0.01 and keeping CI = 95%. CONCLUSION: Partial tears of the supraspinatus tendon were the most common pathology in non-traumatic shoulder myalgia, diagnosed on ultrasound, followed by sub-acromial sub-deltoid bursitis and biceps tenosynovitis, having moderate linear relation with age. KEYWORDS: Shoulder pain, Impingement syndrome, Rotator Cuff Tears, Tenosynovitis, Ultrasound Shoulder

Clinical Impairments and Rotator Cuff Tendon Pathology in Primary and Intrinsic Secondary Adhesive Capsulitis.

This study was conducted to compare the differences in clinical impairments between patients with primary and intrinsic secondary adhesive capsulitis and confirm rotator cuff tendon pathology in intrinsic secondary adhesive capsulitis. This study included 130 patients with unilateral adhesive capsulitis in freezing or frozen stages. Clinical impairment was evaluated using visual analog scale score, shoulder passive range of motion, Cyriax stage, and Constant-Murley score. Plain radiography, ultrasonography, single-contrast arthrography, and intravenous gadolinium-enhanced magnetic resonance imaging were performed in all patients. Among 130 patients, 77 patients were diagnosed as primary adhesive capsulitis and 53 patients as intrinsic secondary adhesive capsulitis. Among intrinsic secondary adhesive capsulitis patients, 44 rotator cuff tendon tears, 6 calcific tendinitis, and 3 rotator cuff tendon tears with calcific tendinitis were observed. No significant intergroup difference was observed in all clinical parameters, including shoulder passive range of motion, visual analog scale, Cyriax stage, and Constant-Murley score. The prevalence of subacromial subdeltoid bursitis was significantly higher in intrinsic secondary adhesive capsulitis compared with primary adhesive capsulitis. There was no significant difference in all clinical parameters investigated between patients with primary and intrinsic secondary adhesive capsulitis caused by rotator cuff tendon pathology.

A prospective study of 100 patients with rotator cuff tendinopathy showed no correlation between subacromial bursitis and the efficacy of ultrasound-guided corticosteroid injection.

The objective of this study was to determine whether the presence of subacromial bursitis in patients with rotator cuff tendinopathy (RCT) was associated with a better outcome after ultrasound (US)-guided subacromial corticosteroid injection. A single-center prospective study was performed including patients referred for subacromial injection to manage RCT. At baseline, all patients received an US-guided intra-bursal injection of betamethasone (1ml). The primary endpoint was reduced pain 3months (M3) after the procedure: a good responder was defined by a decrease in Visual Analogue Scale pain of more than 30%. Secondary endpoints included functional recovery assessed by the Oxford Shoulder Score (OSS) and clinical success at 6weeks (W6). We also explored the association between good clinical response and other factors, such as US or X-ray features. One hundred patients were included and 49 presented with subacromial bursitis. At M3, 60% of patients (54/100) were considered good responders. The rate of good responders did not differ between the bursitis and non-bursitis groups (p = 0.6). During follow-up, OSS improved over time whether bursitis was present or not. We did not find any US or X-ray features significantly associated with a favorable clinical outcome. The presence of subacromial bursitis did not influence clinical outcomes at 3months post-subacromial injection in patients suffering from RCT. The presence of subacromial bursitis did not influence clinical outcomes at 3months post-subacromial corticosteroid injection in patients with rotator cuff tendinopathy. For patient management, looking for ultrasonographic signs of bursitis does not appear relevant for the indication of the injection. • Ultrasound-guided subacromial corticosteroid injections led to a significant improvement in 60% of patients suffering from rotator cuff tendinopathy. • The presence of subacromial bursitis was not associated with better improvement at 3months post-injection. • Except for the Minnesota score referring to job satisfaction, we did not find any baseline clinical, X-ray, or ultrasound characteristics associated with a successful outcome.

SIRVA: Shoulder injury related to vaccine administration.

Shoulder injury related to vaccine administration (SIRVA) is a prolonged episode of shoulder dysfunction that commences within 24 to 48 hours of a vaccination. Symptoms include a combination of shoulder pain, stiffness, and weakness. There has been a recent rapid increase in reported cases of SIRVA within the literature, particularly in adults, and is likely related to the mass vaccination programmes associated with COVID-19 and influenza. The pathophysiology is not certain, but placement of the vaccination in the subdeltoid bursa or other pericapsular tissue has been suggested to result in an inflammatory capsular process. It has been hypothesized that this is associated with a vaccine injection site that is "too high" and predisposes to the development of SIRVA. Nerve conduction studies are routinely normal, but further imaging can reveal deep-deltoid collections, rotator cuff tendinopathy and tears, or subacromial subdeltoid bursitis. However, all of these are common findings within a general asymptomatic population. Medicolegal claims in the UK, based on an incorrect injection site, are unlikely to meet the legal threshold to determine liability.

Effects of Muscle Energy Technique versus Shoulder Mobilization on Pain and Function in Patients with Subacromial Pain Syndrome

Abstract Background Subacromial pain syndrome is most leading cause of disability that includes the wide spectrum of disorders including subacromial tendinopathy, partial or full thickness tear of rotator cuff and subacromial bursitis. The manual therapy interventions for this condition are still debatable. Aim To evaluate the comparative effects of muscle energy technique (MET) versus posterior shoulder mobilization with movement (MWM) on pain, function and shoulder range of motion in patients with subacromial pain syndrome. Method Patients diagnosed with subacromial pain syndrome were recruited in this pragmatic parallel double blinded randomized clinical trial. The sample was selected through non-probability convenient sampling technique. Forty patients out of 56 meeting the eligibility criteria were equally divided into two groups, MET group (n = 20) and MWM group (n = 20), through a randomization web service. Data were collected at baseline and after successful completion of a six week trial treatment. Pain severity was measured by using a numeric pain rating scale, shoulder disability was measured by using the Shoulder Pain and Disability Index (SPADI) and ranges of motion were measured by using goniometry. Data was analyzed through SPSS 24. Results Outcome measures including pain, disability and shoulder range of motion were significantly (p ≤ 0.05) improved in both groups after the intervention. When comparing both groups, pain score was U = 82.0 (p ≤ 0.001) and disability score was t = –2.913 (p ≤ 0.006) favoring MET. Conclusion Both MET and MWM were effective for symptomatic management in this sample of 40 patients with subacromial impingement syndrome. MET seems to show some superior effects as compared to MWM.

Clinical and ultrasound findings of ‘swimmer’s shoulder’ and its association with training history in elite Portuguese swimmers: a cross-sectional study

ABSTRACT Objectives To assess the prevalence of shoulder injuries and ultrasound findings in elite Portuguese swimmers and their association with symptoms and personal or training-related factors. Methods This cross-sectional study was conducted at the Portuguese Open and Youth Swimming National Championships between 27 and 30th July 2022. Each athlete entered details regarding personal and training history into a questionnaire and underwent a physical and ultrasound shoulder examination. Results A total of 102 swimmers out of 662 Portuguese athletes were included in the study. Shoulder pain experienced during the previous season was reported by 42% of the athletes. A high prevalence of shoulder structural abnormalities was noted, specifically supraspinatus tendinosis (91%), tears (29%), and subacromial bursitis (29%). Specific training for injury prevention was associated with higher rates of infraspinatus tendinosis (p = 0.047), and supraspinatus tears were linked to greater swimming distances per week (p < 0.001) and practice (p < 0.001), more years of practice (p = 0.018), shoulder pain at the time of evaluation (p = 0.023), a higher number of missed competitions (p = 0.041), and shoulder injections (p = 0.009). Subacromial bursitis was associated with shoulder pain at the time of evaluation (p = 0.002) and during the previous season (p < 0.001), missed competitions (p < 0.001), and requirement for physical therapy (p = 0.006). Conclusions A high prevalence of shoulder morphological changes was found in surveyed swimmers and there were several associations with training load, regardless of individual characteristics of each athlete. It is essential to understand the true impact of current injury prevention programs and to develop effective measures to protect swimmers’ health.

Shoulder injuries in Facioscapulohumeral muscular dystrophy patients (P6-8.001)

<h3>Objective:</h3> To describe the types, prevalence, and history of shoulder injuries in patients with facioscapulohumeral muscular dystrophy (FSHD). <h3>Background:</h3> FSHD is a dominantly inherited, slowly progressive muscular dystrophy with variable clinical manifestations. It usually initially presents as weakness in the face, shoulder, and upper extremities, eventually extending to the lower body. MRI studies have shown that wasting in the shoulder tends to follow a muscle-specific pattern, but to date there are no studies investigating shoulder injuries as an outcome, nor their impact on patients. <h3>Design/Methods:</h3> We distributed a cross-sectional anonymous web-administered survey of adult FSHD patients identified through the US National FSHD Registry and the FSHD Society registry. The survey collected FSHD history, functional status, severity scores, and detailed history of shoulder injury (defined as “any shoulder condition that caused pain, stiffness, or dysfunction in addition to that from FSHD”). <h3>Results:</h3> We identified 613 FSHD patients ranging from 18 to 91 years old (M=56.4, SD=14.7). Average age of symptom onset and diagnosis were 24 and 35, respectively, with an average Brooke Upper Extremity Score of 2.7 (SD=1.03). 89% of patients reported current shoulder weakness, while 34% reported a history of shoulder injury. The most-reported injuries were rotator cuff tendinitis/tendinopathy and rotator cuff tear, both with a prevalence of 9.8% – followed by subacromial bursitis (7.1%), shoulder impingement (6.0%), and dislocated shoulder (5.0%). Of the patients who reported a history of at least one shoulder injury: 42% believed that FSHD was entirely to blame, and 49% rated the impact of their injury on their life – at its worst – at 8/10 or higher. <h3>Conclusions:</h3> By exploring the previously undescribed burden of shoulder injuries in the FSHD patient population, this study may improve patients’ understanding of their condition and inform clinicians’ approach to monitoring the disorder. <b>Disclosure:</b> Mr. Liu has nothing to disclose. Dr. Tawil has received personal compensation in the range of $500-$4,999 for serving as a Consultant for DYNE Therapeutics. Dr. Tawil has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arrowhead Pharma. Dr. Tawil has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Fulcrum Therapeutics. Dr. Tawil has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acceleron Pharma. Dr. Tawil has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MT Pharma. Dr. Tawil has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Pharma. Dr. Tawil has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for miRecule. The institution of Dr. Tawil has received research support from Friends of FSH Research. The institution of Dr. Tawil has received research support from FSH Society. The institution of Dr. Tawil has received research support from NIH. The institution of Dr. Tawil has received research support from Fulcrum. Dr. Tawil has received intellectual property interests from a discovery or technology relating to health care. Dr. Tawil has received publishing royalties from a publication relating to health care. Dr. Statland has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arrowhead. Dr. Statland has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ML Bio. Dr. Statland has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MT Pharma. Dr. Statland has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Epic Bio. Dr. Statland has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Armatus . Dr. Statland has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Dyne Therapeutics. Dr. Statland has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avidity . Dr. Statland has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Fulcrum Therapeutics. Dr. Statland has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. The institution of Dr. Statland has received research support from NIH. The institution of Dr. Statland has received research support from FSHD Society. The institution of Dr. Statland has received research support from Friends of FSH Research. The institution of Dr. Statland has received research support from FSHD Canada. The institution of Dr. Statland has received research support from MDA.

Comparison of corticosteroid injection, physiotherapy and combined treatment for patients with chronic subacromial bursitis – A randomised controlled trial

Objective To investigate whether combination of corticosteroid subdeltoid injections and physiotherapy was more effective than either treatment alone in chronic subacromial bursitis. Design Prospective, three-arm randomised controlled trial. Setting Rehabilitation department of an academic hospital. Subjects Patients with chronic subacromial bursitis. Interventions Patients were divided into corticosteroid injection (N = 36), physiotherapy (N = 40) and combined (N = 35) groups. Two corticosteroid subdeltoid injections in corticosteroid group, 8-week physical therapy emphasising on therapeutic exercise in physiotherapy group, and combined both treatments in combined group. Main outcome measures The primary outcome measures were pain visual analogue scale and Shoulder Pain and Disability Index at 8 weeks after finishing treatment. The secondary outcome measures were active range of motion, Shoulder Disability Questionnaire, Western Ontario Rotator Cuff Index, patient's evaluation of treatment effect, and symptom recurrence. Results Group comparison showed significant statistical difference in shoulder flexion (P < 0.003) and patient's evaluation of treatment effect (P < 0.001). The time and group interactions comparison revealed significant statistical differences in pain score (P < 0.024), external rotation (P < 0.044) and patient's evaluation of treatment effect (P < 0.001). The above statistics were in favour of the corticosteroid and combined groups rather than physiotherapy group. The percentage of recurrence was 36.1, 7.5 and 17.1 in the corticosteroid, physiotherapy and combined groups, respectively (P < 0.001). Conclusion Corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone, but the recurrence rate was least in the physiotherapy group.