Symptoms Of Subacromial Impingement Research Articles

A RANDOMIZED CONTROLLED TRIAL OF AUTOLOGOUS TENOCYTE INJECTION VERSUS CORTICOSTEROID INJECTION FOR SYMPTOMATIC PARTIAL THICKNESS ROTATOR CUFF TEARS

BACKGROUND Symptomatic supraspinatus tears are difficult to treat, causing persistent subacromial impingement symptoms. Clinical studies of Autologous Tenocyte Injection (ATI) have shown that cultured tenocytes can synthesize extracellular matrix and facilitate healing of damaged tendon tissue. This randomized controlled trial (RCT) investigated the efficacy of ATI compared to corticosteroid injection (CS), combined with a graded rehabilitation program, in patients with symptomatic tendinopathy and partial thickness cuff tears. METHODS Eligible participants with a duration of symptoms >6 months were recruited and randomized to receive ATI to the interstitial tear or CS to the subacromial bursa in a 2:1 ratio, under ultrasound guidance, followed by a rehabilitation protocol. Assessments were undertaken pre-treatment and at 1, 3, 6 and 12 months post-treatment, including the Constant Score, Visual Analogue Pain Scale (VAS) and American Shoulder and Elbow Surgeons Assessment (ASES). Magnetic resonance imaging (MRI) was performed at baseline, 6 and 12 months. RESULTS Thirty participants were enrolled (ATI=19, CS=11). The ATI group performed significantly better in the Constant Score at 1 (p=0.020, ATI=81.8, CS=67.6), 6 (p=0.026, ATI=84.9, CS=71.1) and 12 (p=0.024, ATI=86.5, CS=65.4) months, reported better (p<0.05) VAS scores at all post-treatment timepoints and reported better ASES scores at all timepoints including 6 (p=0.012, ATI=88.6, CS=74.0) and 12 (p<0.01, ATI=93.3, CS=62.9) months. A total of 7 of 11 CS participants withdrew from the trial between 6 and 12 months due to worsening pain. These patients were subsequently offered and underwent ATI, with 6 and 12 month improvements similar to the primary ATI group. CONCLUSION ATI resulted in a significantly better and sustained reduction in pain, and improvement in shoulder function, compared with CS. This is the first Level 1 study using ATI to treat supraspinatus tears.

THE PREVALENCE AND PROFILE OF AFRICAN PATIENTS WITH OS ACROMIALE THAT PRESENT WITH SHOULDER PAIN AT A TERTIARY HOSPITAL IN PRETORIA, SOUTH AFRICA

Os acromiale is a developmental defect caused by failure of fusion of the anterior epiphysis of the acromion between the ages of 22 and 25. The prevalence of os acromiale in the general population ranges from 1.4% to 15%. Os acromiale has been reported as a contributory factor to shoulder impingement symptoms and rotator cuff injuries, despite being a common incidental observation. In this retrospective study, we examined the prevalence of os acromiale in black African patients with shoulder pain.We retrospectively reviewed the clinical records, radiographs, and magnetic resonance imaging (MRI) scans of 119 patients who presented with atraumatic and minor traumatic shoulder pain at a single institution over a one-year period. Anteroposterior, scapula Y-view, and axillary view plain images were initially evaluated for the presence of os acromiale, and this was corroborated with axial MRI image findings. Patients with verified os acromiale had their medical records reviewed to determine their first complaint and the results of their clinical examination and imaging examination.Radiographs and MRI on 24 patients (20%) revealed an osacromiale. This cohort had a mean age of 59.2 years, and there were significantly more females (65%) than males. Meso-acromion was identified as the most prevalent type (n=11), followed by pre-os acromion (n=7). All patients underwent bilateral shoulder x-rays, and 45 percent of patients were found to have bilateral meso- acromion. Most patients (70%) were reported to have unstable os acromiale with subacromial impingement symptoms, and nine patients (36%) had confirmed rotator cuff tears based on clinical and Mri findings. Surgery was necessary for 47% of the 24 patients with confirmed Os acromiale (arthroscopic surgery, n=7; open surgery, n=1) in order to treat their symptomsThe prevalence of os acromiale in our African patients with atraumatic shoulder symptoms is greater than that reported in the general population. Os acromiale is a rare condition that should always be considered when evaluating shoulder pain patients.

A RANDOMIZED CONTROLLED STUDY OF AUTOLOGOUS TENOCYTE INJECTION (ATI) VERSUS CORTICOSTEROID INJECTION FOR INTERSTITIAL ROTATOR CUFF TEAR AND IMPINGEMENT SYNDROME

Interstitial supraspinatus tears can cause persistent subacromial impingement symptoms despite non operative treatment. Autologous tendon cell injection (ATI) is a non-surgical treatment for tendinopathies and tear. We report a randomised controlled study of ATI compared to corticosteroid injection (CS) as treatment for interstitial supraspinatus tears and tendinopathy.Inclusion criteria were patients with symptom duration > 6 months, MRI confirmed intrasubstance supraspinatus tear, and prior treatment with physiotherapy and ≥ one CS or PRP injection. Participants were randomised to receive ATI to the interstitial tear or corticosteroid injection to the subacromial bursa in a 2:1 ratio, under ultrasound guidance. Assessments of pain (VAS) and function (ASES) were performed at baseline, and 1, 3, 6 and 12 months post treatment.30 participants (19 randomised to ATI) with a mean age of 50.5 years (10 females) and a mean duration of symptoms of 23.5 months. Baseline VAS pain and ASES scores were comparable between groups. While mean VAS pain scores improved in both groups at 3 months after treatment, pain scores were superior with ATI at 6 months (p=0.01). Mean ASES scores in the ATI group were superior to the CS group at 3 months (p=0.026) and 6 months (p=0.012). Seven participants in the CS group withdrew prior to 12 months due to lack of improvement. At 12 months, mean VAS pain in the ATI group was 1.6 ± 1.3. The improvements in mean ASES scores in the ATI group at 6 and 12 months were greater than the MCID (12.0 points). At 12 months, 95% of ATI participants had an ASES score > the PASS (patient acceptable symptom state).This is the first level one study using ATI to treat interstitial supraspinatus tear. ATI results in a significant reduction in pain and improvement in shoulder function.

A randomised controlled trial of autologous tenocyte versus corticosteroid injection for interstitial rotator cuff tear and impingement syndrome

Introduction: Interstitial supraspinatus tears can cause persistent subacromial impingement symptoms. This is the first comparative study to investigate safety and efficacy of Autologous Tenocyte Injection (ATI) compared to corticosteroid injection (CS) for interstitial rotator cuff tears.

Relationship Between Intensity of Neck Pain and Disability and Shoulder Pain and Disability in Individuals With Subacromial Impingement Symptoms: A Cross-Sectional Study

ObjectiveThis study aimed to verify a possible relationship between shoulder disability and shoulder pain intensity and the variables related to cervical-spine dysfunction, and determine which of these can differentiate moderate to severe shoulder pain (>4 on a numerical rating scale [NRS]) from mild shoulder pain (≤4 on the NRS) in individuals with subacromial impingement symptoms. MethodsOne hundred and forty volunteers with shoulder pain were evaluated. Demographic information and variables related to the shoulder and neck were collected. Self-reported pain and disability of the shoulder and cervical spine were measured using the Shoulder Pain and Disability Index (SPADI) and Neck Disability Index (NDI) questionnaires, respectively. An NRS was used to measure pain in the shoulder and cervical spine. A purposeful modeling strategy was used to determine the best model to predict shoulder disability and shoulder pain (dependent variables). Multiple logistic regression analysis followed by receiver operating curve analysis was used to determine which variables better differentiated moderate to severe shoulder pain from mild shoulder pain. ResultsVariables such as Neck Disability Index (NDI) score (β = 1.09, P = .00) and age (β = −0.19, P = .03) were associated with the total SPADI score. Neck pain was significantly associated with shoulder pain (β = 0.40, P = .00). The combination of variables predicting moderate to severe shoulder pain was total SPADI score (odds ratio [OR] = 1.15, P = .003), neck pain (OR = 3.20, P = .04), and age (OR = 1.01, P = .05). ConclusionOur results demonstrate the important connection between shoulder- and neck-related symptoms in individuals with subacromial impingement symptoms.

Kinesiology taping with exercise does not provide additional improvement in round shoulder subjects with impingement syndrome: A single-blinded randomized controlled trial

ObjectiveRound shoulder posture (RSP) may exaggerate symptoms of subacromial impingement. The effects of kinesiology taping with exercise on posture, pain, and functional performance were investigated in subjects with impingement and RSP. DesignThis study was a single-blinded randomized controlled trial. SettingAn outpatient rehabilitation clinic in a university hospital. ParticipantsThirty-four subjects with subacromial impingement and RSP. InterventionsKinesiology taping with and without tension was applied 2 times per week for 4 weeks. Both groups also performed strengthening and stretching exercises 3 times per week for 4 weeks. Main outcome measurementsThe pain level, shoulder angle and self-reported score were evaluated at pre-intervention, 2-week post-intervention and 4-week post-intervention time points. ResultsFunctional performance improved after intervention in both groups (p = 0.027). A greater decrease in pain level was related to better functional performance of the shoulder in both groups (r = −0.760 and −0.674; p < 0.010). Moderate correlations were found for posture and functional performance of the shoulder in the intervention group (0.48). ConclusionFour weeks of strengthening and stretching exercises with or without kinesiology taping improved functional performance in subjects with impingement and RSP. Improvement in clinical symptoms was related to better performance of posture.

Non-union of Scapular Spine Fracture Case-Report: a Cause of Classical Subacromial Impingement Syndrome

Fractures of the scapular spine are relatively uncommon and in most cases healing of the fracture is achieved following conservative treatment. We report a case of a 36 year old male who developed a painful atrophic non-union scapular spine fracture producing secondarily subacromial impingement symptoms and his sustained recovery 9 years after treatment by open reduction, internal fixation and bone grafting.

Surgical technique and early outcomes of intramedullary nailing of displaced proximal humeral fractures in an Asian population using a contemporary straight nail design.

Despite being a common orthopedic injury, the optimal management of proximal humeral fractures remains a topic of debate. Although intramedullary nails have been used to treat these fractures, several complications have been reported with older nail devices. We describe our surgical technique and aim to evaluate the early functional and radiological outcomes of displaced Neer's two- to four-part proximal humeral fractures undergoing fixation with a contemporary straight intramedullary nail. A prospective cohort study of 22 consecutive patients (mean age 55.7 ± 18.0) with acute displaced proximal humeral fractures underwent intramedullary nailing (Depuy Synthes MultiLoc Humeral Nail) by a single surgeon in a single institution. According to Neer's classification, 11 had two-part fractures, 9 had three-part fractures, and 2 had four-part fractures. Functional and radiological outcomes, as well as occurrence of complications, were assessed at 12 months postoperatively. The mean Constant-Murley score and American Shoulder and Elbow Surgeons score at 12 months were 75.5 ± 12.1 and 81.7 ± 6.2, respectively. Mean range of motion was forward flexion 144.3 ± 28.4, abduction 141.3 ± 30.5, external rotation 58.0 ± 13.9, and internal rotation 62.0 ± 15.2. Mean visual analog scale score was 1.7 ± 0.8. Radiographic fracture union was achieved at a mean of 3 months post-op. One patient underwent a second surgery for screw removal due to a proximal screw backing out. No other complications were found in our cohort. Notably, no patients had clinical signs and symptoms of subacromial impingement and/or rotator cuff tear. Our study demonstrated that intramedullary nailing using the contemporary straight nail design is well suited for Neer's two- and three-part proximal humeral fractures, with good early outcomes and low rates of complications. Results for four-part fractures were, however, inferior in our cohort, suggesting that further studies with larger patient numbers are needed to determine the role of intramedullary nailing for four-part fractures.

The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome

Study DesignProspective cohort. IntroductionAssessment of scapular dysfunction is considered important in the clinical evaluation and treatment of patients with symptoms of subacromial impingement. However, sparse research has been conducted into the reliability and predictive value of clinical tests with which to identify scapular dyskinesis. Purpose of the StudyTo evaluate intrarater and interrater reliability and predictive value of the Scapular Dyskinesis Test (SDT) in patients with subacromial impingement syndrome. MethodsForty-five patients with subacromial impingement syndrome were included. The presence of scapular dyskinesis was classified by 2 raters using the SDT. Intrarater and interrater reliabilities were examined and compared. Patients with and without scapular dyskinesis were compared in terms of Oxford Shoulder Score and EQ-5D-5L scores at baseline and 3 months, as well rating of overall improvement in shoulder condition. ResultsSDT could not be performed in 5 patients, leaving 40 patients for further analysis. Kappa with squared weights was 0.64 for rater A and 0.86 for rater B; the intrarater agreement was 88% for A and 96% for B. For interrater comparison, the Kappa value was 0.59 and agreement 86%. No statically significant differences in Oxford Shoulder Score and EQ-5D-5L baseline and change scores or overall improvement in shoulder condition at 3 months were observed between patients with or without scapular dyskinesis. ConclusionsIntrarater and interrater reliability and agreement of the SDT were determined. The findings that functional impairment and outcomes did not differ between patients with or without the presences of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome. Level of Evidence1b.

Non-union of Scapular Spine Fracture Case-Report: A Cause of Classical Subacromial Impingement Syndrome

Fractures of the scapular spine are relatively uncommon and in most cases healing of the fracture is achieved following conservative treatment. We report a case of a 36 year old male who developed a painful atrophic non-union scapular spine fracture producing secondarily subacromial impingement symptoms and his sustained recovery 9 years after treatment by open reduction, internal fixation and bone grafting.

An unusual cause of subacromial impingement after traumatic intrathoracic displacement of the scapula

Intrathoracic displacement of the scapula is a rare injury, with only five cases reported in the literature. They usually occur following high-energy accidents, often involving a motor vehicle. We report a case of a 50-year-old woman who presented with symptoms of subacromial impingement 31 years ago after a road traffic accident, which resulted in multiple fractures and malunion of the fourth and fifth ribs posteriorly; this incident resulted in displacement of the inferior tip of the scapula between the malunited ribs. Scapula-thoracic dyskinesis as a result of this injury led to symptoms of subacromial impingement.

Fijación doble para luxación acromioclavicular aguda: recuperación de la estabilidad horizontal de la clavícula como factor clave para la reducción anatómica

IntroductionDifferent publications have concluded that coracoclavicular and acromioclavicular ligament complex reconstructions with re-establishment of clavicular horizontal stability are key elements in avoiding residual instability of the acromioclavicular joint. MethodsA total of 14 patients diagnosed with acute types III, IV and V acromioclavicular dislocations were evaluated after a double fixation technique using coracoclavicular suture anchors and a hook plate with the use of an acromioclavicular reductor to obtain anatomical reduction of the dislocated acromioclavicular joint between February 2011 and February 2012. The Constant-Murley score and simple X-ray evaluations were performed at 4, 8 and 12 weeks after surgical treatment. All hook plates were removed 12 weeks after surgery, and three weeks after this procedure, coracoclavicular and acromioclavicular healing was evaluated by using magnetic resonance imaging to finally complete a 6 month follow-up for each patient. ResultsThe 14 patients, with a mean age of 26 years, included in the study had an overall follow-up of 6 months. The mean Constant-Murley score was 97 points at twelve weeks follow-up. No complications were observed, and all the patients had mild sub-acromial impingement symptoms that subsided once the hook plate was removed at 12 weeks follow-up. DiscussionThe results support that the acromioclavicular reduction tool helps to obtain anatomical reduction of the joint during the coracoclavicular reconstruction, while the hook plate holds this joint reduction in place, and allows an early start of physiotherapy, with no associated complications.

Night Pain is not a useful Diagnostic Indicator of Cuff Tear in Patients with Symptoms of Subacromial Impingement

BackgroundSymptoms of shoulder impingement are very common in clinical practice; however, diagnosis of the exact cause of the impingement remains a challenge. Evidence-based guidelines published for physiotherapists state that night pain is particularly associated with rotator cuff tears. This retrospective study aimed to determine whether patients diagnosed with impingement of the shoulder are more likely to report night pain if a tear of the rotator cuff is present.MethodsThe findings at surgery of 873 patients following open or arthroscopic decompression of the shoulder were studied to determine whether a tear of the rotator cuff had been identified. The pre-operative response for each of these patients regarding sleep disturbance as a result of their shoulder pain was cross-matched with the surgical findings.ResultsThere was no significant difference between those patients who were found to have a cuff tear and those with an intact rotator cuff and their complaint of night pain.DiscussionNight pain is a common complaint of patients presenting with impingement of the shoulder. It cannot be used in isolation as a diagnostic predictor for the presence of a rotator cuff tear.

Minor or occult shoulder instability: an intra-articular pathology presenting with extra-articular subacromial impingement symptoms

Disruption in the balance of shoulder stability can produce a widely varied spectrum of clinical symptoms, ranging from minor shoulder instability to frank shoulder dislocation, followed by recurrent instability. In this study, a series of patients suffering from minor shoulder instability, all with clinical signs of preoperative subacromial impingement associated with instability, were treated. The shoulder instability alone was addressed, with the aim of eliminating the clinical symptoms of subacromial impingement and pain. In this study, 20 patients with minor shoulder instability, presenting with subacromial impingement symptoms, underwent arthroscopic treatment to address capsule-labral pathology. All patients underwent a preoperative assessment by one independent physiotherapist, using Constant and WOSI scores, as well as the Castagna test, on both the affected and non-affected sides. The Hawkins test and subacromial pain in 90° of abduction and internal rotation were also evaluated. All patients followed the same rehabilitation protocol by a second physiotherapist. All patients were followed up at 6, 12 and 24 months postoperatively by the same independent physiotherapist. We observed that 20/20 patients had a positive Hawkins sign at >20° of internal rotation preoperatively, while 4/19 had a positive Hawkins sign--all with less pain--at the 24-month follow-up (P < 0.0001). Moreover, 20/20 had a positive Castagna test preoperatively, while 1/20 had a positive Castagna test at the 24-month follow-up. In terms of shoulder scores, at 24 months, the Constant score had improved from a median value of 70 (51-91) preoperatively to a median value of 91 (86-100). The median WOSI score was 48.3 (12.7-78.6) preoperatively and improved to 84.9 (39.5-98.5) at 24 months postoperatively. Minor shoulder instability is an intra-articular pathology presenting with extra-articular subacromial impingement symptoms. By treating the intra-articular pathology, the extra-articular symptoms can be relieved in the vast majority of patients.

Inter-examiner reproducibility of clinical tests and criteria used to identify subacromial impingement syndrome

IntroductionA specific algorithm has been proposed for classifying impingement related shoulder pain in athletes with overhead activity. Data on the inter-examiner reproducibility of the suggested clinical tests and criteria and...

An unusual complication of the Mackenzie approach for a Copeland hemiarthroplasty

We report the case of a patient with end-stage osteoarthritis who received a successful Copeland resurfacing hemiarthroplasty through a Mackenzie anterosuperior approach, which involves taking the anterior portion of the deltoid attachment from the acromion along with an osteo-periosteal sleeve. The patient went on to develop severe subacromial impingement symptoms 4 months postoperatively. X-rays revealed a large anteroinferior acromial osteophyte that had not been present preoperatively and was deemed to represent a malunited osteo-periosteal sleeve from the Mackenzie approach.

Effectiveness of individualized physiotherapy on pain and functioning compared to a standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controlled trial

BackgroundShoulder impingement syndrome is a common musculoskeletal complaint leading to significant reduction of health and disability. Physiotherapy is often the first choice of treatment although its effectiveness is still under debate. Systematic reviews in this field highlight the need for more high quality trials to investigate the effectiveness of physiotherapy interventions in patients with subacromial impingement syndrome.Methods/DesignThis randomized controlled trial will investigate the effectiveness of individualized physiotherapy in patients presenting with clinical signs and symptoms of subacromial impingement, involving 90 participants aged 18-75. Participants are recruited from outpatient physiotherapy clinics, general practitioners, and orthopaedic surgeons in Germany. Eligible participants will be randomly allocated to either individualized physiotherapy or to a standard exercise protocol using central randomization.The control group will perform the standard exercise protocol aiming to restore muscular deficits in strength, mobility, and coordination of the rotator cuff and the shoulder girdle muscles to unload the subacromial space during active movements. Participants of the intervention group will perform the standard exercise protocol as a home program, and will additionally be treated with individualized physiotherapy based on clinical examination results, and guided by a decision tree. After the intervention phase both groups will continue their home program for another 7 weeks.Outcome will be measured at 5 weeks and at 3 and 12 months after inclusion using the shoulder pain and disability index and patients' global impression of change, the generic patient-specific scale, the average weekly pain score, and patient satisfaction with treatment. Additionally, the fear avoidance beliefs questionnaire, the pain catastrophizing scale, and patients' expectancies of treatment effect are assessed. Participants' adherence to the protocol, use of additional treatments for the shoulder, direct and indirect costs, and sick leave due to shoulder complaints will be recorded in a shoulder log-book.DiscussionTo our knowledge this is the first trial comparing individualized physiotherapy based on a defined decision making process to a standardized exercise protocol. Using high-quality methodologies, this trial will add evidence to the limited body of knowledge about the effect of physiotherapy in patients with SIS.Trial registrationCurrent Controlled Trials ISRCTN86900354

Upper and lower trapezius muscle activity in subjects with subacromial impingement symptoms: Is there imbalance and can taping change it?

Objectives To investigate (i) whether subacromial impingement symptoms (SIS) were associated with upper and lower trapezius muscle imbalance and (ii) the effect of a scapula taping technique on upper and lower trapezius muscle activity. Design Cross-sectional study with nested within-subject intervention. Setting University research laboratory. Participants Subjects who demonstrated SIS ( n = 16) on clinical testing and an age and gender matched group of asymptomatic subjects ( n = 32). Main outcome measures Surface electromyography (EMG) to measure activity in the upper (UFT) and lower (LFT) fibres of trapezius during repeated humeral elevation in the scapular plane. Results Symptomatic subjects demonstrated a significantly (95% CI 2.13 to 4.17, p = 0.019) higher ratio of UFT:LFT activity than the asymptomatic subjects (95% CI 1.35 to 2.25). With tape in situ the symptomatic subjects demonstrated a significant (95% CI −8.6% to −17.3%, p < 0.001) reduction in UFT activity but no significant (95% CI +2.8% to −17.5%, p = 0.145) change in activity of LFT. No relationship ( r = − 0.116, p = 0.669) was found between the degree of underlying muscle imbalance and the reduction in UFT under the taped condition for the symptomatic group. Conclusion Subacromial impingement symptoms are associated with altered upper and lower trapezius muscle activity which can be partially addressed by the application of tape.

The immediate effect of scapular taping on surface electromyographic activity of the scapular rotators in swimmers with subacromial impingement symptoms

Altered scapular rotator muscle activity has been implicated in shoulder pain and dysfunction of a subacromial impingement (SI) origin, including in sporting populations such as swimmers. The application of scapular taping in an attempt to alter scapular rotator muscle activity is a commonly employed physiotherapeutic intervention in the injury management and rehabilitation of athletes. Previous studies have considered the immediate changes in the surface electomyographic activity of the scapular rotators in response to scapular taping, but only in a-symptomatic samples. The aim of this study was therefore to investigate the effect of scapular taping on the scapular rotators in a symptomatic sample.

Rate of return to work and driving following arthroscopic subacromial decompression

The aim of the present paper was to evaluate the return to work and return to driving of a cohort of patients undergoing arthroscopic subacromial decompressions +/- arthroscopic acromioclavicular joint excision. Arthroscopic subacromial decompressions +/- arthroscopic acromioclavicular joint excision were performed in 68 patients between February 2000 and November 2000. All patients had symptoms of subacromial impingement +/- acromioclavicular joint arthrosis for more than 6 months that had not settled with conservative treatment. All had positive local anaesthetic injection tests. All patients were followed up at 3 weeks and 3 months postoperatively. Their Constant-Murley score was measured preoperatively and at 3 weeks and 3 months postoperatively. Patients were asked to record when they had returned to work and when they had returned to driving. Only one non-manual worker did not return to work within 6 weeks. Eighty-five per cent of manual workers returned to manual work within 3 months. Fifty-one patients held driving licences. The average time to return to driving was 28.9 days. Average preoperative Constant-Murley scores were 47.5 (20-67). At 3 weeks postoperation average Constant-Murley scores were 66.8 (40-92), and at 3 months 76.5 (48-99).