Subacromial Impingement Syndrome Patients Research Articles

Machine Learning-Based Ultrasomics for Predicting Subacromial Impingement Syndrome Stages.

To determine the performance of machine learning (ML)-based ultrasomic analysis of subacromial impingement syndrome (SIS) stage evaluation. In this retrospective study, 324 patients with SIS were included. The SIS stage was evaluated with a Neer test. Regions of the musculi supraspinatus were manually segmented by an experienced radiologist. Then, 5936 ultrasomic features were extracted from the Ultrasomics Platform software. The Wilcoxon test was used to identify differentially expressed radiomic features. Then, these differentially expressed features were submitted to the least absolute shrinkage and selection operator (LASSO) for model construction. The area under the curve (AUC) of the receiver operating characteristic was used to evaluate the performance of the ultrasonic model for SIS stage evaluation. Finally, a total of 223 early-stage and 101 advanced-stage SIS patients were randomly divided into a training cohort (n=227) and a validation cohort (n=97). After feature-dimensionality reduction, a total of 28 radiomic features were submitted to LASSO analysis. Finally, 10 radiomic features were finally included for radiomics model construction. The AUC results showed that the ultrasomics model had moderate performance for SIS stage evaluation in both the training cohort (AUC=0.839) and the validation cohort (AUC=0.789). ML-derived ultrasomics can discriminate the SIS stage in patients with SIS. This noninvasive and low-cost approach may be helpful in the preliminary screening of shoulder pain.

Reliability of scapular upward rotation and anterior-posterior tilt measurements using a modified digital inclinometer in patients with subacromial impingement syndrome.

Reliable scapular upward rotation and anterior-posterior tilt data are required for patients with subacromial impingement syndrome (SIS). Only a few studies have explored the reliability of such measurements derived using a modified inclinometer. To determine the relative and absolute reliability of scapular upward rotation and anterior-posterior tilt measurements derived using a modified digital inclinometer in patients with SIS. Seventeen SIS patients were assessed twice within 1 week. We determined the relative and absolute measurement reliability by calculating the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). Both intra- and interrater reliability were determined. The intra-rater reliability (both measurements) was high (0.72-0.88), and the interrater ICC was high to excellent (0.72-0.98). Clinically acceptable SEM and MCID values were obtained for scapular upward rotation (SEM: 4.28-9.33∘, MCID: 5.1-11.3∘) and anterior-posterior tilt (SEM: 3.72-7.55∘, MCID: 2.5-10.8∘). Measurements of scapular upward rotation and anterior-posterior tilt using a modified digital inclinometer reliably reveal scapular position and kinematics in patients with SIS.

Needle placement approach to subacromial injection in patients with subacromial impingement syndrome: A systematic review.

Subacromial impingement syndrome (SAIS) is the most common cause of shoulder pain and is costly, in terms of disability and health service provision. Research evidence suggests that, generally, the anterior, lateral and posterior approaches are used by clinicians for subacromial injection. However, it is uncertain which of these approaches is more effective than the other in the management of SAIS. The aim of the present study was to determine the effectiveness of the anterior, lateral approach to subacromial injection compared with the posterior approach for the treatment of SAIS. A comprehensive search was undertaken of CINAHL, MEDLINE, Cochrane, PEDro and the E-Journals databases using full texts, from 1980 to April 2014 and updated in December 2016 via the Chartered Society of Physiotherapy (EBSCOhost). Studies of SAIS patients receiving cortisone injections which investigated needle placement through the lateral, posterior or anterior routes were included. Study selection, data extraction and appraisal of the study were undertaken by the researcher and his supervisor. Quality criteria were selected from PEDro, to form a checklist of 10 items. A total of 4265 citations were retrieved and screened for eligibility; 39 articles were assessed as full text and 8 met the inclusion criteria. They include four randomized controlled trials and four controlled trials. Due to the varying methodological quality, and clinical and statistical heterogeneity of these studies, they were analysed qualitatively, as a meta-analysis was not possible. The evidence establishing the superiority of any one method of subacromial injection approach over the other is unclear in clinical practice. This calls for further research into this area.

Inter- and intrarater reliability of goniometry and hand held dynamometry for patients with subacromial impingement syndrome.

The purpose of this study was to examine the intra- and interrater reliability of measuring shoulder range of motion (ROM) and strength among patients diagnosed with subacromial impingement syndrome (SAIS). Twenty-five patients (14 female patients; mean age, 60.4± 7.84 years) diagnosed with SAIS were assessed to determine the intrarater reliability for glenohumeral ROM. Twenty-five patients (16 female patients; mean age, 60.4± 7.80 years) and 76 asymptomatic volunteers (52 female volunteers; mean age, 29.4± 14.1 years) were assessed for interrater reliability. Dependent variables were active shoulder ROM and isometric strength. Intrarater reliability was fair-to-excellent for the SAIS patients (intraclass correlation coefficient [ICC], 0.52–0.97; standard error of measurement [SEM], 4.4°–9.9° N; coefficient of variation [CV], 7.1%–44.9%). Based on the ICC, 11 of 12 parameters (92%) displayed an excellent reliability (ICC> 0.75). The interrater reliability showed fair-to-excellent results (SAIS patients: ICC, 0.13–0.98; SEM, 2.3°–8.8°; CV, 3.6%–37.0%; controls: ICC, 0.11–0.96; SEM, 3.0°–35.4°; CV, 5.6%–26.4%). In accordance with the intrarater reliability, glenohumeral adduction ROM was the only parameter with an ICC below 0.75 for both samples. Painful shoulder ROM in the SAIS patients showed no influence on the quality of reliability for measurement. Therefore, these protocols should be considered reliable assessment techniques in the prevention, diagnosis, and treatment of painful shoulder conditions such as SAIS.

POSTURAL ALTERATIONS IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME.

An aberrant upper body posture has been proposed as one of the etiological factors contributing to the development of subacromial impingement syndrome (SAIS). Clinicians have translated this supposition into assessment and rehabilitation programs despite insufficient and conflicting evidence to support this approach. The purpose of this study was to compare several postural variables between the SAIS patients and asymptomatic healthy controls. Case-Control Study. A total of 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated several postural variables including forward head posture (FHP), forward shoulder posture (FSP), thoracic kyphosis index (TKI), scapular index (SI), normalized scapular protraction (NSP), and the lateral scapular slide test (LSST). The variables were compared between patient and control groups according to sex. Significant differences were observed in the female patients compared to asymptomatic controls for the FHP (49.38 + 9.6o vs 55.5o+8.38, p=0.03), FSP (45.58 + 10.1o vs 53.68 + 7.08, p=0.02), and LSST in third position (10.2 + 2.1cm vs 11.5 + 0.7cm, p=0.01). Male patients showed a significant difference only in the FSP compared to controls (61.9o+9.4o vs 49.78 + 9.28, p<0.001). While inadequate data on the relationship between dysfunctional posture and SAIS has led to broad variations in current rehabilitation strategies, the results of the present study revealed different patterns of postural aberrations in female and male patients with SAIS. This clarifies the need to develop individualized or sex-specific approaches for assessing posture in men and women with SAIS and rehabilitation programs based on the assessment results. 3b.

The Importance of Night Pain for the Effectiveness of Theurapotic Ultrasound in the Sub acromial Impingement Syndrome: A Randomized Controlled Trial

Objective: The aim of this study is to assess the importance of night pain for the effectiveness of therapeutic ultrasound in treating Subacromial Impingement Syndrome (SIS). Methods: In this double-blind, placebo controlled study, patients with SIS accompanying with night pain were evaluated. The cases were divided as A and B groups randomly. Group A, received standard conservative treatment and additional ultrasound or placebo ultrasound randomly while having night pain. On the other hand, group B, received cold application and same standard conservative treatment. When the night pain subsided, ultrasound or placebo ultrasound was given randomly. The cases were evaluated with visual analogue scale, shoulder disability index and Constant Murley functional assessment scale during follow ups. Results: In group A, statistically meaningful improvement in resting, movement and night pain, disability and functionality were detected. However there were no statistically important differences between cases receiving ultrasound or placebo ultrasound. There were statistically important improvement in resting and movement pain, disability and fuctionality of group B cases. But with ceasing the cold application and starting either of ultrasound or placebo ultrasound, some increase in night pain was seen. There were no statistically important difference between ultrasound and placebo ultrasound. Conclusion: Adding ultrasound to the standard conservative treatments in SIS patients with or without night pain makes no additional benefit.

Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review

BackgroundAlterations in scapular orientation and dynamic control, specifically involving increased anterior tilt and downward rotation, are considered to play a substantial role in contributing to a subacromial impingement syndrome (SIS)....

Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM).

BackgroundThe Subacromial Impingement Syndrome (SIS) is the most common diagnosed disorder of the shoulder in primary health care, but its aetiology is unclear. Conservative treatment regimes focus at reduction of subacromial inflammatory reactions or pathologic scapulohumeral motion patterns (intrinsic aetiology). Long-lasting symptoms are often treated with surgery, which is focused at enlarging the subacromial space by resection of the anterior part of the acromion (based on extrinsic aetiology). Despite that acromionplasty is in the top-10 of orthopaedic surgical procedures, there is no consensus on its indications and reported results are variable (successful in 48-90%). We hypothesize that the aetiology of SIS, i.e. an increase in subacromial pressure or decrease of subacromial space, is multi-factorial. SIS can be the consequence of pathologic scapulohumeral motion patterns leading to humerus cranialisation, anatomical variations of the scapula and the humerus (e.g. hooked acromion), a subacromial inflammatory reaction (e.g. due to overuse or micro-trauma), or adjoining pathology (e.g. osteoarthritis in the acromion-clavicular-joint with subacromial osteophytes).We believe patients should be treated according to their predominant etiological mechanism(s). Therefore, the objective of our study is to identify and discriminate etiological mechanisms occurring in SIS patients, in order to develop tailored diagnostic and therapeutic strategies.MethodsIn this cross-sectional descriptive study, applied clinical and experimental methods to identify intrinsic and extrinsic etiologic mechanisms comprise: MRI-arthrography (eligibility criteria, cuff status, 3D-segmented bony contours); 3D-motion tracking (scapulohumeral rhythm, arm range of motion, dynamic subacromial volume assessment by combining the 3D bony contours and 3D-kinematics); EMG (adductor co-activation) and dynamometry instrumented shoulder radiographs during arm tasks (force and muscle activation controlled acromiohumeral translation assessments); Clinical phenotyping (Constant Score, DASH, WORC, and SF-36 scores).DiscussionBy relating anatomic properties, kinematics and muscle dynamics to subacromial volume, we expect to identify one or more predominant pathophysiological mechanisms in every SIS patient. These differences in underlying mechanisms are a reflection of the variations in symptoms, clinical scores and outcomes reported in literature. More insight in these mechanisms is necessary in order to optimize future diagnostic and treatment strategies for patients with SIS symptoms.Trial registrationDutch Trial Registry (Nederlands Trial Register) NTR2283.

Comparison of the Short-Term Efficacy of Physical Therapy in Subacromial Impingement Syndrome Patients with Stage I and II Magnetic Resonance Imaging Findings

©2011 Turkish League Against Rheumatism. All rights reserved. Amac: Bu calismada evre I ve II kismi subakromiyal sikisma sendromlu hastalar arasinda kombine fizik tedavi programinin etkinligi karsilastirildi. Hastalar ve yontemler: Manyetik rezonans goruntuleme (MRG) bulgularina gore evre I ve II olarak degerlendirilen subakromiyal sikisma sendromlu 43 hasta calismaya dahil edildi. Agri ve fonksiyonel durumu degerlendirmek icin Constant ve Kaliforniya Los Angeles Universitesi Omuz Skalasi kullanildi. Tedavi oncesinde, tedavi sonrasinda ve tedaviden 1 ay sonra istirahat, hareket ve uyku esnasindaki agri seviyeleri gorsel analog skala ile puanlandi. Iki grup arasinda ve gruplarin kendi icindeki iyilesmeler degerlendirildi. On bes gunluk seanslarda uygun egzersiz programi ile birlikte ultrason, yuzeyel sicak tedavisi ve transkutanoz elektriksel sinir stimulasyonu yontemlerini iceren fizik tedavi programi her iki gruba da uygulandi. Bulgular: Gruplar arasi karsilastirma tedavi sonrasi ve takipler suresindeki degerlendirme olcutleri karsilastirildiginda anlamli bir fark ile karsilasilmadi. Sonuc: Evre II hastalar fizik tedavi programina evre I MRG bulgularina sahip hastalar kadar iyi yanit verdi.

Low-Level Laser Therapy in Subacromial Impingement Syndrome

Although previous studies have evaluated the effect of different kinds of physical therapy in subacromial impingement syndrome (SIS), there have been few investigations assessing the effectiveness of low-level laser therapy (LLLT) in shoulder disorders. The goal of this prospective randomized study was to assess whether gallium-arsenide (Ga-As) laser therapy improves the outcome of a comprehensive home exercise program in patients with SIS. Forty-four newly-diagnosed SIS patients were enrolled in this study. Group 1 patients (n = 22) received Ga-As laser therapy combined with a 12-wk comprehensive home exercise program, and group 2 patients (n = 22) received the same 12-wk comprehensive home exercise program alone. Night pain, shoulder pain and disability index (SPADI), and University of California-Los Angeles end-result (UCLA) scores were used as outcome measures. Both groups showed a significant reduction in night pain and SPADI scores at the second and 12th weeks with respect to baseline values, with the exception of the SPADI total score at the second week in group 1. UCLA results improved significantly in both groups at the 12th in comparison to the second week. There were no significant differences between groups in mean actual changes in night pain and SPADI scores at the second week from baseline. When values at the 12th week were compared to baseline, mean actual changes in night pain differed significantly between the groups, with a larger change in group 1, but there was no difference between groups in mean actual change in SPADI scores. Second- and 12th-week UCLA scores did not differ between the two groups. Our study was unable to demonstrate any distinct advantage of low-level laser therapy over exercise alone. Comprehensive home exercise programs should be the primary therapeutic option in the rehabilitation process in SIS.