Subacromial Impingement Research Articles

The effectiveness of high-intensity laser therapy on pain, range of motion, functional capacity, quality of life, and muscle strength in subacromial impingement syndrome: a 3-month follow-up, double-blinded, randomized, placebo-controlled trial.

The aim of this study was to perform a placebo-controlled assessment of the short- and long-term efficiency of high-intensity laser therapy (HILT) in treatment of subacromial impingement syndrome (SAIS). Sixty-three patients (32 in HILT + exercise and 31 in sham HILT + exercise group) who were diagnosed with SAIS were included. The assessments were performed before (baseline, 0) and after treatment (3rd week/12th week). Active range of motion (ROM) with goniometric measurement, pain with visual analog scale (VAS), shoulder function with Constant-Murley score (CMS), quality of life with SF-36 (short-form 36) health survey, muscle strength using isokinetic device (including peak torque level measurements at shoulder internal rotation (IR) and external rotation (ER) at 120, 180, and 210 degrees) were assessed. Significant improvements were determined in the assessments at the 3rd and 12th week controls in both HILT and control groups. In the comparison of the values of the groups (3rd/12th week), the HILT group had a statistically significant improvement compared with the placebo group; in the active shoulder flexion, IR, and ER ROM measurements; in VAS scores; in CMS activities of daily living, ROM, strength and total scores; in all the sub-parameters of SF-36; and in IR 120,180, 210 and ER 120,180 degree/s peak torque values of isokinetic measurements. In the comparison of both groups, HILT + exercise treatment is more effective in reducing pain and increasing the ROM, functioning, quality of life, and the muscular strength assessed with isokinetic in the short and long term.

Shoulder Impingement (Care of the Young Athlete)

Patient Education| 2021 Shoulder Impingement (Care of the Young Athlete) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Shoulder Impingement (Care of the Young Athlete). Pediatric Patient Education 2021; 10.1542/peo_document568 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Care of the Young Athlete Topics: athlete, shoulder region, pain Shoulder impingement is an overuse injury that causes achy pain on the front or side of the shoulder. The pain is felt most when the arm is overhead or extended to the side. Shoulder impingement also is called rotator cuff tendonitis, subacromial impingement, supraspinatus tendonitis, and shoulder bursitis. Shoulder impingement is common in swimmers and athletes who play baseball, tennis, and volleyball. It can also occur in weight lifters, gymnasts, divers, and rowers. Causes include a rapid increase in overhead activity, weakness or strength imbalance in the rotator cuff or scapular muscles, postural abnormalities, shoulder joint instability, or improper training or technique. The following is information from the American Academy of Pediatrics summarizing treatment phases and goals for shoulder impingement. Treating shoulder impingement involves limiting activities that cause pain and using ice and nonsteroidal anti-inflammatory drugs (NSAIDs) to... © 20122012 American Academy of Pediatrics. Reviewed 7/2020. All rights reserved. You do not currently have access to this content.

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.

Comparison of the Efficiency of Platelet-Rich Plasma and Corticosteroid Injection Therapies in Improving Pain and Shoulder Functions in Subacromial Impingement Syndrome

Comparison of the Efficiency of Platelet-Rich Plasma and Corticosteroid Injection Therapies in Improving Pain and Shoulder Functions in Subacromial Impingement Syndrome

Acromial morphology and morphometry associated with subacromial impingement syndrome.

Acromion is a major associated structure of subacromial impingement syndrome, one of the most common diagnoses in chronic shoulder pain world-wide. The aims of this study are to study morphometry of acromion and to find risk group using acromial morphometry. Total samples were 392 scapulae. The samples were of both sexes, ranging from the age of 31 to 90. Acromion type and osteophytes were observed. Acromial parameters were measured. The relationships were analyzed among acromion type, acromial osteophyte, acromial parameters, age group, sex and side. Curved acromion had the highest prevalence in all age groups. Hooked acromion had the second highest prevalence since the age of 41. Hooked acromion prevalence was higher in male than in female. The highest prevalence of acromial osteophytes was on anteroinferior surface in all age group. The prevalence of acromial osteophytes on anteroinferior surface and acromial facet increased with age. In addition, acromion type was associated with only osteophytes on anteroinferior surface of acromion. Anterior one-third acromial thickness in the age of 31 to 50 was different from those of 51 to 90. There are differences between all parameters and sexes, but not side. General population with age above 50 and concerned male group with age above 40 who have chronic shoulder pain should be investigated for subacromial impingement syndrome. Surgical treatment is recommended because hooked acromion and osteophytes are mostly the root of problem.

Chronic subacromial impingement leads to supraspinatus muscle functional and morphological changes: Evaluation in a murine model.

Muscle atrophy and fatty infiltration have been directly correlated with higher rates of incomplete or failed healing following surgical repair of the rotator cuff. The purpose of this study was to evaluate clinically relevant functional and morphological changes in the supraspinatus muscle at various time points in this model of rotator cuff tendinopathy. Subacromial impingement was induced in 47, male C57BL/6 mice (total 94 limbs) by implantation of a metal clip in the subacromial space. Specimens were evaluated at 4, 6, and 12 weeks postoperatively. Gait analysis was used to measure various kinematic parameters. Supraspinatus muscle wet weight, histology, and quantitative reverse-transcription polymerase chain reaction analysis of genes related to muscle atrophy and adipogenesis were performed to characterize the structural, cellular, and molecular changes. Muscle atrophy and fatty infiltration was evident beginning at 6 weeks, with progression out to 12 weeks. Gait analysis identified significant functional changes in many aspects of gait and abnormal stance tracing as early as 4 weeks, verifying alterations in upper extremity function. We have demonstrated that clinically relevant changes to the supraspinatus muscle are seen starting 6 weeks after induction of subacromial impingement. Furthermore, the gait analysis provides key functional outcome measurements that may be useful for future evaluation of new therapeutic strategies.

The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review.

(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.

Collagens in primary frozen shoulder: expression of collagen mRNA isoforms in the different phases of the disease.

Primary frozen shoulder (pFS) has three phases that differ in clinical presentation. It is characterized by contracture of the joint capsule. We hypothesized that there is a general upregulation of collagens in pFS, and that this is highest in the first phase of the disease. The aims of this study were to investigate the expression of various collagens and degradation of collagens in patients with primary pFS and relate this to the three phases of the condition. From twenty-six patients with pFS and eight control patients with subacromial impingement, biopsies were obtained during shoulder arthroscopy from the middle glenohumeral ligament and the anterior capsule, and mRNA levels for collagens, MMP-2 and -14 and TGF-β1, - β2 and -β3 in the tissue were analysed using real-time PCR. Genes for collagens type I, III, IV, V, VI and XIV, were activated in pFS, and the total mRNA for all collagens was increased (P<0.05). This upregulation was independent of disease phases in pFS. In addition, MMP-2, MMP-14, TGF-β1 and TGF-β3 were upregulated in all phases of the disease. There is a general upregulation and an increased degradation of collagens in pFS in all three phases of the disease. This indicates a constantly increased turnover of the fibrotic tissue in the capsule from pFS. The difference in clinical presentation of pFS observed in the three phases of the disease is not primarily a result of variations in collagen production.

Comparing Efficacy of Shoulder Ultrasound and Magnetic Resonance Imaging in Shoulder Impingement.

Background: Shoulder impingement syndrome is the most frequent cause of shoulder pain. Ultrasonography (US) and magnetic resonance imaging (MRI) have pivotal role for diagnosing shoulder impingement and rotator cuff pathologies. There are several advantages of US; being a dynamic form of imaging as compared to the static MRI, it is portable, better tolerated by the patient, less time consuming, less expensive and more readily available. Aim: The aim of this study is to compare the efficacy of US and MRI in diagnosis of shoulder impingement, using MRI as a reference standard. Methods: Thirty patients with clinical diagnosis of subacromial impingement were imaged by both US and MRI in the department of Radiology at Benha University Hospitals. The findings of the 2 modalities were recorded and compered. Results: There was no statistically significant difference found between MRI & US regarding supraspinatus tendon pathology and non-rotator cuff pathology (P> 0.05). US showed a sensitivity, specificity, PPV, NPV and accuracy of 100% for each in diagnosing full thickness tear of supraspinatus tendon using MRI as reference. For partial thickness tears, it showed a sensitivity of 80%, specificity of 95%, PPV of 88.9%, NPV of 90.5 % and accuracy of 90%.Conclusion: US is comparable to MRI in evaluation of shoulder impingement syndrome and rotator cuff tears, particularly more accurate in full thickness tears. Since US is less expensive and more available, with advantage of dynamic real time assessment, it could be used as the first line investigation in patients presenting with shoulder pain.

Effects of Ultrasound-Guided Peritendinous and Intrabursal Corticosteroid Injections on Shoulder Tendon Elasticity: A Post Hoc Analysis of a Randomized Controlled Trial

ObjectivesThe study aimed to investigate whether the shoulder tendons changed their elasticity after ultrasound-guided peritendinous or intrabursal corticosteroid injections. DesignPost hoc secondary analysis of a double-blinded, randomized controlled study with 3 months of follow-up. SettingOutpatient rehabilitation clinic. ParticipantsPatients with subacromial impingement syndrome (N=60). InterventionsPatients with unilateral shoulder pain were randomly assigned to receive standard ultrasound-guided subacromial or dual-target corticosteroid injections. The supraspinatus tendons were exposed to 40 mg triamcinolone acetonide in the formal group, whereas the long head of the biceps brachii tendons (LHBT) and supraspinatus tendons were individually infiltrated by 20 mg triamcinolone acetonide in the latter group. Patients’ bilateral shoulders were divided into group 1 (n=30, receiving standard subacromial injections), group 2 (n=30, receiving dual-target injections), and group 3 (n=60, without injections). Main Outcome MeasuresStrain ratio of LHBT and supraspinatus tendons using ultrasound elastography. ResultsThe repeated-measures analysis of variance revealed no intragroup difference of the strain ratio of the LHBT (P=.412 for group 1, P=.936 for group 2, P=.131 for group 3) and supraspinatus tendon (P=.309 for group 1, P=.067 for group 2, P=.860 for group 3) across the 3 time points. Treating group 3 as the reference, the linear mixed model revealed no significant changes in tendon elasticity after either the standard subacromial injection (P=.205 for the LHBT and P=.529 for the supraspinatus tendon) or the dual-target injection (P=.961 for the LHBT and P=.831 for the supraspinatus tendon). ConclusionsElasticity of the LHBT and supraspinatus tendons is unlikely to change after a single dose of peritendinous or intrabursal corticosteroid injections. Future studies with a shorter follow-up interval are needed to validate whether corticosteroid injections can cause transient changes of the tendon’s elasticity.

Bicipital groove cross-sectional area on ultrasonography: Does a correlation to intra-articular tendon pathology exist?

BackgroundThe etiology and relevance of long head of biceps tendon (LHBT) pathology is debated. As it can have important therapeutic consequences and physical examination can be misleading, various morphologic parameters have been described to try to predict it. HypothesisWe hypothesized that bicipital groove cross-sectional area (CSA), as assessed by ultrasonography, could be related to intra-articular tendon pathology. Material and methodsFifty-eight consecutive consenting patients who underwent arthroscopic shoulder surgery at our hospital were selected. Diagnosis consisted mainly of rotator cuff tears, but also of anterior instability and subacromial impingement. Before surgery, ultrasonography was performed to measure width, depth and cross-sectional area of the bicipital groove. LHBT pathology was assessed during arthroscopy and classified as tendinopathy, partial disruption or complete tear and correlated to the ultrasonography measurements. ResultsBicipital groove width was of 6.7±1.2mm in patients with a normal LHBT and 7.3±1.9mm with patients with an abnormal LHBT (p=0.234). Bicipital groove depth was of 3.5±0.5mm in patients with a normal LHBT and 3.7±1.1mm with patients with an abnormal LHBT (p=0.251). Bicipital groove CSA was of 16.6±4.5 mm2 in patients with a normal LHBT and 19.1±7.1 mm2 with patients with an abnormal LHBT (p=0.108). ConclusionOur results do not support any correlation between LHBT pathology and the bicipital groove CSA, even though this measurement, as its width and depth, are somewhat higher in patients with a LHBT injury. Level of evidenceI; diagnostic study.

Efficacy of low-level laser therapy combined with exercise for subacromial impingement syndrome: A randomised controlled trial

Objective: To investigate the effect of low-level laser therapy (LLLT) combined with exercise on shoulder pain and disability in patients with subacromial impingement syndrome (SIS). Design: Randomised controlled trial. Setting: Pontifical Catholic University. Subjects: We enrolled 120 subacromial impingement syndrome patients Intervention: Groups I (n = 42), II (n = 42) and III (n = 36) were treated with Low-level laser therapy and exercise, exercise only and Low-level laser therapy only, respectively. Interventions were conducted three times a week for 8 weeks. Main outcome measures: The primary outcome was the change in shoulder pain and disability index (SPADI). Secondary outcomes included changes in the numeric pain rating scale and medication intake. Results: Average ages of patients in groups I, II and III were 51.9 ± 8.7 years, 56.0 ± 10.4 years and 54.2 ± 7.1 years, respectively. Pain scores at baseline (P = 0.829), 2 months (P = 0.057) and 3 months follow-ups (p = 0.004) were 6.8 (4.7–7.7), 0.2 (0.0–0.5) and 0.3 (0.0–1.0) for group I; 6.6 (5.7–8.0), 0.5 (0.2–2.0) and 0.2 (0.0–3.3) for group II; and 6.5 (5.1–7.4), 2.4 (0.1–6.7) and 4.0 (2.0–5.0) for group III, respectively. SPADI scores at baseline (P = 0.029), 2 months (P < 0.001) and 3 months follow-ups (P = 0.001) were 60.8 (37.7–70.8), 3.8 (0.0–10.8) and 2.3 (0.8–10.8) for group I; 61.5 (41.5–71.5), 9.2 (3.8–29.2) and 14.2 (1.5–38.0) for the group II; and 73.3 (59.2–80.8), 34.2 (16.9–54.6) and 33.1 (22.3–49.2) for the group III, respectively. Conclusion: Low-level laser therapy combined with exercises reduce pain intensity, improve shoulder function and reduces pain intensity and medication intake over 3 months. Clinical Trial Registration number: NCT 02725749

Short Term Effectiveness of Intraatricular Injection of Methylprednisolone Acetate in Subacromial Impingement Syndrome in a tertiary care hospital.

Objective: To determine mean decrease in VAS pain score of intraarticular injection of methyl prednisolone acetate in patients of subacromial impingement syndrome. Methods: Its Descriptive Case Series/ Quasi experimental study. Study was conducted in department of Orthopedics Unit- I, Jinnah hospital Lahore. Study completed in Six months i.e. from June 2014 to December 2014.After taking an informed consent, 70 newly diagnosed cases of Subacromial impingement syndrome by history and examination (described by the patient as pain in subacromial space when the humerus was elevated or internally rotated and tested by having the patient place his hand on the unaffected shoulder and gradually forward flexing the shoulder (positive impingement sign)which have not received any kind of treatment were included. Results: Effectiveness of intraarticular injection of methyl prednisolone acetate was measured on visual analogue scale (VAS) from 0 to 10 by VAS score after 6 weeks. 70 patients with mean age of 36.2 ± 10.6 years were included. 61 patients (75.7%) were male, 10 patients (14.3%) had gout and 20% were diabetic. Mean pretreatment VAS score was 5.03 ± 1.58 while mean post-treatment VAS score was 3.86 ± 0.839. Mean reduction was 1.17 ± 1.57 ranged from 2 to 6. There was non-significant association of age and diabetes with mean reduction in VAS score while female gender and gout were significantly and negatively associated with treatment outcome. It is concluded that mean reduction in VAS score after 6 weeks of treatment of subacromial impingement syndrome after intra articular methylprednisolone injection is 1.17 ± 1.57 and acceptable. Conclusion: It is concluded that intraatricular injection of methyl prednisolone injection is efficacious and effective for treatment of Subacromial impingement syndrome in Pakistani population. Keyword: subacromial impingement syndrome, intra articular methylprednisolone injection, visual analogue scale, effectiveness.

CORRELATION BETWEEN THE KERLAN-JOBE ORTHOPEDIC CLINIC SCREEN AND SUBACROMIAL IMPINGEMENT TEST-ITEM CLUSTER IN COLLEGIATE BASEBALL PITCHERS: A PILOT STUDY.

Shoulder injuries in baseball related to throwing account for 60% of all baseball injuries and 75% of those throwing injuries occur in pitchers. Impingement is the beginning of a continuum of rotator cuff pathology that can result in pain and disability in pitchers. Identification of self-reported measures and clinical tests that can indicate early pathology of shoulder impingement is needed for overhead athletes. Early identification of shoulder impingement is important to the long-term health and function of these athletes. The purpose of this study was to determine if a correlation exists between self-reported pain and disability using the Kerlan-Jobe Orthopedic Clinic (KJOC) score and the Park Test-Item Cluster (TIC) for subacromial impingement in college baseball pitchers. The research hypotheses are that there will be a correlation 1) between the KJOC score and the TIC by Park and 2) between the KJOC and the Hawkins-Kennedy impingement, the painful arc, and the infraspinatus muscle strength tests individually. Cross-sectional pilot study. Twenty-one collegiate baseball pitchers completed the KJOC and then were tested using the Park test-item cluster. Kruskal-Wallis was used to test the relationship of individual demographics with KJOC scores. Spearman rho correlation was used to determine if the number of positive clinical tests in the Park TIC or with the individual tests within the TIC correlated with scores on the KJOC. No significant relationships between KJOC scores and demographics were found. A significant moderate-to-good relationship was found between the painful arc test and the KJOC (r = -.601, p = 0.00) and a significant fair correlation was found between the number of positive tests within the Park TIC and KJOC (r = -.426, p = 0.05). No significant relationships were found between the Hawkins-Kennedy and KJOC (r = -.348, p = 0.12) or between the infraspinatus strength test and KJOC (r = -.040, p = 0.86). The correlations between the painful arc test and the number of positive impingement tests with the composite score on the KJOC suggests a relationship between these two outcome measures, shoulder irritability, and decreased function in collegiate baseball pitchers. Of the three tests included in the Park TIC, the painful arc test was the only one with an independent significant correlation to the KJOC. The combination of impairment-specific cluster testing and an activity-focused self-assessment tool could be utilized to identify potential pathology and alert the medical professional that assessment and intervention are necessary. Level 2 (Diagnosis).

Surgical management of 2- or 3-part proximal humeral fractures: comparison of plate, nail and K-wires

BackgroundProximal humeral fractures (PHFs) are fairly common injuries, and their treatment is a challenge. The aim of this study is to compare clinical and functional outcomes of different osteosynthesis techniques.Materials and methodsWe retrospectively reviewed patients’ files and the hospital’s digital database between March 2002 and April 2018. We treated surgically 148 patients with 2- and 3-part PHFs: 64 with plate and screws, 53 with intramedullary nailing and 31 with retrograde K-wires. We constituted three groups according to the type of treatment and two subgroups for each according to the number of fragments (Neer II or Neer III). Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-12 (SF-12) scores were recorded.ResultsMean DASH and SF-12 scores both from the group treated with plate (Group I) and the one subjected to intramedullary nailing (Group II) were statistically superior to results from the patients treated by retrograde K-wires (Group III), while nails showed better functional results than the locking plates. In the first two groups, no difference was found between Neer II and III subgroups, while in Group III the DASH scores were significantly better in Neer II subgroup than those in Neer III subgroup. Avascular necrosis was the most frequent cause of revision surgery in Group I (4 cases) where we had 8 cases of reintervention (12.5%). In Group II, the subacromial impingement was the only cause for revision surgery with 3 cases (5.6%).ConclusionsIntramedullary nails showed better functional results and a lower complication rate than the locking plates. Both techniques showed superior results compared to those available with retrograde K-wires. So the nail seems to be a more reliable and adequate method for treating 2- and 3-part proximal humeral fractures.

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

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

Third-generation intramedullary nailing for displaced proximal humeral fractures in the elderly: quality of life, clinical results, and complications.

Antegrade insertion of third-generation intramedullary nail (IMN) has been shown to provide excellent results in young patients for treatment of displaced two-part surgical neck fracture. In elderly patients, osteoporosis makes internal fixation problematic and frequently contributes to failed fixation and poor clinical results. The purpose of this study was to report the health-related quality of life (HRQoL), functional results, and postoperative complications obtained with straight third-generation antegrade nailing of proximal humerus fractures (PHFs) in elderly patients. A retrospective review of 32 patients aged 80 y.o. or older presenting a two-part or three-part PHFs treated with a straight IMN with a minimum follow-up of 12months. Results assessed included 1) radiographic measures 2) clinical data: Charlson Comorbidity Index (CCI), VAS, range of motion (ROM), Individual Relative Constant score (IRC), Simple Shoulder Test (SST) and 3) Health-related Quality of life (HRQoL) with the EQ-5D index/EQ-VAS. Mean age was 82.1 (range 80-90) and mean follow-up was 45.6months (range 16-53months) with 91% of female patients and a mean CCI 4.6. 81% were two-part surgical neck fractures and 19% were three-part greater tuberosity fractures. The mean neck-shaft angle (NSA) at final follow-up was 132º ± 17.9º. 15.6% underwent hardware removal because of subacromial impingement and one patient (3%) was revised to RSA because of severe secondary fracture displacement. Mean IRC was 67,7 ± 30, the mean SST and VAS-Pain were 8.1 ± 3.1 and 3.2 ± 3.2, respectively, and the mean EQ-5D/EQ-VAS were 0.40 ± 0.33/64.2 ± 8.9. At last review, mean active forward flexion, abduction, and external rotation were 115º ± 35º, 100º ± 35º, and 20º ± 15º, respectively. Appropriate selection of fracture and proper operative technique with a third-generation nail result in good functional results and good HRQol with a low complication rate in elderly population.

Long-Term Clinical and Radiological Results After Hook Plate Osteosynthesis of Lateral Clavicle Fractures.

To assess both clinical and radiological long-term outcomes after hook plate osteosynthesis for Neer type II lateral clavicle fractures. Retrospective case series. Level-1 trauma center. Patients who underwent open reduction internal fixation with a hook plate for displaced fractures of the lateral third of the clavicle (Neer type II) at a single trauma hospital were identified. Lateral clavicle open reduction internal fixation with a hook plate. At the first of 2 long-term follow-up appointments, bilateral magnetic resonance imaging (MRI) scans and strength measurements were performed, Constant-Murley score, subjective shoulder value (SSV), and Oxford shoulder score (OSS) of both shoulders were obtained. At the second follow-up, specific acromioclavicular (AC) score, SSV, and OSS were obtained. Twenty-one patients (mean age, 29.5 ± 9.7 years) could be included who were available for at least 1 of 2 follow-ups after 7.4 years (±2.3) and 13.9 years (±2.2). Bony union was achieved in all patients (100%) at an average of 3.4 months (±1.4). The hook plate was removed at an average of 5.5 months (±3.3) after initial surgery in all patients. No significant side-to-side differences were found in OSS, Constant-Murley score, SSV, and specific AC score and for strength testing and MRI scans. Long-term outcome after hook plate fixation of Neer type II lateral clavicle fractures demonstrated good clinical results and shoulder strength without higher radiographic rates of AC joint osteoarthritis, subacromial impingement, or rotator cuff lesions. That may be related to a standardized early plate removal after bony fracture union. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of the effect of two different types of dry-needling techniques on subacromial impingement syndrome

IntroductionInfraspinatus is one of the main muscles that is involved in the subacromial impingement syndrome. Dry needling and routine physical therapy can improve this syndrome. However, the dry needling technique is not well defined. Designrandomized controlled clinical trial, single-blind study. MethodSixty-six patients diagnosed with shoulder impingement syndrome were recruited and randomly divided into three groups. InterventionsIn 1st group; patients received deep dry needling technique in addition to routine physical therapy, in Hong's group; patients received Hong's dry needling technique in addition to routine physiotherapy and in third group; patient just received routine physical therapy. Main outcome measure(s)Before, immediately after and 4 weeks after the intervention, pain, disability and the pressure pain threshold were measured. ResultsThe findings of this study indicated that in DDN group, pain and disability reduction was significantly more than two other groups. Although, the pressure pain tolerance increased in all three groups after treatment, but the increase between groups was not significantly different. All study groups showed reduction in pain, while there was no significant difference between the three groups. ConclusionPain and disability reduction in the DDN group compared to the other two groups may reveal the treatment with deep dry needling technique along with routine physiotherapy is more effective than receiving dry needling with Hong's technique or routine physiotherapy alone. However, there was no significant difference between the three groups in pressure pain tolerance threshold and pain reduction.

The Impact of Myofascial Shoulder Pain on Hopelessness State among Women in Turkey

One of the major complaints of patients for consulting primary healthcare providers is shoulder pain. The most common causes of this problem are subacromial impingement syndrome (SIS). The aim of the current study was to evaluate the hopelessness status of women with myofascial shoulder pain and to compare them with women suffering from traumatic pain. The prospective study design was used in the current study, 60 women were assigned equally to Myofascial group (group M), a group where women complain of shoulder pain, palpable, and tender myofascial trigger points, and 30 women who sustained traumatic shoulder pain in the control group (group T). Beck Hopelessness Scale was used to detect the hopelessness level. Mann Whitney U test was used for statistical analysis. P <0.05 was considered significant. The results showed that the mean was a statistically significant difference between the groups regarding hopelessness state (7.4) for the myofascial group and (3.8) for the traumatic group, P <0.05. Hopelessness status of women with myofascial shoulder pain should be acknowledged because women may need social and psychological support in addition to medical treatment to overcome their complaints.