Supraspinatus Tendon Thickness Research Articles

The Prevalence of Shoulder Disorders among Professional Bullfighters: A Cross-Sectional Ultrasonography Study.

We aimed to investigate clinical and ultrasound signs of shoulder overuse injuries in professional bullfighters; side-to-side differences (dominant vs. non-dominant); and to determine potential differences according to bullfighters’ categories. An observational cross-sectional study was conducted. Thirty professional and active bullfighters were assessed. A bilateral ultrasound assessment of the subacromial bursa, long biceps head tendon (LHBT), and rotator cuff was performed to determine the presence of bursitis, subluxation, partial or total tendon rupture, tenosynovitis, or calcification. Supraspinatus tendon thickness was measured. Finally, a battery of clinical orthopedic tests (Yergason, Jobe, infraspinatus, Gerber, and bursa tests) were also performed. Most identified ultrasound findings were located in the dominant side, being the presence of bursitis (n = 9; 30%), LHBT tenosynovitis (n = 8; 26.7%), and subscapularis tendon calcification (n = 5; 16.7%) the most prevalent. No side-to-side or between-categories differences were found for supraspinatus tendon thickness (all, p > 0.05). The most frequent positive signs were the infraspinatus test (40.0%), Gerber lift-off test (33.3%), and bursitis, Jobe, and Yergason tests (all, 26.7%). Ultrasound signs were commonly found at LHBT, subacromial bursa, and rotator cuff in professional bullfighters without difference between categories and sides. No side-to-side or between-categories differences were found. Positive clinical test signs suggestive of bursitis, LHBT, and rotator cuff tendinopathy were frequently observed.

To determine the role of ultrasonography as a primary imaging modality as compared to MRI in patients with shoulder pain.

ABSTRACTContext:Prevalence of shoulder pain in general population worldwide ranges from 16 -26%. It is necessary to evaluate different causative factors in shoulder pain and explore the utility of ultrasonography in rotator cuff and non-rotator cuff diseases as a primary imaging modality and reserve MRI for unequivocal casesAims:To evaluate patients with shoulder pain using ultrasound as first line of imaging modality compared to MRI.Methods and Material:A Prospective Cross-sectional Descriptive and Analytical study was done in patients with shoulder pain referred to radiology department for USG and MRI.Statistical Analysis Used:Analysis was performed using STATA (14.2). Descriptive statistics was used to portray baseline profile of study population. Sensitivity, specificity, PPV, NPV and Kappa value usedResults:In the resent study the maximum patients were between 40-59 years with Male: Female ratio of 3.5:1. Trauma was the most common etiological factor and restricted range of motion was seen in 47 (94%). Supraspinatus tendon was the most common tendon to show abnormality followed by Subscapularis. For Supraspinatus tendon and Subscapularis tendon partial thickness tear- USG had a sensitivity of 90.62% and 100%, specificity of 88.88% and 95.74%, PPV of 93.5% and 60.00% and NPV of 84.21% and 100% respectivelyConclusion:Ultrasound although being operator dependent and not as accurate as MRI, provides rapid real time non-invasive cross-sectional imaging of joint and thus can be considered as primary modality for imaging rotator cuff pathologies, as it is readily available and cost effective.

Supraspinatus tendon thickness and subacromial impingement characteristics in younger and older adults

BackgroundSubacromial impingement (SAI) may be a cause of age-related rotator cuff abnormalities; therefore, the purpose of this study was to compare SAI characteristics between younger and older adults. In addition to the fact that thickened supraspinatus tendon (SST) indicates tendon abnormalities, SAI characteristics have been recognized as follows: greater SST thickness, reduced acromiohumeral distance (AHD), greater reduction of AHD (∆AHD) with arm elevation, and a higher percentage of SST within AHD (i.e., occupation ratio: OcAHD). Furthermore, we investigated the relationships between SST thickness and AHD, as well as SST thickness and ∆AHD to clarify the effect of SAI on rotator cuff abnormalities.MethodsHealthy younger (n = 18, 21–24-year-old) and older (n = 27, 45–80-year-old) adults without any shoulder symptoms participated in this study. We measured their SST thickness and AHD at rest and at arm elevation (30° and 60°) in the scapular plane using ultrasound, and calculated ∆AHD as the relative change expressed as a percentage of the baseline. OcAHD was expressed as the ratio of SST thickness at rest to AHD at rest and in elevated positions.ResultsThe older subjects had approximately one mm thicker SST (P = 0.003, 95% Confidence interval [CI] = 0.410 to 1.895) and approximately 1.0 to 1.3 mm greater AHD than the younger subjects (P = 0.011, 95%CI = 0.284 to 2.068 at rest; P = 0.037, 95%CI = 0.082 to 2.609 for 30° of arm elevation; P = 0.032, 95%CI = 0.120 to 2.458 for 60° of arm elevation). However, there were no differences in ΔAHD and OcAHD between the groups.ConclusionThis study demonstrated that, compared with the younger subjects, the older subjects showed thicker supraspinatus tendon but no other SAI characteristics including decreases in AHD and increases in OcAHD. Thus, this study suggests that older subjects showed age-related SST abnormalities without SAI, although the magnitude of the differences in SST thickness is notably small and the clinical significance of this difference is unclear.

Functional and morphological changes in shoulder girdle muscles after repeated climbing exercise

ABSTRACT This study aimed to investigate the acute effect of repeated climbing actions on functional and morphological measures of the shoulder girdle. Fifteen male indoor climbers participated in this study. All the climbers declared route level 6a+, as the best climbing grade (French climbing grade scale). Functional (range of motion – ROM and muscle strength), and morphological measurements (muscle/tendon stiffness and thickness) after a repeated climbing exercise protocol were analysed. The ROM and muscle strength showed significant decreases from baseline to Immediate-Post (IA) as well as significant increases from IA to 1 h-Post for all movements (p ≤ .001 for all). Muscle stiffness showed significant increases from baseline to IA after as well as significant decreases from IA to 1 h-Post for all muscles (p ≤ .001 for all). However, the thickness showed significant increases from baseline to IA for supraspinatus tendon and muscle thickness and occupation ratio (p ≤ .001 for all), while a significant decrease was observed in acromiohumeral distance (p ≤ .001). Significant decreases from IA to 1 h-Post were found for muscles/tendons and occupation ratio (p ≤ .001 for all), while a significant increase for AHD (p ≤ .001). Our data demonstrated acute alterations in tendon thickness due to acute signs of implement symptom in climbers.

Shoulder Tendon Adaptations Following a Graded Exercise Test to Exhaustion in Highly Trained Wheelchair Rugby Athletes With Different Impairments.

ObjectiveThis study aimed to identify acute changes in biceps and supraspinatus tendon characteristics before and after a graded exercise test to exhaustion (GXT) in highly trained wheelchair rugby (WR) athletes. A secondary aspect was to define chronic tendon adaptations related to the impairment of the athlete and the occupation of the tendon within the subacromial space (occupation ratio).MethodsTwelve WR athletes with different impairments (age = 32 ± 6 years; body mass = 67.2 ± 11.2 kg; 9.0 ± 3.6 years competing) volunteered for this study. Performance Corrected Wheelchair Users Shoulder Pain Index was used to quantify shoulder pain. Quantitative Ultrasound Protocols (QUS) were used to define supraspinatus and biceps tendon thickness, echogenicity, and echogenicity ratio of both dominant and non-dominant shoulder before and after the GXT including 22 ± 3.1 min submaximal propulsion and 10.2 ± 1.7 min maximal propulsion on a treadmill. Furthermore, the acromio-humeral distance (AHD) defined from ultrasound (US) images was used to calculate the occupation ratios.ResultsA mixed-effect multilevel analysis that included shoulder as grouping variable, demonstrated a significant reduction in the echogenicity of the biceps following GXT whilst controlling for impairment [spinal cord injury (SCI) and non-SCI] and the occupation ratio (β = −9.01, SEβ = 2.72, p = 0.001, 95% CI = [−14.34; −3.68]). This points toward fluid inflow into the tendon that may be related to overload and acute inflammation. In addition, persons with a SCI (n = 8) had a thicker supraspinatus tendon in comparison to persons with non-SCI (n = 3) which may be related to chronic tendon adaptations (β = −0.53 mm, SEβ = 0.26, p = 0.038, 95% CI = [−1.04; −0.03]). Finally, a greater occupation ratio was associated with signs of tendinopathy (i.e., greater biceps and supraspinatus tendon thickness, and lower supraspinatus echogenicity and echogenicity ratio).ConclusionAcute biceps tendon adaptations in response to the GXT in highly trained WR athletes were evident with chronic adaptations in the supraspinatus tendon being related to the impairment of the athlete. Ultrasound can be used to monitor tendon adaptations in WR athletes for medical diagnosis to assist the scheduling and type of training.

Temporospatial parameters, shoulder kinematics, and acute tendon changes in four different stroke patterns in male wheelchair users with spinal cord injury.

Manual wheelchair propulsion causes shoulder tendon pathologies in wheelchair users with spinal cord injury. Four different wheelchair stroke patterns can cause varying amounts of acute changes in the shoulder tendons. To evaluate and compare acute changes in the supraspinatus and biceps tendons and acromiohumeral distance (AHD) after propulsion between different stroke patterns in individuals with spinal cord injury. In addition, to associate tendon changes with demographic and biomechanical characteristics. Prospective and comparative study between four groups. Tertiary rehabilitation hospital. Male wheelchair users with spinal cord injury. Participants were divided into four groups according to stroke pattern (arcing, semicircular [SC], single-loop [SL], and double-loop [DL]), in which they used their wheelchair on a motorized treadmill at a speed of 1m/s. A sample of 40 people was created, 10 in each group. All participants performed a propulsion test. Temporospatial variables and shoulder kinematics were analyzed. Supraspinatus tendon thickness (SSTT), long head of biceps tendon thickness (LHBTT), and AHD were measured before and after the propulsion test. SC pattern had lower cadence and larger contact angle. A reduction in SSTT and LHBTT in arcing pattern, LHBTT and AHD in SC pattern, and LHBTT in DL pattern was observed (all p < .05). However, SL pattern did not differ significantly in all ultrasonographic measurements (all p > .05). Body mass index was associated with a decrease in SSTT. Age and number of daily push-ups were associated with a decrease in AHD. Fewer tendon changes after the propulsion in the SL pattern suggested that the supraspinatus and biceps tendons were preserved in this pattern. The SL pattern may be a better choice for male wheelchair users with supraspinatus and biceps tendon pathologies.

Shoulder abduction strength is correlated with acromiohumeral distance in patients with acute subacromial impingement syndrome symptoms but not with supraspinatus tendon thickness regardless of disease stage

We aimed to investigate the relationships of isometric and eccentric shoulder abduction strength with acromiohumeral distance and supraspinatus tendon thickness based on the disease stage in patients with subacromial impingement syndrome. Eighty-two patients with subacromial impingement syndrome were assessed. Acromiohumeral distance and supraspinatus tendon thickness were measured using ultrasonography. Isometric and eccentric shoulder abduction strength were measured with a hand-held dynamometer. Spearman’s correlation coefficients were calculated. Isometric (rho = 0.428, p=.021) and eccentric (rho = 0.487, p=.007) shoulder abduction strength showed moderate correlations with acromiohumeral distance in patients with acute symptoms (n = 29). There was no relationship between acromiohumeral distance and abduction strength in patients with chronic symptoms (n = 53) (p&amp;gt;.050). Supraspinatus tendon thickness showed no significant correlation with abduction strength (p&amp;gt;.050). These findings suggest that the relationship between acromiohumeral distance and abduction strength differs according to disease stage. However, supraspinatus tendon thickness was not correlated with abduction strength regardless of disease stage. In patients with acute subacromial impingement syndrome symptoms increasing shoulder abduction strength may be a potential strategy to improve acromiohumeral distance.

Acromiohumeral distance and supraspinatus tendon thickness in people with shoulder impingement syndrome compared to asymptomatic age and gender-matched participants: a case control study

BackgroundShoulder impingement syndrome (SIS) is the most common form of shoulder pain. Conservative and surgical treatments for SIS are often not effective. One such surgical intervention is subacromial decompression, aimed at widening the subacromial space (SAS). A better understanding of the changes in the SAS may help explain the relative ineffectiveness of current interventions.Objective: To measure the acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT) in people with SIS using a case control study.MethodsThe AHD and STT of 39 participants with SIS ≥3 months and 39 age, gender and dominant arm matched controls were measured using ultrasound imaging. Between-group differences for AHD and STT were compared using t-tests. A linear regression was used to determine if there was a relationship between AHD and STT measures, with group as a covariate.ResultsCompared to controls (mean age 55.7 years, SD 10.6), individuals with SIS (mean age 57.1 years, SD 11.1) had a significantly larger AHD (mean difference 2.14 mm, 95% CI 1.21, 3.07, p < 0.001) and STT (mean difference 1.25 mm, 95% CI 0.60, 1.90, p < 0.001). The linear regression model indicated an association between AHD and STT (β = 0.59, 95% CI 0.29, 0.89, p < 0.01, R2 = 0.35, n = 78), suggesting that as STT increases in size, so does the AHD.ConclusionIndividuals with SIS had a larger AHD and greater STT than controls. These results suggest the SAS is already wider in people with SIS and that the symptoms associated with SIS may be more related to an increased STT than a smaller SAS.

Changes in shoulder outcomes using ultrasonographic assessment of breast cancer survivors: a prospective longitudinal study with 6-month follow-up

This study aimed to describe changes in supraspinatus tendon thickness, acromiohumeral distance, and the presence of fluid in the subacromial bursa as measured by ultrasound, as well as shoulder range of motion and strength, perceived shoulder disability, and health-related quality of life in women before and after breast cancer treatment. Women who underwent surgery for unilateral breast cancer who did not suffer from shoulder pain or difficulty performing activities of daily living in the 6 months prior to surgery were included. One pre-surgical (A0) and three post-surgical assessments at 7–10 days (A1), 3 months (A2), and 6 months (A3) after surgery were carried out. The thickness of the supraspinatus tendon on the affected side decreased between post-surgical (A1) and 6-month (A3) follow-up assessments (p = 0.029), although the minimal detectable change was not reached. The active range of motion of the affected shoulder decreased after surgery. Strength changes were observed in both shoulders after surgery. The intensity of shoulder pain increased between post-surgical and 6-month follow-up assessments. Shoulder function was decreased at the post-surgical assessment and increased throughout the follow-ups. Health-related quality of life declined after surgery. A trend of decreasing thickness of the supraspinatus tendon of the affected shoulder was observed. Detecting these possible structural changes early would allow for early or preventive treatment.

Platelet-rich Plasma and Its Application in Clinical Trial

Platelet-rich Plasma and Its Application in Clinical Trial

Supraspinatus Tendon Changes and Glenohumeral Range of Motion in College Baseball Players.

Baseball players commonly show altered glenohumeral range of motion during internal rotation, external rotation, total rotation, and horizontal adduction. These altered ranges of motion appear to be associated with throwing shoulder injuries, which frequently involve the supraspinatus tendons; thus, we aimed to examine the relationship between altered glenohumeral range of motion and supraspinatus tendon changes in collegiate baseball players. To investigate this association using the Pearson correlation coefficient, we measured glenohumeral internal rotation, external rotation, total rotation, and horizontal adduction ranges of motion and supraspinatus tendon thickness in 22 college baseball players. Consequently, there was a significant relationship between increase in supraspinatus tendon thickness and greater deficit of internal rotation (r=-0.520, P=0.013). Increased supraspinatus tendon thickness tended to be associated with greater external rotation gain (r=0.394, P=0.073). No other range of motion had any relationship with supraspinatus tendon changes. These results might indicate that restricted glenohumeral internal rotation and excessive gain in external rotation increase the risk of supraspinatus tendon abnormalities in baseball players.

The fate of sutures post rotator cuff repair

Ultrasonographic imaging has been widely used as a diagnostic tool for rotator cuff tears. Several studies have explored the changes in rotator cuff tendon morphology after arthroscopic cuff repair; however, none have addressed the fate of sutures. The aim of this study was to determine (1) if the sutures migrate through the tendon during the postoperative healing period in patients who have had arthroscopic rotator cuff repair; (2) if the sutures do migrate, the time point at which it does; and (3) if the quality of the tendon, in terms of tendon stiffness, modulus of elasticity, bursal thickness, and anatomic footprint, affects suture migration. This was a prospective study involving 21 patients who had primary arthroscopic rotator cuff repair performed by a single surgeon. All patients were assessed at 8 days, 6 weeks, 12 weeks, and 24 weeks postrepair; during each assessment, patients underwent an ultrasonographic examination (using a Siemens ACUSON S3000 ultrasonographic system, following a standardized protocol), where supraspinatus tendon thickness and thickness of tendon tissues below and above the suture were measured. Measurements of anatomic footprint, bursal thickness, tendon stiffness, and modulus of elasticity were obtained to assess tendon quality. Of the 21 participants, 14 (67%) had full-thickness tears and 7 (33%) had partial-thickness tears. Between the 12th- and 24th-week follow-up, 2 patients' tendons were found to be not intact. Within the first 12 weeks of the postrepair healing period, the sutures migrated inferiorly, through to the middle of the tendon at the footprint-articular junction (ie, ratio of tendon tissue thickness below the suture to the total tendon thickness = 0.5) (P = .03). The mean anatomic footprint increased from 8.4 ± 1.6 mm to 9.1 ± 1.2 mm between 8 days and 6 weeks (P = .04); bursal thickness decreased during the 24-week period from 1.5 ± 0.9 mm to 0.7 ± 0.4 mm (P = .005); tendon modulus of elasticity increased from 154 ± 75 kPa to 205 ± 96 kPa between 8 days and 24 weeks (P = .05). This is the first study to investigate suture position and migration post arthroscopic rotator cuff repair. The findings of this study suggest that sutures migrating to the middle of the tendon during the postoperative healing process is a normal phenomenon observed on ultrasonography.

Sarcopenia Is Associated With Increased Risks of Rotator Cuff Tendon Diseases Among Community-Dwelling Elders: A Cross-Sectional Quantitative Ultrasound Study.

Backgrounds: Recently, the association between sarcopenia and various musculoskeletal disorders, such as lumbar spine stenosis and fibromyalgia, has been highlighted. However, the relationship between sarcopenia and rotator cuff tendon diseases has rarely been investigated. This study aimed to evaluate whether sarcopenia was associated with shoulder pain and to determine whether rotator cuff tendons differed in echotexture between the sarcopenic and non-sarcopenic populations.Methods: The thickness and echogenicity ratio of the tendon vs. the overlying muscle (ERTM) or subcutaneous tissue (ERTT) were measured using high-resolution ultrasonography in 56 sarcopenic patients and 56 sex- and age- matched controls. The association between ultrasound measurements of the rotator cuff tendon complex and sarcopenia was investigated using the generalized estimating equation (GEE).Results: The sarcopenic group had an increased prevalence of shoulder pain. Based on the GEE analysis, sarcopenia was significantly associated with an increase in supraspinatus tendon thickness (β coefficient = 0.447, p < 0.001) and a decrease in the ERTM for the biceps long head and rotator cuff tendons. A negative trend of association was observed between sarcopenia and ERTT in the supraspinatus tendons (β coefficient = −0.097, p = 0.070). Nevertheless, sarcopenia was not associated with an increased risk of rotator cuff tendon tears.Conclusions: Patients with sarcopenia have a higher risk of shoulder pain. A consistent tendinopathic change develops in the supraspinatus tendons in sarcopenic patients. However, sarcopenia is less likely to be associated with serious rotator cuff pathology, such as tendon tears. Prospective cohort studies are warranted to explore the causal relationship between sarcopenia and shoulder disorders.

Comparison of Sonographic Findings of the Rotator CuffBetween Diabetic and Non-diabetic Patients with Shoulder Pain.

The aim of study is to evaluate the shoulder by sonography in patients presenting with shoulder pain and correlate the findings observed with the diabetic patient. Study was done in 60 patients who presented in the Department of Orthopedics with a history of the shoulder pain. Shoulder ultrasound was performed according to standard protocol, thickness of the supraspinatus tendon, presence of the tear, biceps tendon subacromial subdeltoid effusion and subacromial impingement were assessed. Of the 60 patients, 46 were male and 14 were female. Among them 15 patients were diabetics, 12 patient were male and 3 patient were female. Supraspinatus(SST) tendon thickness was greater in diabetics than in non-diabetics. Similarly, Subacromial bursal effusion, Biceps tendon effusion and Subacromial impingement were also seen in greater frequency in diabetic patients. However, no significant correlation was found between tear and the diabetes. There was increased supraspinatus tendon thickness, subacromial impingement, subacromial bursal effusion and biceps tendon effusion in diabetic patient compared to non-diabetic patient.

Immediate Changes and Recovery of the Supraspinatus, Long Head Biceps Tendon, and Range of Motion after Pitching in Youth Baseball Players: How Much Rest Is Needed after Pitching? Sonoelastography on the Supraspinatus Muscle-Tendon and Biceps Long Head Tendon.

BackgroudBaseball players are subjected to repeated loads on the supraspinatus and long head biceps tendon from youth, and repetitive pitching motions can cause shoulder injuries. The purpose of this study was to evaluate the immediate changes caused by pitching in the supraspinatus muscle-tendon, long head of the bicep tendon (LHBT), and shoulder range of motion (ROM) and to verify their recovery over time in youth baseball players.MethodsFifteen youth baseball players (mean age, 11.5 ± 1.3 years) were enrolled. The thicknesses of the supraspinatus tendon and LHBT and the strain ratios (SRs) of supraspinatus muscle and tendon were measured by sonoelastography. ROMs of shoulder joints (abduction, external rotation at 90° of abduction [ABER], and internal rotations at 90° of abduction [ABIR]) and horizontal adduction (HA) were measured using a goniometer. All measurements were performed on the throwing shoulders before and immediately after pitching (mean pitch count, 78.3 ± 13.3) and at 30 minutes, 24 hours, and 72 hours after pitching.ResultsThe thickness of supraspinatus tendon (6.64–6.27 mm, p = 0.026) and that of LHBT (2.56–2.26 mm, p = 0.021) significantly decreased immediately after pitching. The SRs of supraspinatus muscle tended to decrease, whereas SRs of supraspinatus tendon tended to increase immediately after pitching. ABER increased (119.7°–127.3°, p = 0.001) and HA decreased (34.7°–29.3°, p = 0.023) immediately after pitching. All immediate changes recovered 72 hours after pitching.ConclusionsThe immediate effects of pitching on the supraspinatus muscle-tendon, LHBT, and shoulder ROM in youth baseball players were confirmed in the current study. These changes were recovered to pre-pitch levels 72 hours after pitching. Therefore, we recommend that youth baseball players should rest for three days after pitching to minimize the risk of shoulder injury.

Supraspinatus tendon measurement using high frequency ultrasound in Sudanese pediatrics

ABSTRACT The frequency of rotator cuff diseases makes shoulder ultrasound (US) one of the most prevalent musculoskeletal ultrasound (MSK US) applications. Sudanese children’s supraspinatus tendon thickness and width were measured as part of this study to help with the early detection of supraspinatus tendon disease. Between August and December 2020, researchers conducted this cross-sectional investigation. There were 114 participants in the study, ranging in age from 4 to 14 years, with 81 males (71.1%) and 33 females (28.9%) participating. Study variables were incorporated into a customized data collection sheet used to gather the information. The supraspinatus tendons were found to be 5.31 ± 0.69 mm in thickness and 26.91 ± 2.06 mm in width. While the supraspinatus tendon thickness was correlated significantly (p < 0.01) to age (r = 0.280), weight (r = 0.254), and height (r = 0.335) in terms of their p-values, it was not correlated significantly to body mass index (BMI) (p > 0.05). A significant correlation (p < 0.01) was found between the supraspinatus tendon’s width and age (r = 0.519), weight (r = 0.507), height (r = 0.489), and BMI (r = 0.309). Standard reference values for supraspinatus tendon measures were found in Sudanese children. US musculoskeletal assessments of the supraspinatus tendons are proposed as a method for detecting anomalies in these tendons.

The effect of swimming volume and intensity on changes in supraspinatus tendon thickness

ObjectivesTo compare the change in supraspinatus tendon thickness (STT) following a high volume (HV) and high intensity (HI) swimming practice in shoulders of elite swimmers. DesignCohort Study. SettingNon-clinical, state swim team training facility. ParticipantsA convenience sample of eight non-injured state and national level swimmers from a regional swim team were recruited for this study. Main outcome measuresUltrasound measures of STT were collected in response to the two swimming practice sessions. Measures were taken prior to each swim practice; immediately after practice; 6-hours post practice and 24-hours post practice. ResultsA significant increase in STT resulted from both the HI and HV (p < 0.05) practice immediately post practice. For the HI practice, the STT remained significantly thicker than pre-practice measures at the 6-hour post practice test (p < 0.05) however no longer significant 24-hours post practice. The difference in the change in STT between the HI and HV practice was significantly different immediately post practice and 6-hours post practice (p < 0.05) however no longer significant 24-hour post practice. ConclusionUltrasound measures of STT following different swimming volumes and intensities may provide information on shoulder tendon loads.

Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study.

Background:Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing.Purpose:To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy.Study Design:Controlled laboratory study.Methods:A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of “standard care” exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale).Results:No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping.Conclusion:Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases.Clinical Relevance:In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy.Registration:NCT03425357 (ClinicalTrials.gov identifier).

Blood Flow Restriction Training for the Rotator Cuff: A Randomized Controlled Trial.

Blood flow restriction (BFR) training utilizes a tourniquet, applied to the proximal portion of one or more extremities, to occlude blood flow during exercise. Significant gains in strength and cross-sectional area can be achieved in muscles, both distal and proximal to BFR cuff application. To compare strength gains of the rotator cuff and changes in tendon size in subjects who performed side-lying external-rotation exercise with or without BFR. Forty-six subjects (mean age 25.0 [2.2]y) were randomized to either a BFR + exercise group or to the exercise-only group. Subjects performed 4 sets of the exercise (30/15/15/15 repetitions) at 30% 1-repetition maximum 2 days per week for 8 weeks. Subjects in both groups experienced strength gains in the supraspinatus and the external rotators (P = .000, P = .000). However, there was no difference in strength gains between groups for the supraspinatus (P = .750) or the external rotators (P = .708). Subjects in both groups experienced increases in supraspinatus tendon thickness (BFRP = .041, exercise onlyP = .011). However, there was no difference between groups (P = .610). Exercise with BFR applied to the proximal upper extremity did not augment rotator cuff strength gains or tendon thickness when compared with subjects who only exercised. This study did demonstrate that performing multiple sets of high repetitions at a low load led to significant increases in rotator cuff strength and tendon size in the dominant upper extremity.

THE EFFECTS OF ISOLYTIC AND STATIC POSTERIOR SHOULDER STRETCHING IN INDIVIDUALS WITH SUBACROMIAL IMPINGEMENT SYNDROME

Static posterior shoulder stretching exercise (PSSE) in modified cross-body position (MCBP) improves posterior shoulder tightness (PST) and glenohumeral internal rotation deficit (GIRD). Isolytic stretching (isotonic eccentric contraction) is a form of muscle energy technique. The effects of isolytic PSSE were not investigated in shoulder pathologies. PURPOSE: To investigate the effects of isolytic and static PSSE in MCBP on shoulder internal rotation (IR) and external rotation (ER) range of motion (ROM) and strength, PST, subacromial space (SAS), supraspinatus tendon thickness (SsTT), supraspinatus tendon occupation ratio (STOR), functionality and disability level in individuals having subacromial impingement syndrome (SIS) with GIRD. METHODS: Sixty-three participants having SIS with GIRD were randomly divided into three groups. Isolytic Stretching Group (ISG) and Static Stretching Group received standard physiotherapy and isolytic or static PSSE in MCBP. The control group (CG) received physiotherapy without PSSE. Shoulder ROM and PST were assessed with bubble inclinometer, strength with hand-held dynamometer, SAS (at 0° and 60° scapular plane shoulder elevation), SsTT, and STOR with ultrasonography, functionality and disability level with Modified Constant-Murley Scale and Quick Disability of the Arm-Shoulder-Hand Questionnaire. GIRD was determined by the difference in bilateral shoulder IR ROM. Data were analyzed with two-way ANOVA with repeated measures. RESULTS: All groups improved in terms of shoulder mobility, strength, SAS, STOR, functionality, and disability level after 4-weeks of treatment (p<0.05). IR ROM and SAS increased, PST, GIRD, and STOR decreased more in stretching groups compared to CG (p<0.001). Improvements in stretching groups were similar (p>0.05). ER ROM, strength, functionality, and disability levels improved more in ISG compared to CG (p<0.05). CONCLUSIONS: Standard physiotherapy including PSSE in MCBP is superior to treatment program without PSSE to improve shoulder mobility, SAS and STOR. Both isolytic and static stretchings are equally effective. Standard physiotherapy plus isolytic PSSE provided a greater improvement in ER ROM, strength, functionality and disability levels compared to treatment program without PSSE. Research was not founded.