Supraspinatus Thickness Research Articles

Effects of Blood Flow Restriction on Pain and Muscle Thickness Following Tendinopathy: A Case Study

Introduction: Blood flow restriction (BFR) training, in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb, coupled with low-load resistance exercise (LLRE) has resulted in gains comparable with traditional progressive resistive exercise in healthy populations. The use of BFR with LLRE may help people with supraspinatus tendinopathy through proximal effects to improve strength and muscle size. The purpose of this case report is to describe the proximal effect of the LLRE+BFR program on a patient with supraspinatus tendinopathy.
 Materials and Methods: The patient was a 40-year-old man with a history of shoulder pain and weakness for the past months. He received an LLRE+BFR program for his right shoulder including rotator cuff and scapular strengthening exercises and lower limbs aerobic exercises based on protocols of strengthening and aerobic exercises of BFR. Outcomes measured at baseline and 4 weeks included the 4 items: 1) Strength of supraspinatus muscle and four scapular stabilizer muscles including serratus anterior strength, middle trapezius strength, and lower trapezius strength by dynamometer, 2) supraspinatus thickness by ultrasound, 3) pain pressure threshold of supraspinatus and deltoid muscles by algometer, and 4) pain reported bay in each session based on pain numeric scale.
 Results: After 6 weeks, the strength of supraspinatus and scapular stabilizers except for the lower trapezius increased. The supraspinatus thickness and pain pressure threshold in the supraspinatus and deltoid muscle also increased after 4 weeks. The mean of pain reported by the patient based on the pain numeric scale before and after each session was also decreased.
 Conclusion: The patient had measurable improvements following the use of an LLRE+BFR program. LLRE+BFR program may be an option for strength training in people with supraspinatus tendinopathy; however, more research is needed to determine effectiveness across the population of people with supraspinatus tendinopathy.

Comparison of Clinical and Ultrasound Imaging Outcomes Between Corticosteroid and Hypertonic Dextrose Injections for Chronic Supraspinatus Tendinopathy

Both corticosteroids and hypertonic dextrose injections are commonly used for chronic supraspinatus tendinopathy. To compare the supraspinatus echogenicity and clinical effects of echo-guided hypertonic dextrose versus corticosteroid injection for treating chronic supraspinatus tendinopathy. Cohort study; Level of evidence, 3. The authors performed a secondary data analysis of a previous clinical trial including patients who received normal saline versus hypertonic dextrose injection; patients who received corticosteroid injection were recruited between August 2017 and July 2021. Baseline patient data were matched among these 3 groups at a 1:1:1 ratio. At baseline and 2, 6, and 12 weeks after the intervention, the authors compared morphological changes (supraspinatus thickness and echogenicity) and clinical parameters (visual analog scale [VAS] for pain, Shoulder Pain and Disability Index [SPADI], and range of motion [ROM]). Analysis of variance was used to compare mean changes from baseline among the groups. A total of 75 patients (25 in each group) were included. At 2-week follow-up, both the dextrose and the steroid groups exhibited improvement in VAS scores (mean difference [MD] from baseline: -2.0 in dextrose group; -3.3 in steroid group (P < .001)), SPADI scores (MD from baseline: -10.6 in dextrose group; -24.6 in steroid group (P < .001)), and flexion ROM (MD from baseline: 13.6° in dextrose group; 21.1° in steroid group) (P =.001). At 6 weeks after injection, the hypertonic dextrose group exhibited more favorable echogenic improvement in supraspinatus tendon morphology compared with the other 2 groups (P < .001). However, the steroid group showed significantly more improvement in clinical parameters compared with the other 2 groups at both week 6 (MD from baseline: VAS, -3.2; SPADI, -26.6; flexion ROM, 21.5°) and week 12 (MD from baseline: VAS, -2.5; SPADI, -20.4; flexion ROM, 15.2°) (P < .001 for all). Hypertonic dextrose injection improved supraspinatus echogenicity after 6 weeks but provided short-term symptomatic relief in the patients with chronic supraspinatus tendinopathy when compared with corticosteroid or saline injections. Steroid injection exerted a more favorable clinical effect at weeks 6 and 12 but demonstrated a negative effect on the supraspinatus.

Development of shoulder pain with job-related repetitive load: mechanisms of tendon pathology and anxiety.

The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression. We recruited dental hygiene (DH) students (n = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (n = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasonography, and psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog scale for pain score greater than the minimal clinically important difference) between DH and OT students using Fisher exact test. We used mixed effects models to longitudinally compare the change in outcomes between 3 groups: DH students who develop and did not develop shoulder pain, and OT students. The incidence of shoulder pain is higher in DH students (relative risk = 4.0, 95% confidence interval [CI] 1.4, 11.4). After 1 year, DH students with pain had the greatest thickening of the supraspinatus (0.7 mm, 95% CI 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4 mm, 95% CI 0.1, 0.8) and OT students (0.9 mm, 95% CI 0.5, 1.2). Anxiety score increased 3.8 points (95% CI 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at 1 year (relative risk = 2.9, 95% CI 1.0, 8.6). Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and it thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.

Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study

BackgroundStudies evaluating the role of both corticosteroids and platelet-rich plasma (PRP) in the treatment of rotator cuff (RC) tendinopathies have been contradicting.We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections.MethodsThis is a randomized double-blind clinical trial. All individuals with diagnosis of RC tendinitis during 2014–2017 were considered. Individuals were randomly allocated to either receive PRP or corticosteroids.Overall, 3cc of PRP was injected within the subacromial joint and another 3cc was injected at the site of the tendon tear, under the guide of sonography. For the corticosteroid group, 1cc of Depo-medrol 40mg and 1cc of lidocaine (2%) was injected within the subacromial joint.ResultsOverall, 58 patients entered the study. Comparison of pain, range of motion (ROM), Western Ontario RC (WORC), Disability of Arm-Hand-Shoulder (DASH) scores, and supraspinatus thickness showed significant improvement during follow-ups in both groups (p<0.05).During 3 months of follow-up, pain improvement was significantly better within the PRP group during (from 6.66±2.26 to 3.08±2.14 and 5.53±1.80 to 3.88±1.99, respectively; p=0.023). Regarding ROM, the PRP group had significant improvement in adduction (20.50°±8.23° to 28°±3.61° and 23.21°±7.09° to 28.46°±4.18° for the PRP and corticosteroid groups, respectively; p=0.011) and external rotation (59.66°±23.81° to 76.66°±18.30° and 57.14°±24.69° to 65.57°±26.39°, for the PRP and corticosteroid groups, respectively; p=0.036) compared to the corticosteroid group.ConclusionWe found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies; however, pain and ROM may show more significant improvement with the use of PRP. Considering that the use of corticosteroids may be contraindicated in some patients and may be associated with the risk of tendon rupture, we suggest the use of PRP in place of corticosteroid-based injections among patients with RC tendinopathy.Trial registrationClinical trial registration code: IRCT201302174251N9

Reliability of ultrasonographic measurement of the supraspinatus thickness at different angles of shoulder abduction in patients with stroke.

[Purpose] The primary purpose of this study was to evaluate the usefulness of the intraclass correlation coefficient for evaluating the reliability of the measurement of the supraspinatus thickness on shoulder ultrasonography at different angles in a resting position in patients with stroke. [Participants and Methods] The study included 20 patients with stroke. The supraspinatus thickness was measured on both sides on ultrasonography, with the participants’ shoulders in abduction at 3 testing angles (0°, 30°, and 60° abduction). Each measurement was performed three times, and the average of the three measurements was recorded. The intraclass correlation coefficient was calculated, with the supraspinatus thickness measured twice at an interval of 24 hours as the factor. [Results] All intraclass correlation coefficients for the hemiplegic and normal sides were greater than 0.93 when the shoulders were at the three testing angles. [Conclusion] In this investigation, the reliability of measuring the supraspinatus thickness on shoulder ultrasonography at each angle for 3 times was evaluated and was found to be excellent.

Musculoskeletal Ultrasonography Assessment of Functional Magnetic Stimulation on the Effect of Glenohumeral Subluxation in Acute Poststroke Hemiplegic Patients.

Background Glenohumeral subluxation (GHS) is common in patients with acute hemiplegia caused by stroke. GHS and upper limb function are closely related. Objective Using musculoskeletal ultrasonography (MSUS) to objectively evaluate the efficacy of functional magnetic stimulation (FMS) in the treatment of GHS in acute hemiplegic patients after stroke. Methods The study used prospective case control study. Stroke patients with GHS were recruited and assigned to control group and FMS group. Control group received electrode stimulation at the supraspinatus and deltoid muscles of the hemiplegic side, while FMS group was stimulated at the same locations. Before and after treatment, the distances of the acromion-greater tuberosity (AGT), acromion-lesser tuberosity (ALT), acromiohumeral distance (AHD), supraspinatus thickness (SST), and deltoid muscle thickness (DMT) in patients' bilateral shoulder joint were measured by MSUS, respectively. Meanwhile, Fugl-Meyer Assessment (FMA) was used to evaluate the improvement of upper limb function. Results 30 patients were recruited. After FMS treatment, there was a significant decrease in the difference value between ipsilateral side and contralateral side of AGT [t = 8.595, P < 0.01], ALT [t = 11.435, P < 0.01], AHD [t = 8.375, P < 0.01], SST [t = 15.394, P < 0.01], and DMT [t = 24.935, P < 0.01], and FMA score increased [t = −13.315, P < 0.01]. Compared with control group, FMS group decreased more significantly in the difference value between ipsilateral side and contralateral side of AGT [t = 2.161, P < 0.05], ALT [t = 3.332, P < 0.01], AHD [t = 8.768, P < 0.01], SST [t = 6.244, P < 0.01], and the DMT [t = 3.238, P < 0.01], and FMA score increased more significantly in FMS group [t = 7.194, P < 0.01]. Conclusion The study preliminarily shows that the MSUS can objectively and dynamically evaluate the treatment effect of GHS in hemiplegic patients. Meanwhile, compared with control group, the FMS is more effective and has fewer side effects, and the long-term effect of FMS is worth further study. This trial is registered with ChiCTR1800015352.

Reliability of Ultrasound Measurement of Muscle Thickness in Patients with Supraspinatus Tendon Pathology.

SUMMARY – Objectives of the study were to observe supraspinatus muscle thickness in patients with supraspinatus tendon pathology using ultrasound (US) and examining inter- and intra-rater reliability, and to compare muscle thickness with cross-sectional area (CSA) and occupation ratio measured by both US and magnetic resonance imaging (MRI). The investigation was designed as a prospective cohort study. Two groups of patients were included in the study: 43 patients with tendon rupture and 44 patients without tendon rupture as a control group. A written consent was obtained from all patients. In both groups, muscle thickness, CSA and occupation ratio were measured with US, and CSA and occupation ratio with MRI. Study results showed statistically significant between-group differences. The mean supraspinatus muscle thickness measured by US was 14.01 mm and 19.83 mm in patients with and without tendon rupture, respectively. CSA and occupation ratio measured by US and MRI also showed statistically significant between-group differences. Pearson correlation coefficient between supraspinatus thickness and occupation ratio and CSA measured by US and MRI showed strong to moderate correlation. US measurements showed moderate to strong intra- and inter-rater reliability. In conclusion, supraspinatus muscle thickness measurement by US is a reliable method for muscle atrophy evaluation and strongly correlates with other acknowledged methods.

Shoulder-Muscle Activation in Individuals With Previous Shoulder Injuries.

Understanding how muscles activate in a population with a previous glenohumeral-joint (GH) injury may help clinicians understand how to build a conservative treatment plan to strengthen or activate the specific muscles in an attempt to reduce recurrent shoulder injury and development of GH laxity. To investigate muscle-activation differences between the previously injured limb of individuals with a history of GH-joint injury and healthy matched controls during functional isometric contractions. Case control. University research laboratory. 17 individuals (8 women, 9 men; age 22.3 ± 2.6 y, height 172.4 ± 8.8 cm, mass 75.4 ± 16.5 kg) with previous unilateral shoulder pain and 17 (8 women, 9 men; age 22.9 ± 3.9 y, height 170.9 ± 11.3 cm, mass 73.6 ± 22.9 kg) with no history of shoulder pain or injury. Diagnostic ultrasound measurements of the supraspinatus were completed in both resting and contracted states to assess changes in muscle thickness. Manual muscle tests (anterior deltoid, upper trapezius, infraspinatus, lower trapezius, serratus anterior) and functional isometric contractions (forward flexion, scaption, abduction) were measured using electromyography. Peak, normalized activation of each muscle and supraspinatus thickness activation ratio were compared between groups and bilaterally within groups using separate ANOVAs. The anterior deltoid was significantly less activated during all functional isometric tasks in previously injured subjects than in healthy subjects (P = .024). In previously injured subjects, the involved limb-lower trapezius was significantly less activated during scaption and abduction tasks than the contralateral side (P = .022 and P = .031, respectively). There were decreases in muscle activation in the anterior deltoid between previously injured and healthy people, as well as in the lower trapezius, in previously injured subjects. Understanding the source of muscle-activation deficits can help clinicians focus rehabilitation exercises on specific muscles.

Comparison of changes in supraspinatus muscle thickness in persons with subacromial impingement syndrome and asymptomatic adults

Purpose: To compare changes in supraspinatus muscle thickness in persons with subacromial impingement syndrome (SAIS) and asymptomatic adults and to determine the reliability of the ultrasound imaging (USI) protocol. Subjects: Twenty-two persons with SAIS and 22 age- and gender-matched asymptomatic controls. Methods: Ultrasound images of supraspinatus muscle thickness at rest and at 0°, 30°, 60°, and 90° of arm elevation were captured and measured. To determine same-day intratester reliability, one examiner imaged the same subject twice and two examiners took turns capturing images in order to determine same-day intertester reliability. Subjects were asked to return for between-day intratester reliability. Results: Statistical analyses revealed a larger mean supraspinatus thickness in the SAIS group at the 0° condition than in the asymptomatic group (p < 0.05). Same-day intratester and intertester reliability was good with ICC(2,3) = 0.73–0.96 for asymptomatic controls and ICC(2,3) = 0.61–0.94 for persons with SAIS. Overall, between-day intratester reliability was fair to good for most conditions [ICC(2,3) = 0.31–0.90]. Conclusions: The thicker supraspinatus muscles at 0° in the SAIS group may indicate a protective spasm. The USI protocol used in the study demonstrated good same-day intratester and intertester reliability for both groups.

CSM 2014 Orthopaedic Section Poster Presentations (OPO1106–OPO1165, OPO2218–OPO2298, OPO3106–OPO3183)

CSM 2014 Orthopaedic Section Poster Presentations (OPO1106–OPO1165, OPO2218–OPO2298, OPO3106–OPO3183)

SAT0422 Increased Supraspinatus Thickness with Reduced Acromohumeral Distance in People with Mild and Moderate Rotator Cuff Tendinopathy: A Reliability and Comparative Study

BackgroundSubacromial impingement syndrome has historically been ascribed to extrinsic compression of the supraspinatus tendon (SsT) due to altered acromial morphology. More recently intrinsic tendon pathology has been proposed as an...

Sonographic Evaluation of Supraspinatus Cross-sectional Area in Collegiate Baseball Players

To establish the normal thickness of the supraspinatus tendon in collegiate baseball players with the use of ultrasound and to determine whether there are any significant differences between the dominant and nondominant supraspinatus thickness. A cross-sectional observational study. An outpatient clinical setting. Twelve healthy, asymptomatic collegiate pitchers between the ages of 19 and 22 years. Sonographic evaluation of 12 asymptomatic pitchers (9 right-hand dominant and 3 left-hand dominant) between the ages of 19 and 22 years was performed in a transverse plane (short axis) and longitudinal view (long axis) of their right and left shoulders. Maximum thickness was measured in both the long- and short-axis views. On the long-axis view, measurement was taken at the point where there was maximal height observed at the footprint insertion. Mixed-model analysis of variance was used to test for differences in tendon thickness across factors. Post hoc contrasts were performed with a Tukey adjustment for the P values. The mean ± SD values, side-to-side difference, and difference between dominant and nondominant values were calculated and statistically analyzed for differences. An ultrasound examination showed a significant 3-way interaction (P = .038) for view by side of hand dominance. Post hoc contrasts revealed that supraspinatus tendon thickness for right-handed pitchers in the long-axis view on the right side showed a mean value of 8.0 ± 0.32 mm versus the long-axis view on the left side of 6.5 ± 0.34 mm (P = .006) and the short-axis view on the right of 7.4 ± 0.40 mm versus the short-axis view on the left of 6.1 ± 0.26 mm (P = .036). Supraspinatus tendon thickness for left-handed pitchers in the long-axis view on the left side showed a mean value of 7.5 ± 0.59 mm versus the long-axis view on the right side of 5.9 ± 0.56 mm (P = .137) and the short-axis view on the left of 6.5 ± 0.45 mm versus the short-axis view on the right of 6.5 ± 0.68 mm (P = .999). A database of normal values for supraspinatus tendon thickness in collegiate baseball pitchers has been developed. The results are consistent with expectations when the dominant side is compared with the nondominant side for right-handed pitchers with increased tendon thickness noted on the dominant side. There was no side-to-side difference found in left-hand dominant pitchers.

Do the rotator cuff tendons of young athletic subjects hypertrophy in response to increased loading demands?

The rotator cuff is composed of muscle and tendon units. Although muscle has been shown to adapt to mechanical loads, the response of human tendon is not well defined. We hypothesized that increased loading demands on the rotator cuff of young trainees would cause an adaptive muscle response but not an adaptive hypertrophic tendon response. The hypertrophic response of the rotator cuff tendon, shoulder strength, aerobic fitness, and the lean body weight of 70 young male recruits were studied before and after a 1-year course of elite infantry training. Shoulder strength was assessed by the maximum number of pull-ups done and the rotator cuff thickness by ultrasound measurement of the supraspinatus thickness. Aerobic physical fitness was assessed by maximum oxygen consumption (Vo(2) max). Lean body weight was measured by skin-fold thickness. The mean number of pull-ups done increased from 17.5 to 21.7 (P = .01), but the supraspinatus thickness at the beginning of training (6.1 mm) was unchanged at the end of the training. Vo(2) max increased from 57 to 64 mL/kg/min (P = .0001). Lean body weight increased from 58.3 to 64.7 kg (P = .0001). As a result of increased loading, the strength of the rotator cuff muscles of young trainees increased, but by the parameter of hypertrophy, no evidence was found of a parallel adaptive response of the rotator cuff tendon.

Reliability of the Supraspinatus Muscle Thickness Measurement by Ultrasonography

ObjectiveTo assess the intrarater and interrater reliability of the supraspinatus thickness measured by ultrasonography (US) in normal subjects and to identify the relationship between the supraspinatus thickness measured by US and cross sectional area (CSA) of the supraspinatus muscle by magnetic resonance imaging (MRI) in hemiplegic patients.MethodWe examined 20 shoulders of normal subjects and 10 shoulders of hemiplegic patients. In normal subjects, one examiner measured the supraspinatus thickness twice by US at the scapular notch and another examiner measured the supraspinatus thickness several days later. The intrarater and interrater reliability of supraspinatus thickness measurements were then evaluated. In hemiplegic patients, the supraspinatus thickness at the scapular notch was measured by US in affected side and compared with CSA of the supraspinatus muscle at the scapular notch and the Y-view of MRI.ResultsOne examiner's supraspinatus thickness measurement average was 1.72±0.21 cm and 1.74±0.24 cm, and the other examiner's supraspinatus thickness measurement average was 1.74±0.22 cm in normal subjects. Intraclass correlation coefficients of intrarater and interrater examination were 0.91 and 0.88, respectively. For hemiplegic patients, the supraspinatus thickness measured by US was 1.66±0.13 cm and CSA by MRI was 4.83±0.88 cm2 at the Y-view and 5.61±1.19 cm2 at the scapular notch. The Pearson Correlation Coefficient between the supraspinatus thickness at the scapular notch and the CSA at the Y-view was 0.72 and that between the supraspinatus thickness and CSA at the scapular notch was 0.76.ConclusionThe supraspinatus thickness measurement by US is a reliable method and is positively correlated with the CSA of the supraspinatus muscle in MRI in hemiplegic patients. Therefore, supraspinatus thickness measurement by US can be used in the evaluation of muscle atrophy and to determine therapeutic effects in hemiplegic patients.