Supraspinatus Tendon Thickness Research Articles

Swim-Training Volume and Shoulder Pain Across the Life Span of the Competitive Swimmer: A Systematic Review.

Competitive swimmers are exposed to enormous volumes of swim training that may overload the soft tissue structures and contribute to shoulder pain. An understanding of training factors associated with the injury is needed before practice guidelines can be developed. To investigate the relationship between swim-training volume and shoulder pain and to determine swim-training volume and shoulder pain prevalence across the life span of the competitive swimmer. Relevant studies within PubMed, Web of Science, and MEDLINE. Studies that assessed the relationship between a defined amount of swim training and shoulder pain in competitive swimmers. Twelve studies (N = 1460 participants) met the criteria. Swimmers were grouped by age for analysis: young (<15 years), adolescent (15-17 years), adult (18-22 years), and masters (23-77 years). Adolescent swimmers showed the highest rates of shoulder pain (91.3%) compared with other age groups (range = 19.4%-70.3%). The greatest swim-training volumes were reported in adolescent (17.27 ± 5.25 h/wk) and adult (26.8 ± 4.8 h/wk) swimmers. Differences in exposure were present between swimmers with and those without shoulder pain in both the adolescent (P = .01) and masters (P = .02) groups. In adolescent swimmers, the weekly swim-training volume (P < .005, P = .01) and years active in competitive swimming (P < .01) correlated significantly with supraspinatus tendon thickness, and all swimmers with tendon thickening experienced shoulder pain. Evidence suggests that swim-training volume was associated with shoulder pain in adolescent competitive swimmers (level II conclusion). Year-round monitoring of the athlete's swim training is encouraged to maintain a well-balanced program. Developing athletes should be aware of and avoid a sudden and large increase in swimming volume. However, additional high-quality studies are needed to determine cutoff values in order to make data-based decisions regarding the influence of swim training.

Subacromial space outlet in female patients with multidirectional instability based on hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder measured by ultrasound

The objective of the study was to compare the acromiohumeral distance (AHD) between patients diagnosed with hypermobility type of the Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorder (HSD) and healthy controls by evaluating the relative amount the tendon occupies in the subacromial area. Furthermore, the aim was to evaluate if there was a change in AHD with arm elevation within and between groups. Twenty-nine female patients with hEDS/HSD (aged 34 ± 12.9 years) and 20 healthy controls (aged 33 ± 10.8 years) participated in the study. The supraspinatus tendon (SST) thickness and AHD were measured using ultrasound. The interplay between the SST and the AHD was expressed as the occupation ratio (OcAHD), calculated as the SST thickness as a percentage of AHD. The measures were performed in the resting position and in subsequently 45° and 60° of active arm elevation in the scapular plane. The main finding is that patients with hEDS/HSDhave a larger subacromial space outlet compared with the controls when measured by ultrasound. Furthermore, in both groups, we found an increased OcAHD during active arm elevation compared with the resting position, which indicates that similar mechanisms occur for patients with hEDS/HSDand healthy controls. Patients with hEDS/HSDhave a larger available subacromial space outlet compared with healthy individuals. OcAHD increased during active arm elevation compared with the resting position in both groups. This knowledge is important when designing rehabilitation exercise programs for shoulder instability patients with abnormal glenohumeral biomechanics.

Ultrasonographic and Myotonometric Evaluation of the Shoulder Girdle After an Isokinetic Muscle Fatigue Protocol.

The aim of the study was to investigate supraspinatus tendon thickness, acromiohumeral distance (AHD), and stiffness/creep measures of the shoulder girdle in overhead asymptomatic athletes in muscle fatigue conditions. Observational, case series study. Biomechanics and motion analysis lab. Twenty-four male overhead volleyball (n = 8), handball (n = 8), and tennis (n = 8) athletes. All subjects were without shoulder injury history. The subjects were tested for supraspinatus tendon thickness (in short and long axis), AHD using ultrasound scans and stiffness/creep of upper trapezius, infraspinatus, anterior and posterior deltoid, and pectoralis major using the myotonometer device before and immediately after a fatigue protocol. The fatigue protocol consisted of 3 sets of 32 maximum isokinetic concentric contractions performing shoulder internal and external rotation at isokinetic speed of 120°/s. A significant increase in supraspinatus tendon thickness (both in short and long axis) (P = .045 and P = .01, respectively) and a reduction in AHD (P = .01) were found after an isokinetic protocol. The stiffness increased significantly in upper trapezius (P ≤ .01), infraspinatus (P = .003), posterior deltoid (P = .047), and pectoralis major (P = .01), whereas the creep showed a significant decrement for upper trapezius (P = .001) and infraspinatus (P = .003). The present study has demonstrated the postexercise fatigue in overhead athletes. The increase of stiffness (reduction of muscle creep) and tendon thickness (simultaneous to the reduction of AHD) may indicate rotator cuff overloading as a primary intrinsic tendon pathology process.

Deformation of coracoacromial ligament during overhead movement as an early indicator of subacromial impingement in elite adolescent badminton players

ABSTRACTObjectives: Deformation of the coracoacromial ligament during overhead movement has been linked to shoulder pathologies such as impingement and rotator cuff tear. We, therefore, explored this relationship in a group of elite adolescent badminton players.Method: We performed bilateral shoulder physical and ultrasonographic examination in 35 adolescent asymptomatic badminton players, 13 players with unilateral shoulder pain, and 15 non-athletes of similar age. Coracoacromial ligament deformation, defined as the maximal vertical distance between the ligament apex to a line connecting the acromion and coracoid process, was measured during shoulder abduction and internal rotation and compared within and between groups. Other ultrasonographic measurements and the incidence of shoulder pathologies were also evaluated.Result: Among badminton athletes who reported dominant shoulder pain, coracoacromial ligament deformation was significantly larger in their dominant shoulder than in their non-dominant shoulder (3.5 and 2.0 mm, respectively; p = 0.013); this difference was not present in other groups. Regardless of the presence or absence of pain, athletes displayed more coracoacromial ligament deformation and increased supraspinatus tendon thickness in their dominant shoulder than did the control group. Abnormal ultrasound findings were noted in all groups; however, the incidence was not significantly different.Conclusion: Increased coracoacromial ligament deformation during overhead movement is associated with shoulder pain in elite adolescent badminton players. Our findings may help clinicians identify athletes at risk of subacromial impingement syndrome.

The cricketer’s shoulder: Not a classic throwing shoulder

ObjectivesTo describe the musculoskeletal adaptations inherent to the cricketers’ shoulder and determine potential predictors of shoulder injury in elite South African cricketers. DesignProspective longitudinal cohort study; SettingNon-clinical, at national cricket indoor training venues. ParticipantsOne hundred and six elite cricketers, representing 82% of the South African national and franchise teams, consent. A total of 105 cricketers (27 ± 4 years) were eligible for participation in this study. Main outcome measuresA pre-season shoulder screening battery including a shoulder function questionnaire, two ultrasonographic shoulder measurements and 14 musculoskeletal tests including pain provocation, range of motion, strength and flexibility was assessed. Non-contact dominant shoulder injuries were documented throughout the 2016/2017 season. ResultsThe musculoskeletal profile of a cricketer's shoulder is described. 17% (95%CI: 9–24%) of cricketers sustained an injury during the 2016/2017 season. Two of the 17 screening tests predicted seasonal dominant shoulder injury (p < 0.05): a dominant supraspinatus tendon thickness ≥5.85 mm (sensitivity: 72%, specificity: 63%) and non-dominant pectoralis minor length ≤12.85 cm (sensitivity: 83%, specificity: 55%). ConclusionThe musculoskeletal adaptations inherent to cricketing shoulders are distinctly different to the classic “thrower's shoulder” described in baseball. A thickened dominant supraspinatus tendon and a shortened non-dominant pectoralis minor muscle are risk factors for developing shoulder injury in this group. This identifies the need to investigate preventative strategies (strengthening/flexibility) and throwing workload management in cricketers with shoulder injury.

Non-traumatic chronic shoulder pain is not associated with changes in rotator cuff interval tendon thickness

ObjectiveTo determine whether the thickness of the rotator interval tendons is different when comparing both symptomatic and non-symptomatic sides in people with chronic shoulder pain, and to those free of pain. Furthermore, to calculate the level of association between the rotator interval tendon thicknesses and perceived shoulder pain-function. DesignA cross-sectional, observational study. MethodThe supraspinatus, subscapularis and biceps brachii tendon thickness of sixty two patients with chronic shoulder pain were determined from standardized ultrasonography measures performed on both shoulders, whereas only the dominant arm was measured for the control subjects. FindingsSupraspinatus, subscapularis and biceps brachii tendon thickness was comparable between sides in the symptomatic group and was also comparable between the symptomatic and asymptomatic participants. In addition, the correlation between the tendon thickness and shoulder pain-function was non-significant. InterpretationsTendon thickness was unaltered in people with chronic shoulder pain. These findings do not rule out the possibility that other changes in the tendon are present such as changes in the elastic properties and cell population and this should be explored in future studies.

Shoulder tendon characteristics in disabled swimmers in high functional classes – Preliminary report

ObjectiveTo characterize disabled swimmers in comparison to an able-bodied swimmers for (1) supraspinatus tendon thickness, (2) subacromial space and (3) occupation ratio. DesignCross-Sectional Study. SettingResearch laboratory. ParticipantsDisabled swimmers with upper (DSw-Upper) (n = 8) and lower (DSw-Lower) (n = 7) extremity disorders. The DSw-Upper were classified in sports class S7-S8, while DSw-Lower in S9-S10. The control group had 15 able-bodied swimmers. Main outcome measuresUltrasound images of (1) supraspinatus tendon in short axis and long axis, (2) subacromial space, and (3) occupation ratio. ResultsA thicker supraspinatus tendon in short axis was observed in DSw-Upper versus C-Sw (p = 0.012) and DSw-Upper versus DSw-Lower (p = 0.018); and in long axis for DSw-Upper versus CSw (p = 0.0001), and DSw-Upper versus DSw-Lower (p = 0.002). There was a greater occupation ratio in DSw-Upper versus DSw-Lower in short axis (p = 0.013) and long axis (p = 0.035). ConclusionsThe present study showed a thicker supraspinatus tendon and greater occupation ratio with the tendon occupying more of the subacromial space that may predispose upper extremity disabled swimmers to tendon disorders such as subacromial impingement syndrome. Ultrasound examination can be used to assess shoulder tendon characteristics and the relationship to the subacromial space, to determine potential for injury and training load monitoring.

Association Between Years of Competition and Shoulder Function in Collegiate Swimmers.

Background:Shoulder injuries are common among competitive swimmers, and the progression of shoulder pathology is not well understood. The objective of this study was to assess the extent to which years of competitive swim training were associated with physical properties of the supraspinatus muscle and tendon, shoulder strength, and self-reported assessments of shoulder pain and function.Hypothesis:Increasing years of competition will be associated with declining physical properties of the supraspinatus muscle/tendon and declining self-reported assessments of pain and function.Study Design:Descriptive epidemiology study.Level of Evidence:Level 4.Methods:After institutional approval, 18 collegiate female swimmers enrolled in the study. For each swimmer, supraspinatus tendon thickness was measured; tendinosis was assessed using ultrasound imaging, supraspinatus muscle shear wave velocity was assessed using shear wave elastography, isometric shoulder strength was measured using a Biodex system, and self-reported assessments of pain/function were assessed using the Western Ontario Rotator Cuff (WORC) score. All subjects were tested before the start of the collegiate swim season. Linear regression was used to assess the association between years of competition and the outcome measures.Results:Years of participation was positively associated with tendon thickness (P = 0.01) and negatively associated with shear wave velocity (P = 0.04) and WORC score (P < 0.01). Shoulder strength was not associated with years of participation (P > 0.39).Conclusion:Long-term competitive swim training is associated with declining measures of supraspinatus muscle/tendon properties and self-reported measures of pain and function. Although specific injury mechanisms are still not fully understood, these findings lend additional insight into the development of rotator cuff pathology in swimmers.Clinical Relevance:Lengthy swimming careers may lead to a chronic condition of reduced mechanical properties in the supraspinatus muscle and tendon, thereby increasing the likelihood of rotator cuff pathology.

Tendon vascularity in overhead athletes with subacromial pain syndrome and its correlation with the resting subacromial space

Supraspinatus tendinopathy is one of the common causes of subacromial pain syndrome (SAPS) in overhead athletes. Changes in tendon vascularity have been reported in painful tendons; however, the prevalence and distribution have not been investigated in young overhead athletes. We conducted a cross-sectional study of 47 overhead athletes (male, 31; female, 16) aged 18 to 36 years with SAPS for >3 months. A sonographer graded the severity of the tendinopathy and area of vascularization. Ultrasound imaging was used to measure supraspinatus tendon thickness, vascularity, and resting subacromial space. A self-written program was used to semiquantify the intensity of vascularity, expressed as the vascular index. The majority (87.2%) of the participants had signs of tendinopathy in the supraspinatus tendon, and 40 (85.1%) of the tendinopathic tendons had vascularity. The majority (66.0%) of the vascularized subjects presented with minimal increase in vascularity, and 19.1% had moderate to severe vascularization. Most (79.2%) of the vascularization was observed in the pericortical region. The vascular index was negatively correlated with the resting subacromial space in male athletes with a reduced subacromial space (ρ = -0.63; P = .038). Of overhead athletes with SAPS, 87.2% had supraspinatus tendinopathy with minimal to moderate vascularization, with the majority of vascularization occurring in the pericortical region. In male athletes with a reduced subacromial space, greater vascularity in the supraspinatus tendon was associated with a smaller resting subacromial space.

Relative and absolute reliability of ultrasound measurements for the thickness of the soft tissue around the shoulder joint of young normal subjects.

[Purpose] The purpose of this study was to examine the reliability of ultrasound measurements by analyzing the relative reliability and absolute reliability when measuring soft tissue thickness around the shoulder joint. [Subjects and Methods] Eleven healthy young adults (22 shoulders) participated in this study. Thickness of the supraspinatus tendon, subacromial bursa, and biceps tendon was measured on both shoulders. This protocol was performed twice in the same day. The relative reliability of ultrasound measurement was evaluated using the intraclass correlation coefficient for determining the degree of consistency and agreement between two measures. The absolute reliability of the ultrasound measurement was evaluated using the standard error of measurement, minimum detectable change, and Bland-Altman analysis. [Results] Ultrasound measurements exhibited high relative reliability: intraclass correlation coefficients for the supraspinatus tendon, subacromial bursa, and biceps tendon thickness were demonstrated to be 0.91, 0.82, and 0.90, respectively. Bland-Altman analyses revealed no significant systematic bias between the repeated measurements for the supraspinatus tendon, subacromial bursa, and biceps tendon thickness. [Conclusion] These findings suggest that ultrasound measurement for the supraspinatus tendon, subacromial bursa, and biceps tendon thickness exhibited good relative reliability and no systematic errors were detected regarding their absolute reliability.

健常若年者に対する棘上筋腱，肩峰下滑液包，上腕二頭筋長頭腱の厚さの超音波測定の検者間信頼性

健常若年者に対する棘上筋腱，肩峰下滑液包，上腕二頭筋長頭腱の厚さの超音波測定の検者間信頼性

Morphological classification of acromial spur: correlation between Rockwood tilt view and arthroscopic finding.

Purpose and hypothesis: Acromion spur is the extrinsic factor for impingement syndrome and rotator cuff tear. The Rockwood tilt view can be used to evaluate prominence of the anterior acromion, however no study has shown the correlation of findings between the Rockwood tilt view and the arthroscopic finding. Methods: We developed the arthroscopic classification of acromion spur as type 1 flat spur, type 2 bump spur, type 3 heel spur, type 4 keel spur, and type 5 irregular spur. Patients with rotator cuff syndrome who underwent arthroscopic surgery were recruited. Two observers were asked to classify the type of spur from arthroscopic findings and Rockwood tilt views separately in random pattern. The prevalence of supraspinatus tendon tear was also recorded as no tear, partial-thickness tear, and full-thickness tear. Results: The keel spur (33.9%) was the most common finding followed by the heel spur (27.8%). The correlation was high especially for the heel, the keel, and the irregular spur (75.47%, 74.03%, and 72.73%, respectively.) These three types of spurs have a high prevalence of full thickness of supraspinatus tendon tear. Conclusion: The Rockwood tilt view can be used to evaluate the morphology of an acromion spur, especially the at-risk spur that correlates highly with the full-thickness supraspinatus tendon tear. The arthroscopic classification will also be a useful tool to improve communication between the surgeon and the guide for appropriate treatment in a rotator cuff tear patient when encountering the heel, keel, and irregular spur.

Reliability of musculoskeletal ultrasound imaging to measure supraspinatus tendon thickness in healthy subjects.

[Purpose] The purpose of this study was to assess intra-rater and inter-rater reliability of musculoskeletal ultrasound (MSKUS) as a tool to measure supraspinatus tendon thickness in healthy subjects. [Subjects and Methods] Twenty healthy subjects were assessed in similar sitting position. Two experienced musculoskeletal ultrasound specialists measured supraspinatus tendon thickness. Tendon was measured twice in one day by each of two raters with an interval of one hour for within day reliability and was re-measured following one week for between days reliability. Data analysis was performed using the intraclass correlation coefficient (ICC) and standard error of measurement (SEM). [Results] Results reflected excellent within day intra-rater and inter-rater reliability with Mean ± standard deviation (SD)=5.14 ± 0.83 and 5.17 ± 0.78, ICC (2,1)=0.89–0.93 and ICC (2,2)=0.98 (0.95−0.99) and SEM=0.18–0.18 and 0.17 while between days intra-rater rater and inter-rater reliability with Mean ± SD=5.14 ± 0.83 and 5.17 ± 0.78, ICC(2,1)=0.88–0.90 and ICC(2,2)=0.95 (0.88−0.98), SEM=0.17–0.38 and 0.17 [Conclusion] The results of the current study indicate that MSKUS is a reliable tool for measuring supraspinatus tendon thickness in healthy subjects.

Ultrasonographic Measures of the Acromiohumeral Distance and Supraspinatus Tendon Thickness in Manual Wheelchair Users With Spinal Cord Injury

Objectives(1) To evaluate the reliability of ultrasonographic measures of the acromiohumeral distance (AHD) in shoulder positions linked to wheelchair propulsion in manual wheelchair users (MWUs) with spinal cord injury (SCI) and able-bodied individuals; (2) to compare ultrasonographic measures of AHD, supraspinatus tendon thickness, and occupation ratio between MWUs with SCI with and without shoulder pain (rotator cuff [RC] tendinopathy); and (3) to compare these ultrasonographic measures between MWUs with SCI and able-bodied individuals. DesignCross-sectional study. SettingRehabilitation centers. ParticipantsThree groups of participants (N=95; aged between 18 and 60y) were recruited within a convenience sample: objective 1: 16 MWUs with SCI (mean age, 43±9y; height, 172±13 cm, weight, 84±10 kg) and 16 able-bodied individuals (mean age, 28±9y; height, 176±11 cm, weight, 72±12 kg); objectives 2 and 3: 37 MWUs with SCI (17 with [mean age, 47±11y; height, 172±14 cm, weight, 68±11 kg] and 20 without [mean age, 45±10y; height, 172±15 cm, weight, 84±30 kg] RC tendinopathy) and 26 able-bodied individuals (mean age, 31±5y; height, 175±12 cm; weight, 89±14 kg). InterventionsNot applicable. Main Outcome MeasuresAHD, supraspinatus tendon thickness, and occupation ratio of the supraspinatus tendon measured using ultrasound imaging systems. Results(1) Excellent intra- and interrater reliability of AHD was obtained in each arm position (intraclass correlation coefficient>.85); (2) MWUs without shoulder pain have thicker tendon than do MWUs with RC tendinopathy; and (3) a significant Group × Position interaction was found for AHD measures when comparing MWUs with SCI with able-bodied individuals (greater AHD at the end of the push phase for MWUs with SCI). A thicker tendon and a higher occupation ratio were also found in MWUs with SCI than in able-bodied individuals. ConclusionsUltrasonography is a reliable technology to evaluate AHD in MWUs in shoulder positions linked to wheelchair propulsion. Supraspinatus tendon thickness and occupation ratio of AHD adequately discriminate between MWUs with SCI and able-bodied individuals. This shows that these ultrasonographic measures can be used in future studies of populations with SCI to better understand the changes at the shoulder joint in MWUs.

Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy

Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy

Painful and painless shoulder magnetic resonance imaging comparisons in hemodialysis patients and correlation with clinical findings.

Shoulder pain is frequently observed in haemodialysis patients. To compare haemodialysis patients with or without shoulder pain in terms of shoulder motion ranges, β2 microglobulin levels and magnetic resonance imaging findings. Forty-three patients undergoing dialysis were enrolled, of which 23 patients had explicit shoulder pain at night, which appeared during dialysis. Range of joint motion and impingement tests were evaluated. β 2 microglobulin value was recorded. MRI was used to evaluate rotator cuff tendons for thickness, homogeneity, integrity and presence of effusion. Ranges of motion were significantly lower in the painful shoulder group. Supraspinatus tendon thickness and the number of areas with effusion were higher in the painful group. There was a positive correlation between the β 2 microglobulin level and supraspinatus (r:0.352 p< 0.05) and subscapular (r:0.454 p< 0.05) tendon thicknesses. While effusion areas and pain (r:0.351 p< 0.05) showed positive correlation, there was a negative correlation between pain and shoulder motion ranges. Shoulder pain in dialysis patients can be related with tendon thickness and effusion. While the β 2 microglobulin level affects tendon thickness, it has no relation to pain and movement constraint.

Ultrasound measures of supraspinatus tendon thickness and acromiohumeral distance in rotator cuff tendinopathy are reliable.

Rotator cuff (RC) tendinopathy has been widely ascribed to impingement of the supraspinatus tendon (SsT) in the subacromial space, measured as the acromiohumeral distance (AHD). Ultrasound (US) is suitable for measuring AHD and SsT thickness, but few reliability studies have been carried out in symptomatic populations, and interrater reliability is unconfirmed. This study aimed to examine the intrarater and interrater reliability of US measurements of AHD and SsT thickness in asymptomatic control subjects and patients with RC tendinopathy. Seventy participants were recruited and grouped as healthy controls (n = 25) and RC tendinopathy (n = 45). Repeated US measurements of AHD and SsT thickness were obtained by one rater in both groups and by two raters in the RC tendinopathy group. Intrarater and interrater reliability coefficients were excellent for both measurements (intraclass correlation > 0.92), but the intrarater reliability was superior. The minimal detectable change values in the symptomatic group were 0.7 mm for AHD and 0.6 mm for SsT thickness for a single experienced examiner; the values rose to 1.2 mm and 1.3 mm, respectively, for the pair of examiners. The results support the reliability of US for the measurement of AHD and SsT thickness in patients with symptomatic RC tendinopathy and provide minimal detectable change values for use in future research studies.

Dynamic changes in anterior third supraspinatus tendon—relations of a muscle and muscle-tendon transition at rest and in abduction

Background: It is said that the anterior third of the supraspinatus tendon controls the upward movement of the humeral head, and we have reported that the anterior third is changed by disease or symptoms. However, there are few studies demonstrating dynamic changes in the shoulder joint. Studies using ultrasonography allow real-time evaluation of soft tissue. Purpose: To clarify the change in thickness of the anterior third of the supraspinatus tendon and the thickness of supraspinatus muscle during rest and exercise, and the relationship between these parts in healthy individuals. Methods: The study assessed 30 shoulders of 15 healthy volunteers (15 males, mean age 23.4± 3.3 years, height 172.7± 5.5 cm, body weight 67.1± 11.1 kg). One person was excluded with a history of fracture of the shoulder girdle. The thickness of the anterior third of the supraspinatus tendon and the thickness of the supraspinatus muscle were measured in 30◦ shoulder joint abduction and at rest. The measurement position at rest was chair sitting, 0◦ shoulder flexion, 0◦ abduction, internal and external rotation midposition, 90◦ elbow joint flexion, and forearmmid-pronation. One assessor measured using a 7.5MHzB-mode linear ultrasonograph (VIAMO, Toshiba, Japan). The probe was placed on the anterior third of the supraspinatus tendon and the direction of the long axis of the supraspinatus muscle fibers of the scapular spine upper 30 cm for measurement site. To determine the reliability of the measurements, we calculated an intraclass correlation coefficient (ICC 1.1) from the four measurements at each site. For the statistical treatment, we used the Wilcoxon rank sum test to compare the difference between the thickness of the supraspinatus tendon at rest and in abduction, and the paired t-test for the difference in muscle thickness. The Pearson product-moment correlation coefficient was used to look for relationships between increases in the thickness of the supraspinatus muscle and the thickness of the anterior third of the supraspinatus tendon. Results: The mean anterior third of the supraspinatus tendon thickness was 4.9± 0.6mm (ICC= 0.91) at rest, 5.6± 0.6mm (ICC= 0.81) in abduction. The muscle thickness was 17.5± 2.8mm (ICC= 0.82) at rest, 19.0± 3.1mm (ICC= 0.87) in abduction. Comparing abduction and rest, there was a significantly increase in the thickness of both the tendon (p< 0.01) and the muscle (p< 0.01) during abduction. There was no correlation between the increases in tendon and muscle thickness (r= 0.01, p= 0.63). Conclusion(s): The thickness of the anterior third of the supraspinatus tendon increased with abduction means that a rotator cuff, joint capsule, and ligament act complexly. Then that the increase in thickness reduced the space between the humeral head and acromion is considered. Implications:Bymeasuring the thickness of anterior third supraspinatus tendon in abduction, it may become to understand that the supraspinatus tendonworks as a spacer. And the abduction of the shoulder may contribute toward the development or exacerbation of symptom due to compression.

Relationship Between Skin Intrinsic Fluorescence--an Indicator of Advanced Glycation End Products-and Upper Extremity Impairments in Individuals With Diabetes Mellitus.

Accumulation of advanced glycation end products (AGEs) is thought to contribute to limited joint mobility in people with diabetes mellitus (DM), but the relationships among AGEs, shoulder structural changes, movement, and disability are not understood. The purpose of this study was to determine the differences and relationships among skin intrinsic fluorescence (SIF), a proxy measure of AGEs, biceps and supraspinatus tendon thickness, upper extremity movement, and disability in groups with and without DM. This was a cross-sectional, case-control study. Fifty-two individuals participated: 26 with type 2 DM and 26 controls matched for sex, age, and body mass index. The main outcome measures were: SIF; biceps and supraspinatus tendon thickness; 3-dimensional peak shoulder motion; and Disability of the Arm, Shoulder and Hand (DASH) questionnaire scores. Mean SIF measurements were 19% higher in the DM group compared with the control group (P<.05). Biceps tendons (mean and 95% confidence interval [CI]) (4.7 mm [4.4, 5.0] versus 3.2 mm [2.9, 3.5]) and supraspinatus tendons (6.4 mm [5.9, 6.8] versus 4.9 mm [4.4, 5.3]) were thicker and peak humerothoracic elevation (139° [135°, 146°] versus 150° [146°, 155°]) and glenohumeral external rotation (35° [26°, 46°] versus 51° [41°, 58°]) were reduced in the DM group compared with the control group (P<.05). In the DM group, SIF was correlated to biceps tendon thickness, DASH score, and shoulder motion (r=.44-.51, P<.05). The SIF score and shoulder strength explained 64% of the DASH scores (P<.01). Because this was a cross-sectional study design, a cause-effect relationship could not be established. Accumulation of AGEs in the connective tissues of individuals with DM appears to be associated with increased tendon thickness and decreased shoulder joint mobility and upper extremity function. Physical therapists should be aware of these possible metabolic effects on structure, movement, and disability when treating people with diabetes.

The Clinical and Sonographic Effects of Kinesiotaping and Exercise in Comparison With Manual Therapy and Exercise for Patients With Subacromial Impingement Syndrome: A Preliminary Trial

ObjectiveThe purpose of this study was to compare the effects of manual therapy with exercise to kinesiotaping with exercise for patients with subacromial impingement syndrome. MethodsRandomized clinical before and after trial was used. Fifty-four patients diagnosed as having subacromial impingement syndrome who were referred for outpatient treatment were included. Eligible patients (between 30 and 60 years old, with unilateral shoulder pain) were randomly allocated to 2 study groups: kinesiotaping with exercise (n = 28) or manual therapy with exercise (n = 26). In addition, patients were advised to use cold packs 5 times per day to control for pain. Visual analog scale for pain, Disability of Arm and Shoulder Questionnaire for function, and diagnostic ultrasound assessment for supraspinatus tendon thickness were used as main outcome measures. Assessments were applied at the baseline and after completing 6 weeks of related interventions. ResultsAt the baseline, there was no difference between the 2 group characteristics (P > .05). There were significant differences in both groups before and after treatment in terms of pain decrease and improvement of Disability of Arm and Shoulder Questionnaire scores (P < .05). No difference was observed on ultrasound for tendon thickness after treatment in both groups (P > .05). The only difference between the groups was at night pain, resulting in favor of the kinesiotaping with exercise group (P < .05). ConclusionFor the group of subjects studied, no differences were found between kinesiotaping with exercise and manual therapy with exercise. Both treatments may have similar results in reducing pain and disability in subacromial impingement in 6 weeks.