In vivo dynamic acromiohumeral distance in shoulders with rotator cuff tears

BackgroundThere are no previous studies on the acromiohumeral distance in shoulders with large-to-massive full-thickness rotator cuff tears. In this study, the acromiohumeral distance in rotator cuff tear and healthy shoulders was measured using 3D-to-2D model-to-image registration techniques.MethodsThe dynamic glenohumeral kinematics during scapular plane abduction and axial rotation were analyzed in 11 rotator cuff tear patients and 10 healthy control subjects. Periodic radiographic images of scapular plane abduction and axial rotation were taken using a flat-panel radiograph image detector. Movements of the shoulder joint were assessed using radiographic images and computed tomography-derived digitally reconstructed radiographs. The acromiohumeral distance was defined as the shortest 3D distance between the acromion and the proximal humerus.FindingsFor scapular plane abduction, the rotator cuff tear group had significantly smaller acromiohumeral distance than the control group at 15°, 30°, 45°, 60°, 75°, 135°, and 150° of humeral abduction (P < 0.05 at each measured angle). For axial rotation in the adducted position, the rotator cuff tear group had significantly smaller acromiohumeral distance than the control group at each point between −20° and 40° of glenohumeral external rotation (P < 0.05 at each measured angle).InterpretationThe minimum measured acromiohumeral distance was 0.9 mm in the rotator cuff tear shoulders and 2.1 mm in the healthy shoulders at 90° of scapular plane abduction. The findings are of clinical relevance because quantitative evaluation of the dynamic acromiohumeral distances in rotator cuff tear and healthy shoulders might provide important insight into subacromial impingement.     

Comparison of acromiohumeral distance in symptomatic and asymptomatic patient shoulders and those of healthy controls

BackgroundThe reduction of the subacromial space has traditionally been linked to rotator cuff pathology. The contribution of this narrowing, both in the development and maintenance of rotator cuff tendinopathy, is still under debate. The objective of the present study was compare the acromiohumeral distance at 0 and 60 degrees of active shoulder abduction in scapular plane, static position, in both symptomatic and contralateral shoulders, between participants with unilateral rotator cuff related shoulder pain, and in asymptomatic participants.MethodThis was a cross-sectional observational study. Seventy-six participants with chronic shoulder pain were assessed. Forty participants without shoulder pain were also recruited to compare the acromiohumeral distance with symptomatic participants. The acromiohumeral distance was measured at 0 and 60 degrees of active shoulder abduction in all the groups by ultrasound imaging. Mean differences between symptomatic versus contralateral shoulders, and versus healthy controls, were calculated.FindingsThere were no statistical significant differences (p > .05) in the acromiohumeral distance at 0 degrees of shoulder elevation between the groups. However, significant differences were found at 60° between symptomatic and contralateral shoulder groups (0,51 mm; 95% CI: −0.90 to −0.12).InterpretationsDifferences in shoulder pain perception at 0° are not attributable to acromiohumeral distance differences. However, treatments focused on increasing AHD at 60° could be prescribed, as a significantly reduced AHD was found in symptomatic shoulders when compared with contralateral shoulders. Further research is needed to determine, not only static differences in AHD, but also dynamic differences.     

Cranial humerus translation,deltoid activation,adductor co-activation and rotator cuff disease — Different patterns in rotator cuff tears,subacromial impingement and controls

Background

Arm adductor co-activation during abduction has been reported as a potential compensation mechanism for a narrow subacromial space in patients with rotator cuff dysfunction. We assessed differences in acromiohumeral distance at rest and the amount of humerus translation during active abduction and adduction in patients with rotator cuff tears (n = 20) and impingement (n = 30) and controls (n = 10), controlled for deltoid, pectoralis major, latissimus dorsi and teres major activation (electromyography).

Methods

During the acquirement of shoulder radiographs, subjects performed standardized isometric arm abduction and adduction tasks. EMG's were normalized between − 1 and 1 using the “Activation Ratio”, where low values express (pathologic) co-activation, e.g. adductor activation during abduction.

Findings

In patients with cuff tears mean rest acromiohumeral distance was 7.6 mm (SD = 1.6): 3.5 mm narrower compared to patients with impingement (95%-CI: 2.4–4.5) and 1.3 mm narrower compared to controls (95%-CI: − 0.1–2.7). Both during abduction and adduction tasks, cranial translation was observed with equal magnitudes for patients and controls, with average values of 2.3 and 1.7 mm, respectively. Where patients with cuff tears had lower adductor Activation Ratios (i.e. more adductor co-activation during abduction), no association between abductor/adductor muscle activation and acromiohumeral distance was found.

Interpretation

The subacromial space is narrower in patients with rotator cuff tears compared to patients with impingement and controls. We found additional subacromial narrowing during isometric abduction and, to a lesser amount, during adduction in all subjects and more adductor co-activation in patients with cuff tears. We found no association between subacromial space and activation of the deltoid and main adductors.     

Relationship between strength and functional indexes (Rowe and Walch-Duplay scores) after shoulder surgical stabilization by the Latarjet technique

IntroductionThe rotator cuff muscles help stabilize the glenohumeral joint. Postoperative recovery of rotator cuff muscle strength appears to be an important factor for optimal joint stabilization and the resumption of professional and/or sports activities.ObjectiveTo study the relationship between internal rotator (IR) and external rotator (ER) muscle strength, shoulder function and the resumption of sports activities (as typically evaluated with functional scores) following surgical stabilization with the Bristow-Latarjet procedure in cases of chronic shoulder instability.Patients and methodsTwenty patients with anterior, post-traumatic, chronic shoulder instability were included prospectively in a cohort study. The Rowe and Walch-Duplay functional scores were rated for the operated shoulder and the isokinetic IR and ER peak torque values were evaluated with a Con-Trex^® dynamometer before surgery and then 3, 6 and 21 months afterwards. The isokinetic evaluation was performed (at 180°/s, 120°/s and 60°/s) in the seated position, with the arms in 45° of abduction and 30° of antepulsion in the plane of the scapula.ResultsThere were no significant postoperative correlations between shoulder function (as judged by the Rowe and Walch-Duplay scores) and IR or ER muscle strength.ConclusionThis study did not provide evidence for a correlation between IR and ER muscle strength and functional scores after surgical stabilization of the shoulder. However, it is necessary to objectively measure the rotator cuff strength recovery to adequate the strengthening of rotator muscle prior to the resumption of sports activities. Isokinetic strength assessment may thus be a valuable decision support tool for the resumption of sports activities and would complement the functional scores studied here.     

Subacromial Motion Metrics in Painful Shoulder Impingement: A Dynamic Quantitative Ultrasonography Analysis

ObjectivesTo explore the subacromial motion metrics in patients with and without subacromial impingement syndrome (SIS) and to investigate whether the abnormality was associated with rotator cuff pathologies.DesignThis cross-sectional observational study used dynamic quantitative ultrasonography imaging for shoulder joint assessment.SettingOutpatient rehabilitation clinic.ParticipantsIndividuals with SIS on at least 1 shoulder (n=32) and asymptomatic controls (n=32) (N=64).InterventionsNot applicable.Main Outcome MeasuresFrame-by-frame, the humeral greater tuberosity against the lateral edge of the acromion was traced to obtain the minimal vertical acromiohumeral distance (AHD). The rotation angle and radius of the humerus were computed using the least-squares curve fitting method.ResultsApproximately two-thirds of the shoulders with SIS did not have any sonographically identifiable rotator cuff pathologies. There was a consistent trend of nonsignificantly increased humeral rotation angles in painful shoulders. The generalized estimating equation demonstrated that the decreased minimal vertical AHD was associated with painful subacromial impingement (β coefficient: ?0.123cm, 95% confidence interval [CI], ?0.199 to ?0.047). The area under the curve for the minimal vertical AHD to discriminate painful or impinged shoulders ranged from 0.624-0.676. The increased rotation angle (β coefficient: 10.516°; 95% CI, 3.103-17.929) and decreased rotation radius (β coefficient: ?2.903cm; 95% CI, ?5.693 to ?0.111) were shown to be significantly related to the presence of supraspinatus tendinopathy.ConclusionsShoulders with SIS were characterized by a decreased minimal vertical AHD during dynamic examination. Abnormal subacromial metrics can develop in patients with mild (or no) rotator cuff pathologies. More prospective cohort studies are warranted to investigate the changes in subacromial motion metrics in populations at risk for painful or impinged shoulders.     

Three-dimensional scapular morphology is associated with rotator cuff tears and alters the abduction moment arm of the supraspinatus

BackgroundNumerous studies have reported an association between rotator cuff injury and two-dimensional measures of scapular morphology. However, the mechanical underpinnings explaining how these shape features affect glenohumeral joint function and lead to injury are poorly understood. We hypothesized that three-dimensional features of scapular morphology differentiate asymptomatic shoulders from those with rotator cuff tears, and that these features would alter the mechanical advantage of the supraspinatus.MethodsTwenty-four individuals with supraspinatus tears and twenty-seven age-matched controls were recruited. A statistical shape analysis identified scapular features distinguishing symptomatic patients from asymptomatic controls. We examined the effect of injury-associated morphology on mechanics by developing a morphable model driven by six degree-of-freedom biplanar videoradiography data. We used the model to simulate abduction for a range of shapes and computed the supraspinatus moment arm.FindingsRotator cuff injury was associated with a cranial orientation of the glenoid and scapular spine (P = .011, d = 0.75) and/or decreased subacromial space (P = .001, d = 0.94). The shape analysis also identified previously undocumented features associated with superior inclination and subacromial narrowing. In our computational model, warping the scapula from a cranial to a lateral orientation increased the supraspinatus moment arm at 20° of abduction and decreased the moment arm at 160° of abduction.InterpretationsThree-dimensional analysis of scapular morphology indicates a stronger relationship between morphology and cuff tears than two-dimensional measures. Insight into how morphological features affect rotator cuff mechanics may improve patient-specific strategies for prevention and treatment of cuff tears.     

Quantifying acromiohumeral distance in elite male field hockey players compared to a non-athletic population

BackgroundShoulders of elite field hockey players are loaded continuously during play. Frequent high shoulder loading is known to influence certain shoulder variables, such as acromiohumeral distance. However, the influence of elite field hockey play on acromiohumeral distance is not examined yet.ObjectiveTo examine the acromiohumeral distance in elite male field hockey players compared to a non-athletic control group.DesignCross-sectional study.MethodsFifty male participants were included; 25 elite field hockey players (age: 24.0 ± 2.72 years; weight: 77.2 ± 5.29 kg; height; 180.5 ± 5.37 cm) and 25 age- and gender matched non-athletes (23.0 ± 2.29 years; weight: 75.7 ± 9.53 kg; height: 181.8 ± 5.52 cm). A Telemed-Colormaster-128 EXT-IZ device was used to bilaterally obtain ultrasound acromiohumeral distance images at 3 different angles of shoulder abduction in the frontal plane.ResultsField hockey players showed a bilateral larger acromiohumeral distance at 45° (mean difference: 1.46 mm [95% CI 0.46; 2.46]; p = 0.005) and 60° (mean difference: 1.07 mm [95% CI 0.21; 1.93]; p = 0.016) compared to controls. In both groups, a significant but clinically less relevant, side difference was established for the acromiohumeral distance at 60° (mean difference: 0.79 mm [95% CI 0.21; 1.34]; p = 0.009).ConclusionWith active shoulder abduction, elite field hockey players show a larger acromiohumeral distance in comparison to non-athletic participants. This may be a protective sport-specific adaptation, to better guard the shoulder from injury. Thus, acromiohumeral distance measurement may help physical therapists/coaches decide which athletes could benefit from specific, additional exercises aimed at enlarging the subacromial space.     

Effects of elastic kinesiology taping on shoulder proprioception: a systematic review

BackgroundShoulder injuries are associated with proprioceptive deficits. Elastic kinesiology tape (KT) is used for treating musculoskeletal disorders, including shoulder injuries, as it arguably improves proprioception.ObjectiveTo synthesize the evidence on the effects of elastic KT on proprioception in healthy and pathological shoulders.MethodsFour databases (PubMed, WoS, CINAHL, SPORTDiscus) were searched for studies that investigated the effects of elastic KT on shoulder proprioception. Outcome measures were active joint position sense (AJPS), passive joint position sense (PJPS), kinesthesia, sense of force (SoF), and sense of velocity (SoV). Risk of bias (RoB) was assessed using the Cochrane Collaboration RoB tool for randomized controlled trials (RCTs), and the ROBINS-1 for non-RCTs, while the certainty of evidence was determined using GRADE.ResultsEight studies (5 RCTs, 3 non-RCTs) were included, yielding 187 shoulders (102 healthy and 85 pathological shoulders). RoB ranged from low (2 studies), moderate (5 studies), to high (1 study). Elastic KT has a mixed effect on AJPS of healthy shoulders (n=79) (low certainty). Elastic KT improves AJPS (subacromial pain syndrome and rotator cuff tendinopathy, n=52) and PJPS (chronic hemiparetic shoulders, n=13) among pathological shoulders (very low certainty). Elastic KT has no effect on kinesthesia among individuals with subacromial pain syndrome (n=30) (very low certainty).ConclusionThere is very low to low certainty of evidence that elastic KT enhances shoulder AJPS and PJPS. The aggregate of evidence is currently so low that any recommendation on the effectiveness of elastic KT on shoulder proprioception remains speculative.     

Comparison of rotator cuff to glenoid proximity based on scapulothoracic upward rotation classification

BackgroundRecent evidence suggests that internal impingement, or rotator cuff tendon deformation against the glenoid, occurs during overhead motions and may therefore be a mechanism of pathology even in non-athletes. Clinically, knowing how movement impacts potential injury mechanisms would be useful to guide movement-based treatment strategies.ObjectiveTo compare the distance between the glenoid and rotator cuff footprint between two groups classified based on scapulothoracic upward rotation (UR) magnitude (i.e., low, high) at 90° humerothoracic elevation.MethodsShoulder kinematics were quantified during scapular plane abduction in 60 participants using single-plane fluoroscopy. Of these, 40 were subsequently classified as having high or low scapulothoracic UR based on the sample's distribution. The minimum distance between the glenoid and rotator cuff footprint was calculated along with the locations of closest proximity (i.e., proximity centers). Minimum distances and proximity center locations were compared between groups using 2-factor mixed-model ANOVAs. The prevalence of glenoid-to-footprint contact was also compared.ResultsGlenoid-to-footprint distances consistently decreased as humerothoracic elevation angle increased, and the anterior aspect of the footprint was closest to the posterosuperior glenoid. Minimum distances were not significantly different between UR groups (p≥0.16). However, group differences existed in proximity center locations (p<0.01). Glenoid-to-footprint contact was identified in 75.0% of participants at an average (SD) of 133.6° (3.2°) humerothoracic elevation.ConclusionThe results of this study suggest that decreased UR as classified and assessed in this study does not significantly impact glenoid-to-footprint distances but does alter the location of the contact, which occurred in most participants.     

Use of Mobilization with Movement in the Treatment of a Patient with Subacromial Impingement: A Case Report

Abstract

Mobilization with movement (MWM) is a fairly new therapeutic technique commonly used by physical therapists. The purpose of this case report was to describe the use of MWM in the treatment of a 27-year old left-hand dominant male patient referred to physical therapy with a diagnosis of supraspinatus tendinopathy secondary to impingement. Interventions consisted of MWM and other manual therapy techniques, modalities, and therapeutic exercises. Outcome measures used included goniometric active range of motion (AROM) measurements and manual muscle tests of the shoulder, impingement tests, and the Shoulder Pain and Disability Index (SPADI) and Short Form-36 (SF-36) questionnaires. Specific outcome measures used to describe the response to MWM of the glenohumeral joint included the Numeric Pain Rating Scale (NPRS) and goniometric measurement of abduction AROM. After the first MWM treatment (session 2/12), the 6/10 pre-application NPRS score during shoulder abduction was reduced to 3/10 post-application; however, abduction AROM did not improve (95°). At the final MWM treatment (session 6/12), the pre-application NPRS score during abduction was reduced from 3/10 to 0/10 post-application; abduction AROM increased from 130° to 175°. After 12 sessions, there was a decrease from moderate pain (7/10) to little or no pain (0-1/10) during active shoulder abduction; restricted (95°) to full shoulder abduction active range of motion (180°); and an improvement in the SPADI score from 45% to 8% with no pain or ADL activity difficulty scores >2. This case report indicates that MWM may be an effective treatment intervention for patients with subacromial impingement. Future research is needed to study the efficacy and mechanisms of this treatment technique.     

Measurement of strain and tensile force of the supraspinatus tendon under conditions that simulates low angle isometric elevation of the gleno-humeral joint: Influence of adduction torque and joint positioning

BackgroundRecently, supraspinatus muscle exercise has been reported to treat rotator cuff disease and to recover shoulder function. However, there have been no report on the direct measurement of strain on the supraspinatus tendon during simulated isometric gleno-humeral joint elevation.MethodsTen fresh-frozen shoulder specimens with the rotator cuff complex left intact were used as experimental models. Isometric gleno-humeral joint elevation in a sitting position was reproduced with low angle of step-by-step elevation in the scapular plane and strain was measured on the surface layer of the supraspinatus tendon.FindingsIn isometric conditions, applied tensile force of the supraspinatus tendon increased significantly with increases in adduction torque on the gleno-humeral joint. Significant increases in the strain on the layer were observed by increase in adduction torque, which were recorded in isometric elevation at − 10° and 0°, but little increase in the strain was observed at 10° or greater gleno-humeral elevation.InterpretationIncreased strain on the surface layer of the supraspinatus tendon was observed during isometric gleno-humeral elevation from − 10 to 0°. These findings demonstrate a potential risk of inducing overstretching of the supraspinatus tendon during supraspinatus muscle exercise.     

关节镜下三点定位技术修补肩袖损伤的临床体会

目的 总结关节镜下三点定位技术修补肩袖损伤的临床体会.方法 收集2018年1月-2019年6月符合纳入标准的肩袖损伤患者52例,根据手术方法不同分为两组.A组采用传统两点定位技术(n=26),B组采用三点定位技术(n=26),比较两组患者手术时间、视觉模拟评分法(VAS)、美国加州大学(UCLA)肩关节评分、美国肩肘外...     

Exploration of the clinical course of frozen shoulder: A longitudinal multicenter prospective study of functional impairments

BackgroundContradictory evidence exists regarding the clinical course of frozen shoulder (FS).ObjectivesTo explore the clinical course of FS regarding disabilities, pain, range of motion (ROM), muscle strength, scapular upward rotation, and proprioception and to establish longitudinal correlations between these variables.MethodsPatients with FS were prospectively followed for 9 months at 3-month intervals. Assessment included the Disabilities of the Arm, Shoulder and Hand questionnaire; visual analogue scale for pain; an inclinometer for shoulder external rotation (ER), internal rotation (IR), flexion, and abduction ROM, and scapular upward rotation and proprioception, as well as handheld dynamometry for muscle strength in shoulder abduction, ER, and IR.ResultsInitially, 149 patients (98 females; mean (SD) age 53 (9) years) were included, with 88 completing all follow-up assessments. Most variables showed early improvement in the clinical course of FS, particularly ER and IR at 90° abduction, which continued to improve from 6 to 9 months of follow-up. Associations were observed between disabilities and pain (r = 0.61), disabilities/pain and ROM (r=-0.62 to -0.59 and r=-0.47 to -0.39, respectively), disabilities/pain and muscle strength (r=-0.24 to -0.35 and r=-0.36 to -0.17, respectively), and between disabilities/pain and scapular upward rotation below shoulder level (r = 0.23 to 0.38 and r = 0.24 to 0.30, respectively). ROM correlated with muscle strength (r = 0.14 to 0.44), while both ROM and ER muscle strength correlated with scapular upward rotation below shoulder level (r=-0.37 to -0.23 and r=-0.17 to -0.12, respectively). Muscle strength correlated with scapular upward rotation above shoulder level (r = 0.28 to 0.38) and lift-off muscle strength correlated with joint repositioning (r=-0.17 to -0.15).ConclusionAlmost all factors improved in the early phase (3–6 months) after baseline assessment, while ER and IR ROM at shoulder level continued to improve long term.     

The effect of a rotator cuff tear and its size on three-dimensional shoulder motion

BackgroundRotator cuff-disease is associated with changes in kinematics, but the effect of a rotator cuff-tear and its size on shoulder kinematics is still unknown in-vivo.MethodsIn this cross-sectional study, glenohumeral and scapulothoracic kinematics of the affected shoulder were evaluated using electromagnetic motion analysis in 109 patients with 1) subacromial pain syndrome (n = 34), 2) an isolated supraspinatus tear (n = 21), and 3) a massive rotator cuff tear involving the supraspinatus and infraspinatus (n = 54). Mixed models were applied for the comparisons of shoulder kinematics between the three groups during abduction and forward flexion.FindingsIn the massive rotator cuff-tear group, we found reduced glenohumeral elevation compared to the subacromial pain syndrome (16°, 95% CI [10.5, 21.2], p < 0.001) and the isolated supraspinatus tear group (10°, 95% CI [4.0, 16.7], p = 0.002) at 110° abduction. Reduced glenohumeral elevation in massive rotator cuff tears coincides with an increase in scapulothoracic lateral rotation compared to subacromial pain syndrome (11°, 95% CI [6.5, 15.2], p < 0.001) and supraspinatus tears (7°, 95% CI [1.8, 12.1], p = 0.012). Comparable differences were observed for forward flexion. No differences in glenohumeral elevation were found between the subacromial pain syndrome and isolated supraspinatus tear group during arm elevation.InterpretationThe massive posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential.     

Modeling a rotator cuff tear: Individualized shoulder muscle forces influence glenohumeral joint contact force predictions

BackgroundRotator cuff tears in older individuals may result in decreased muscle forces and changes to force distribution across the glenohumeral joint. Reduced muscle forces may impact functional task performance, altering glenohumeral joint contact forces, potentially contributing to instability or joint damage risk. Our objective was to evaluate the influence of rotator cuff muscle force distribution on glenohumeral joint contact force during functional pull and axilla wash tasks using individualized computational models.MethodsFourteen older individuals (age 63.4 yrs. (SD 1.8)) were studied; 7 with rotator cuff tear, 7 matched controls. Muscle volume measurements were used to scale a nominal upper limb model's muscle forces to develop individualized models and perform dynamic simulations of movement tracking participant-derived kinematics. Peak resultant glenohumeral joint contact force, and direction and magnitude of force components were compared between groups using ANCOVA.FindingsResults show individualized muscle force distributions for rotator cuff tear participants had reduced peak resultant joint contact force for pull and axilla wash (P ≤ 0.0456), with smaller compressive components of peak resultant force for pull (P = 0.0248). Peak forces for pull were within the glenoid. For axilla wash, peak joint contact was directed near/outside the glenoid rim for three participants; predictions required individualized muscle forces since nominal muscle forces did not affect joint force location.InterpretationOlder adults with rotator cuff tear had smaller peak resultant and compressive forces, possibly indicating increased instability or secondary joint damage risk. Outcomes suggest predicted joint contact force following rotator cuff tear is sensitive to including individualized muscle forces.     

Quantification of sonographic echogenicity by the gray-level histogram in patients with supraspinatus tendinopathy

Purpose

The aim of this study was to compare the gray-level value of the supraspinatus tendon of a painful shoulder with that of a normal shoulder measured by ultrasonography, and to investigate whether a low mean gray-level value of the supraspinatus tendon could indicate a partial-thickness or incomplete full-thickness tear.

Methods

Two hundred and ten patients had significant unilateral shoulder pain with the clinical suspicion of rotator cuff tendinopathy. They underwent bilateral shoulder ultrasonography, and the mean echogenicity of the histogram was calculated on the screen. The mean gray-level value of each patient’s contralateral asymptomatic shoulder was compared with that of the painful shoulder.

Results

Based on the scan of transverse and longitudinal planes, a significant difference existed between the symptomatic shoulder and contralateral asymptomatic shoulder (p < 0.0001). The mean gray-level values of symptomatic shoulders showed no statistically significant difference between the patients who underwent surgery and the patients who underwent conservative treatment.

Conclusions

We demonstrated that the ultrasound gray-level histogram is a promising tool for detecting the hypoechogenic appearance of supraspinatus tendinopathy. A decrease in the mean gray-level value on the symptomatic shoulder may be used as an alternative sonographic indicator of rotator cuff partial-thickness tear or tendinopathy.

Level of evidence

Diagnostic level III.     

Fracture of the scapular neck combined with rotator cuff tear: A case report

BACKGROUNDScapular fracture has a low incidence rate, accounting for 0.4%-0.9% of all fractures, and scapular neck fractures are extremely rare, comprising approximately 7%-25% of all scapular fractures. Scapular neck fractures are often studied as case reports mostly accompanied by other injuries, thus leading to confusion. All previous cases of scapular neck fractures are not associated with rotator cuff injuries.CASE SUMMARYA 62-year-old man was admitted to our emergency department 6 h after his right shoulder and back were impacted by heavy objects. The patient presented chest tightness and shortness of breath. Chest computed tomography (CT) showed pneumohemothorax, multiple rib fractures, and right scapula fractures. Three-dimensional CT reconstruction of the right shoulder joint showed a trans-spinous scapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injury was suspected because the patient had a glenohumeral joint dislocation and was then confirmed by shoulder magnetic resonance imaging. A staged surgery was performed, including open reduction and internal fixation of the right scapula fracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mo follow-up, the fracture line was blurred and the shoulder joint function was good.CONCLUSIONFracture of the scapular neck combined with rotator cuff tear is rare and the rotator cuff injury should not be ignored in clinical work. Stable internal fixation combined with secondary arthroscopic repair of rotator cuff tear can achieve good results.     

Isokinetic assessment of the shoulder rotators: a study of optimal test position

Background: Isokinetic assessment of the shoulder rotator cuff is a common component of shoulder muscles assessment. Nevertheless, the extensive mobility of the shoulder poses great difficulty in finding a consensus protocol for evaluation. Objective: To select an optimal protocol, among three, based on the best reproducibility and reliability of strength scores derived from internal and external rotator tests. Method: The dominant side external and internal rotator muscles of twelve healthy male subjects were evaluated based on a concentric protocol (60° s^?1 and 240° s^?1) in three different test positions: two in lying supine with the arm in either 90° or 45° abduction and one in the seated position with the arm moving in the scapular plane on the dominant shoulder. Subjects were tested twice over 10 days. Results: The two lying installations were associated with the lowest coefficient of variation (7·1–11·8%) and smallest detectable difference (7–15·9 N·m) for peak moment and strength ratios. Consequently, the lying positions were chosen for rotators assessment with 90° of abduction associated with a higher reproducibility for the agonist/antagonist ratios or 45° if some pain was provoked. In any case, the coefficient of variation did not exceed 12%. Conclusion: Based on a reproducibility and reliability analysis, we recommend the testing of isokinetic strength of the shoulder rotators to be conducted in supine lying, with the arm at 90° or 45° abduction in the frontal plane.     

Effect of sternoclavicular joint mobilization on pain and function in a patient with massive supraspinatus tear

Massive irreparable rotator cuff tears can be difficult to treat conservatively, especially when the patient has multiple comorbidities. Although there is evidence to support interventions aimed at the spine, there is paucity in the literature describing interventions to the sternoclavicular joint (SCJ) in individuals with rotator cuff pathology. A 57-year-old female with multiple comorbidities and a body mass index of 59 was referred to physical therapy with a 4-month history of right shoulder pain, significant functional limitations, and magnetic resonance imaging (MRI), demonstrating a full-thickness supraspinatus tear. She presented initially with active shoulder flexion range of motion (ROM) 0–80°, numeric pain rating scale (NPRS) 7/10, and QuickDASH 65.9%. After six physical therapy sessions, the patient had plateaued with improvements in pain and ROM. SCJ mobilizations at visit 7 immediately improved pain, active ROM, and subjective reports of function. The patient was discharged after 13 visits with increased active shoulder flexion ROM to 0–170°, NPRS 1/10, QuickDASH 31.8%, and Global Rating of Change (GROC) +5. This case highlights the successful conservative treatment of an individual with an irreparable rotator cuff tear and numerous comorbidities by using a multimodal approach including SCJ mobilizations.     

本体感觉训练干预对肩袖损伤患者术后肩关节功能、生活质量的影响

目的 探究自行设计的本体感觉训练干预方案对肩袖损伤患者术后肩关节功能、生活质量的影响.方法 选取2018年3月—2020年3月于医院行肩关节镜下肩袖损伤修补术治疗的62例患者为研究对象,按照性别、年龄、病程、受累肩具有可比性的原则分为对照组和观察组,每组31例.对照组采用常规护理干预,观察组在对照组基础上联合本体感觉训...