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

  • Wei-Ting Wu
    Affiliations
    Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Che-Yu Lin
    Affiliations
    Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei, Taiwan
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  • Yi-Chung Shu
    Affiliations
    Institute of Applied Mechanics, College of Engineering, National Taiwan University, Taipei, Taiwan
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  • Lan-Rong Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
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  • Levent Özçakar
    Affiliations
    Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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  • Ke-Vin Chang
    Correspondence
    Corresponding author Ke-Vin Chang, MD, PhD, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, No. 87 Neijiang Street, Wanhua District, Taipei City 108, Taiwan.
    Affiliations
    Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
    Search for articles by this author
Published:August 30, 2022DOI:https://doi.org/10.1016/j.apmr.2022.08.010

      Abstract

      Objectives

      To 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.

      Design

      This cross-sectional observational study used dynamic quantitative ultrasonography imaging for shoulder joint assessment.

      Setting

      Outpatient rehabilitation clinic.

      Participants

      Individuals with SIS on at least 1 shoulder (n=32) and asymptomatic controls (n=32) (N=64).

      Interventions

      Not applicable.

      Main Outcome Measures

      Frame-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.

      Results

      Approximately 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.

      Conclusions

      Shoulders 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.

      Keywords

      List of abbreviations:

      AHD (acromiohumeral distance), CI (confidence interval), GEE (generalized estimating equation), SIS (subacromial impingement syndrome), SPADI (Shoulder Pain and Disability Index)
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