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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Shoulder disorders in general practice: incidence, patient characteristics, and management.Ann Rheum Dis. 1995; 54: 959-964
- Subacromial impingement syndrome.Orthop Rev (Pavia). 2012; 4: e18
- Reduced acromiohumeral distance and increased critical shoulder angle: implications for primary care clinicians.Phys Sportsmed. 2020; 48: 312-319
- Sonographic versus radiographic measurement of the subacromial space width.Chir Organi Mov. 2004; 89: 143-150
- Supraspinatus tendon and subacromial space parameters measured on ultrasonographic imaging in subacromial impingement syndrome.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 363-369
- Ultrasound measurements on acromio-humeral distance and supraspinatus tendon thickness: test-retest reliability and correlations with shoulder rotational strengths.J Sci Med Sport. 2012; 15: 284-291
- Ultrasonographic measures of subacromial space in patients with rotator cuff disease: a systematic review.J Clin Ultrasound. 2011; 39: 146-154
- Quantitative analysis of dynamic subacromial ultrasonography: reliability and influencing factors.Front Bioeng Biotechnol. 2022; 10830508
- Effects of ultrasound-guided peritendinous and intrabursal corticosteroid injections on shoulder tendon elasticity: a post hoc analysis of a randomized controlled trial.Arch Phys Med Rehabil. 2021; 102: 905-913
- Ultrasound-guided standard vs dual-target subacromial corticosteroid injections for shoulder impingement syndrome: a randomized controlled trial.Arch Phys Med Rehabil. 2019; 100: 2119-2128
- Translation and cross-cultural adaptation of the Shoulder Pain and Disability Index (SPADI) into Chinese.Clin Rheumatol. 2017; 36: 1419-1426
- EURO-MUSCULUS/USPRM basic scanning protocols for shoulder.Eur J Phys Rehabil Med. 2015; 51: 491-496
- Static and dynamic shoulder imaging to predict initial effectiveness and recurrence after ultrasound-guided subacromial corticosteroid injections.Arch Phys Med Rehabil. 2017; 98: 1984-1994
- Statistical analysis of correlated data using generalized estimating equations: an orientation.Am J Epidemiol. 2003; 157: 364-375
- Youden index and optimal cut-point estimated from observations affected by a lower limit of detection.Biom J. 2008; 50: 419-430
- Dynamic sonography evaluation of shoulder impingement syndrome.Am J Roentgenol. 2006; 187: 216-220
- Association of bicipital peritendinous effusion with subacromial impingement: a dynamic ultrasonographic study of 337 shoulders.Sci Rep. 2016; 6: 38943
- Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes.Int J Sports Phys Ther. 2011; 6: 51-58
- Association between rotator cuff abnormalities and reduced acromiohumeral distance.Am J Roentgenol. 2006; 187: 376-382
- In vivo dynamic acromiohumeral distance in shoulders with rotator cuff tears.Clin Biomech (Bristol, Avon). 2018; 60: 95-99
- Acromio humeral distance less than six millimeter: its meaning in full-thickness rotator cuff tear.Orthop Traumatol Surg Res. 2011; 97: 246-251
- Correlation between acromiohumeral distance and the severity of supraspinatus tendon tear by ultrasound imaging in a Chinese population.BMC Musculoskelet Disord. 2020; 21: 106
- Acromiohumeral distance and supraspinatus tendon thickness in people with shoulder impingement syndrome compared to asymptomatic age and gender-matched participants: a case control study.BMC Musculoskelet Disord. 2021; 22: 1004
- Is there a decrease in the acromiohumeral distance among recreational overhead athletes with rotator cuff-related shoulder pain?.J Sport Rehabil. 2020; 30: 531-537
- [Metabolic profiling of human blood] [Russian].Biomed Khim. 2014; 60: 281-294
- Receiver operating characteristic curve: overview and practical use for clinicians.Korean J Anesthesiol. 2022; 75: 25-36
- Deltoid muscle contribution to shoulder flexion and abduction strength: an experimental approach.J Shoulder Elbow Surg. 2021; 30: e60-e68
- Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder.Knee Surg Sports Traumatol Arthrosc. 2008; 16: 408-414
- Sonographic evaluations in elite college baseball athletes.Scand J Med Sci Sports. 2005; 15: 29-35
- Classification of rotator cuff tears in ultrasound images using deep learning models.Med Biol Eng Comput. 2022; 60: 1269-1278
Article info
Publication history
Published online: August 30, 2022
Accepted:
August 15,
2022
Received in revised form:
August 11,
2022
Received:
April 19,
2022
Footnotes
K.V.C received funding from (1) National Taiwan University Hospital, Bei-Hu Branch, (2) Ministry of Science and Technology (MOST 106–2314-B-002–180-MY3 and 109–2314-B-002–114-MY3), and (3) Taiwan Society of Ultrasound in Medicine.
The studies involving human participants were reviewed and approved by the institutional review board of the hospital approved the research proposal (IRB No. 201910036RINC). The participants provided their written informed consent to participate in this study.
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
