Shoulder impingement syndrome in relation to shoulder intensive work.
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OBJECTIVES: To analyse the risk of shoulder impingement syndrome relative to shoulder intensive work. METHODS: A cross sectional study of a historical cohort of 1591 workers employed between 1986 and 1993 at a slaughterhouse or a chemical factory. Workers not doing tasks in slaughtering or meat processing constituted the reference group. Intensity of shoulder work in meat processing tasks was assessed by video based observations. Information on shoulder disorders was collected by questionnaire and by physical examinations. Impingement syndrome was diagnosed when shoulder symptoms had been present for at least 3 months during the past year and there were signs of subacromial impingement in the corresponding shoulder at physical examination. Shoulder function was assessed at the same occasion with the Constant scoring technique. Prevalence of shoulder impingement syndrome was analysed according to job title and cumulative exposure. RESULTS: Prevalence ratio for shoulder impingement syndrome was 5.27 (95% confidence interval (95% CI), 2.09 to 12.26) among currently working and 7.90 (95% CI, 2.94 to 21.18) among former slaughterhouse workers. Transformed model based prevalence ratios according to years in slaughterhouse work showed an overall association between cumulative exposure and risk for shoulder impingement syndrome. CONCLUSIONS: This study supports the hypothesis that shoulder intensive work is a risk factor for impingement syndrome of the shoulder. Despite the historical cohort design healthy worker selection may have influenced the exposure-response relation found. (+info)
Sonography and magnetic resonance imaging equivalent for the assessment of full-thickness rotator cuff tears.
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OBJECTIVE: To investigate the diagnostic value of sonography (SG) and magnetic resonance imaging (MRI) in the assessment of full-thickness rotator cuff tears (RCTs). METHODS: Twenty-one consecutive, otherwise healthy patients with noninflammatory unilateral chronic (>3 months) shoulder complaints due to a possible full-thickness RCT were studied (9 women and 12 men, mean +/- SD age 56 +/- 12). According to standardized procedures, SG was performed by both a radiologist and a rheumatologist, and MRI was evaluated by 2 radiologists. All assessors were blinded to the patient's diagnosis. Within 3 weeks after SG and MRI, arthroscopy was performed. SG, MRI, and arthroscopy results were scored as negative or positive for the presence of a full-thickness RCT. The result of surgical inspection was used as the "gold standard." RESULTS: For full-thickness RCTs, the sensitivity was 0.81 for SG and 0.81 for MRI. The specificity was 0.94 for SG and 0.88 for MRI. The positive predictive value was 0.96 for SG and 0.91 for MRI. The negative predictive value was 0.77 for SG and 0.74 for MRI. Accuracy was 0.86 for SG and 0.83 for MRI. CONCLUSION: Full-thickness RCTs can be identified accurately by both SG and MRI. Because of its low cost and because it can be performed in the rheumatology unit, SG seems to be a promising diagnostic tool for use by the rheumatologist. (+info)
The morphometry of the coracoid process - its aetiologic role in subcoracoid impingement syndrome.
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Anatomical morphometric studies of the coracoid process and coraco-glenoid space were carried out on 204 dry scapulae. No statistically significant correlations were found between length, or thickness of the coracoid process, prominence of the coracoid tip, coracoid slope, coraco-glenoid distance, or position of the coracoid tip with respect to the uppermost point of the glenoid. These anatomical characteristics were independent of the dimensions of the scapulae. Three configurations of the coraco-glenoid space were identified. Type I configuration was found in 45% of scapulae and Type II and Type III, in 34% and 21% of specimens, respectively. The lowest value of the coraco-glenoid distance were seen in Type I scapulae. Morphometric characteristics which might predispose to subcoracoid impingement were found in 4% of Type I scapulae. A total of 27 scapulae, nine with each type of configuration were submitted to CT scanning. Scapulae with a Type I configuration were found to have low values for the coraco-glenoid angle and coracoid overlap, which are known to be associated with a short coraco-humeral distance. Subjects with a Type I configuration, and severe narrowing of the coraco-glenoid space, appear to be predisposed to coraco-humeral impingement. These morphometric characteristics may be easily evaluated on CT scans. (+info)
Five year results of rotator cuff repair.
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In thirty nine patients with either an acute rotator cuff rupture or a chronic impingement syndrome plus a cuff tear, a standard acromioplasty was performed along with a cuff repair using a bone detaching approach. Postoperative active motion was allowed in all but three. Follow up examination was performed two and five years after the operation. Continuous improvement in function, range of movement, and strength was observed, while pain increased slightly. The size of the tear and delay in treatment were determining factors in the outcome. (+info)
Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome.
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OBJECTIVE: Subacromial impingement syndrome (SIS) is a frequent cause of shoulder pain. The aim of this study was to investigate the diagnostic values of clinical diagnostic tests, in patients with SIS. METHODS: 72 female, 48 male patients with shoulder pain were included in the study. Five had bilateral shoulder pain, so 125 painful shoulders were evaluated. Details were recorded about the patients' ages and sexes, as well as characteristics of pain and related problems. Detailed physical examination and routine laboratory tests were performed. Conventional radiography and subsequent magnetic resonance imaging of the shoulder region of all patients were performed. Patients were divided into two groups according to the results of subacromial injection test, a reference standard test for SIS. Test positive patients constituted SIS group and test negative patients the non-SIS group. Sensitivity, specificity, accuracy, positive and negative predictive values of some clinical diagnostic tests such as Neer, Hawkins, horizontal adduction, painful arc, drop arm, Yergason and Speed tests for SIS were determined by using 2 x 2 table. RESULTS: The most sensitive diagnostic tests were found to be Hawkins test (92.1%), Neer test (88.7%) and horizontal adduction test (82.0%). Tests with highest specificity were drop arm test (97.2%), Yergason test (86.1%) and painful arc test (80.5%) consecutively. CONCLUSION: The highly sensitive tests seem to have low specificity values and the highly specific ones to have low sensitivity values. Although this finding suggests that these diagnostic tests are insufficient for certain diagnosis, it is suggested they play an important part in clinical evaluation. (+info)
Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.
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BACKGROUND AND PURPOSE: Treatment of patients with impingement symptoms commonly includes exercises intended to restore "normal" movement patterns. Evidence that indicates the existence of abnormal patterns in people with shoulder pain is limited. The purpose of this investigation was to analyze glenohumeral and scapulothoracic kinematics and associated scapulothoracic muscle activity in a group of subjects with symptoms of shoulder impingement relative to a group of subjects without symptoms of shoulder impingement matched for occupational exposure to overhead work. SUBJECTS: Fifty-two subjects were recruited from a population of construction workers with routine exposure to overhead work. METHODS: Surface electromyographic data were collected from the upper and lower parts of the trapezius muscle and from the serratus anterior muscle. Electromagnetic sensors simultaneously tracked 3-dimensional motion of the trunk, scapula, and humerus during humeral elevation in the scapular plane in 3 handheld load conditions: (1) no load, (2) 2. 3-kg load, and (3) 4.6-kg load. An analysis of variance model was used to test for group and load effects for 3 phases of motion (31(-60(, 61(-90(, and 91(-120(). RESULTS: Relative to the group without impingement, the group with impingement showed decreased scapular upward rotation at the end of the first of the 3 phases of interest, increased anterior tipping at the end of the third phase of interest, and increased scapular medial rotation under the load conditions. At the same time, upper and lower trapezius muscle electromyographic activity increased in the group with impingement as compared with the group without impingement in the final 2 phases, although the upper trapezius muscle changes were apparent only during the 4.6-kg load condition. The serratus anterior muscle demonstrated decreased activity in the group with impingement across all loads and phases. CONCLUSION AND DISCUSSION: Scapular tipping (rotation about a medial to lateral axis) and serratus anterior muscle function are important to consider in the rehabilitation of patients with symptoms of shoulder impingement related to occupational exposure to overhead work. [Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. (+info)
Local anaesthetic injection with and without corticosteroids for subacromial impingement syndrome.
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Fifty patients with impingement syndrome refractory to long-term conservative treatment were randomized to three treatment groups. All patients received an injection of 10 ml 0.5% bupivacaine, in group 1 without corticosteroid, in group 2 with crystalline corticosteroid and in group 3 with lipoid corticosteroid. Treatment in group 1 had to be stopped because of inefficacy. In groups 2 and 3 favorable results were achieved in 19 out of 40 patients. (+info)
The painful shoulder: part II. Acute and chronic disorders.
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Fractures of the humerus, scapula and clavicle usually result from a direct blow or a fall onto an outstretched hand. Most can be treated by immobilization. Dislocation of the humerus, strain or sprain of the acromioclavicular and sternoclavicular joints, and rotator cuff injury often can be managed conservatively. Recurrence is a problem with humerus dislocation, and surgical management may be indicated if conservative treatment fails. Rotator cuff tears are often hard to diagnose because of muscle atrophy that impairs the patient's ability to perform diagnostic maneuvers. Chronic shoulder problems usually fall into one of several categories, which include impingement syndrome, frozen shoulder and biceps tendonitis. Other causes of chronic shoulder pain are labral injury, osteoarthritis of the glenohumeral or acromioclavicular joint and, rarely, osteolysis of the distal clavicle. (+info)