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PubMed2005

Reliability and validity of shoulder tightness measurement in patients with stiff shoulders.

The purposes of this study were (1) to examine intratester and intertester reliability of measurement of anterior and posterior shoulder tightness in patients with stiff shoulders (SS), and (2) to assess construct validity by determining the relations between shoulder tightness, shoulder range of motion (ROM), and self-report measures of functional limitation. Anterior and posterior shoulder tightness were measured by two testers in below-chest abduction and cross-chest adduction tests with an inclinometer, respectively, in 16 patients with SS. Both the intratester and intertester reliability for shoulder tightness measurements were good (intratester ICC=0.84 and 0.91; intertester ICC=0.82 and 0.89). The limit of intra-tester and inter-tester agreement (mean, -0.3+/-4.4 degrees ) was acceptable as compared to the standard deviations of the measurements (range, 6.2-7.4 degrees ). Significant relationships between internal rotation and posterior shoulder tightness (R2=0.448, P=0.002), external rotation and anterior shoulder tightness (R2=0.499, P=0.003), and functional disabilities and posterior shoulder tightness (R2=0.432, P=0.006) were found. Significant correlations between shoulder internal rotation and cross-chest adduction, shoulder external rotation and below-chest abduction were observed, indicating that internal and external rotations might be related to posterior and anterior shoulder stiffness. The study also revealed significant relationship between functional disabilities and cross-chest adduction. Below-chest abduction and cross-chest adduction were found to provide reliable data. The construct validity of the abduction and adduction tests is supported by the relationship among these measurements, shoulder ROM, and functional disabilities in patients with SS.

Adult↗
PubMed2004

Predicting shoulder strength using allometry: implications for shoulder outcome assessments.

INTRODUCTION: Shoulder strength is an integral component of shoulder function. In assessing shoulder function many functional scales rely on direct or indirect measures of strength. Strength, and thus these scales, is often highly correlated with age. We propose an allometric method for assessing shoulder strength. Allometric modeling has provided accurate predictions of biologic growth and physiologic function in both human and animal studies. Allometry utilizes the relationship between the two homologous structures on the left and right sides of the body, providing in effect an internal control and thus eliminating many confounding effects, e.g. age and level of activity. METHODS: Twenty patients with unilateral shoulder dysfunction underwent strength testing of their affected and unaffected shoulder. Strength testing of the bilateral shoulders was also assessed in twenty people without shoulder pain in order to delineate the effect of hand dominance on strength in those without shoulder pain. Absolute and predicted strength deficits of the involved shoulder were calculated via regression analysis. Pearson's correlation coefficients were computed between age and strength. RESULTS: Utilizing the contralateral extremity as an internal control eliminates age as a confounding variable in predicting strength outcomes (r = 0.093). CONCLUSION: Allometric concepts, applied to shoulder strength assessment, eliminates age as a confounding variable. Strength testing of both shoulders should be considered in the development of future shoulder outcome scales in order to eliminate the strong influence of age.

Adult↗
PubMed2002

A comparison of peak power in the shoulder press and shoulder throw.

The ability to generate peak power is central for performance in many sports. Currently two distinct resistance training methods are used to develop peak power, the heavy weight/slow velocity and light weight/fast velocity regimes. When using the light weight/fast velocity power training method it was proposed that peak power would be greater in a shoulder throw exercise compared with a normal shoulder press. Nine males performed three lifts in the shoulder press and shoulder throw at 30% and 40% of their one repetition maximum (1RM). These lifts were performed identically, except for the release of the bar in the throw condition. A potentiometer attached to the bar measured displacement and duration of the lifts. The time of bar release in the shoulder throw was determined with a pressure switch. ANOVA was used to examine statistically significant differences where the level of acceptance was set at p < 0.05. Peak power was found to be significantly greater in the shoulder throw at 30% of 1 RM condition [F, (1, 23) = 2.325 p < 0.051 and at 40% of 1 RM [F, (1, 23) = 2.905 p < 0.05] compared to values recorded for the respective shoulder presses. Peak power was also greater in the 30% of 1 RM shoulder throw (510 +/- 103W) than in the 40% of 1 RM shoulder press (471 +/- 96W). Peak power was produced significantly later in the shoulder throw versus the shoulder press. This differing power reflected a greater bar velocity of the shoulder throw at both assigned weights compared with the shoulder press.

Adult↗
PubMed1990

Diffuse idiopathic skeletal hyperostosis (DISH) of the shoulder: a cause of shoulder pain?

Shoulder pain is a common complaint and shoulder hyperostosis a frequent radiological condition. However, little is known about the association between the clinical and radiological findings. To evaluate the clinical relevance of shoulder hyperostosis we performed a controlled, blind study of 99 hospitalized probands with and without thoracospinal hyperostosis on lateral chest X-rays. The study included grading of the shoulder hyperostosis on the basis of three bilateral standard radiographs, assessing shoulder pain in a standardized way by an interviewer and recording extraskeletal causes of shoulder pain. The prevalence of shoulder hyperostosis was doubled in probands with thoracospinal hyperostosis compared to controls (chi 2 = 5.90, P less than 0.025, n = 99). Shoulder hyperostosis, irrespective of thoracospinal hyperostosis, predisposed to shoulder pain (40% versus 18%, chi 2 = 4.06, P less than 0.05, n = 74). Shoulder hyperostosis in combination with thoracospinal hyperostosis (shoulder DISH) predisposed to shoulder pain to an even greater extent (46% versus 12%, chi 2 = 6.64, P less than 0.01, n = 47). We conclude that shoulder hyperostosis is a radiological finding of potential clinical relevance.

Arthrography↗
PubMed1997

Physical examination of the cervical spine and shoulder girdle in patients with shoulder complaints.

OBJECTIVE: To look for differences in mobility in randomly selected patients without shoulder complaints depending on age, gender and left- or right-handedness; to investigate in the patient group whether specific differences exist, depending on the diagnosis made or the afflicted side; and to detect differences between the findings on the mobility examination of the cervical and cervicothoracic spine in patients with shoulder complaints compared with the healthy population. DESIGN: Comparative study. METHOD: The physical examination findings after inclusion and after 26 wk of 101 shoulder patients were compared with those of 75 randomly selected patients without shoulder complaints and adjusted for age and gender. RESULTS: In the population of patients without shoulder complaints, the mobility in the cervical and upper thoracic spine was found to decrease with aging. Significant differences were found between the healthy and the afflicted population at the time of inclusion as well as after 26 wk, even though the majority of patients felt cured at that time. With all types of shoulder complaints, functional disorders in the shoulder girdle were found in which, at the time of inclusion, the emphasis was on pain and, after 26 wk, on restricted motion. Thus, functional disorders in the cervical spine, the higher thoracic spine and the adjoining ribs are not extrinsic causes of shoulder complaints, but an integral part of the intrinsic causes of shoulder complaints. CONCLUSION: Further study is needed to determine if this finding explains the high recurrence rate of shoulder complaints. It may be advisable to include the treatment of functional disorders of the shoulder girdle in treatment of patients with shoulder complaints.

Aging↗
PubMed2005

[Isokinetic dynamometer measurement of shoulder rotational strength in healthy elite athletes (swimming, volley-ball, tennis): comparison between dominant and nondominant shoulder].

OBJECTIVE: To compare lateral rotator (LR) and medial rotator (MR) muscle strength of both shoulders in a sport involving asymmetrical movements (tennis), symmetrical movements (swimming), and symmetrical and asymmetrical movements (volley-ball). MATERIALS AND METHODS: Retrospective study of 42 healthy elite athletes (18 women: 14 tennis players, 19 swimmers and 9 volleyball players. We evaluated the strength of LR and MR of both shoulders by Cybex Norm isokinetic dynamometer, in the concentric mode, in the modified Davies position, at 2 different speeds (60 degrees and 180 degrees s(-1)) and analysed peak torque of LR and MR and LR/MR ratios. RESULTS: TENNIS: The MR peak torque of the dominant shoulder was significantly higher than that of the non-dominant shoulder. The LR/MR ratio of the dominant shoulder was significantly lower than the non dominant shoulder in women. SWIMMING: The LR strength and LR/MR ratio of the dominant shoulder was higher than the non dominant side in men at 60 degrees/second. Both shoulders showed comparable strength in women. VOLLEYBALL: Shoulder muscular strength was symmetrical. CONCLUSION: The higher strength of MR muscles in the dominant shoulder of tennis players (asymmetrical movements) has been reported in the literature. Athletes show asymmetrical shoulder strength in swimming, a symmetrical sport and similar LR and MR strength in both shoulders in volleyball, a sport with asymmetrical movements. To our knowledge, these results have never been reported before.

Adult↗
PubMed1999

Shoulder impingement syndrome in relation to shoulder intensive work.

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.

Abattoirs↗
PubMed1994

[Dynamic anterior jerk of the shoulder. A new clinical test for shoulder instability. Preliminary study].

PURPOSE OF STUDY: A new clinical test named "The shoulder anterior jerk test" is proposed to confirm the diagnosis of chronic shoulder anterior instability. MATERIAL: The test combines of a compression force and a translation force, applied along the arm between the humeral head and the glenoid cavity. In so doing, a subluxation of the humeral head is provoked and it is accompanied with a jerk recognised by the patient as his instability. METHODS: Three different populations of patients had been studied: Population A: 28 patients operated on for chronic anterior dislocation, uni or bilateral (32 shoulders), had been tested before the operation, without and under anesthesia. Population B: 100 patients without any problem at the shoulder, had been tested before and under anesthesia done for knee or hip surgery. Population C: 100 young sportive athletes with normal shoulder tested without anesthesia. RESULTS: Population A: The 28 patients suffering from shoulder instability had all a positive shoulder jerk test under anesthesia. Without anesthesia the test had been positive only in 10 cases (30 per cent). The jerk is potentially present for all the patients, but it is disturbed by apprehension. Population B: Among the 200 shoulders tested, 26 shoulders (17 patients) had a positive test under anesthesia (13 per cent). 5 had positive jerk test without anesthesia. Population C: 5 among the 200 shoulders tested had a positive jerk test (2.5 per cent) Under anesthesia the test has a sensitivity of 100 per cent, a specificity of 87 per cent, a positive predictive value of 55 per cent and a negative value of 100 per cent. Without anesthesia, the test has a sensitivity of 31 per cent, a specificity of 97.5 per cent, a positive predictive value of 66 per cent and a negative predictive value of 90 per cent. DISCUSSION: The instability which is shown by the jerk test is in relation with the anterior subluxation of the humeral head in front of the anterior edge of the glenoïd cavity. It reproducts, with a minimal amplitude, the clinical instability which is recognized by the patient. The test is always positive under anesthesia in case of chronic anterior instability, it may confirm pre-operative diagnosis just before the begining of the procedure and may orientate the choice of it. Apprehension is a major obstacle to the research of the jerk, but it is the same with the other classical clinical tests of the shoulder anterior instability. CONCLUSION: The anterior jerk test of the shoulder is thus a test which is able to prove the diagnosis of an anterior instability. The future will permit to confirm its efficiency and will confirm if the test may differenciate anterior and inferior instability with variation of the abduction, as it has been shown in this preliminary study.

Adolescent↗
PubMedDate not supplied

Groningen Manipulation Study. The effect of manipulation of the structures of the shoulder girdle as additional treatment for symptom relief and for prevention of chronicity or recurrence of shoulder symptoms. Design of a randomized controlled trial within a comprehensive prognostic cohort study.

BACKGROUND: We present the design of the Groningen Manipulation Study. This randomized controlled trial is part of the Dutch Shoulder Disability Study, a comprehensive prognostic cohort study on shoulder disorders, with randomized controlled interventions in subcohorts. OBJECTIVE: To evaluate the effectiveness of manipulative treatment of the structures of the shoulder girdle, in addition to standard treatment by the general practitioner for relief of shoulder symptoms and prevention of persistent or recurrent shoulder symptoms. METHODS: A total of 250 patients with shoulder symptoms and a functional limitation of the shoulder girdle will be included from 30 general practices in Groningen, The Netherlands. All participating patients receive standard treatment by the general practitioner and will be randomly allocated to additional manipulative treatment. Evaluation measurements take place 6, 12, 26, and 52 weeks after randomization. CONCLUSION: The short-term primary outcome measure is the proportion of patients with relief of shoulder complaints and the long-term primary outcome is the proportion of patients without persistent or recurrent shoulder symptoms. Dependent and independent variables include a structured medical history, a physical examination of the shoulder and shoulder girdle, and a measure of the mobility of the cervico-thoracic spine with a 6-degree-of-freedom electromagnetic tracking device.

Adult↗
PubMed2003

Shoulder arthroplasty in patients with a prior anterior shoulder dislocation. Results of a multicenter study.

BACKGROUND: Prior reports of shoulder arthroplasty performed for dislocation-induced arthropathy have included only patients who had had a prior stabilizing procedure. The purpose of this study was to report the results of shoulder arthroplasty in all patients with a prior anterior shoulder dislocation, including both those previously treated operatively and those previously treated nonoperatively. METHODS: Fifty-five shoulders undergoing arthroplasty for arthritis following a prior anterior shoulder dislocation were evaluated. Twenty-seven of the shoulders had undergone a prior anterior stabilization procedure. The measures used to evaluate the shoulders included the Constant score, adjusted Constant score, active mobility, subjective satisfaction, radiographic result, and complications. RESULTS: The shoulders were evaluated at a mean of 45.0 months. The Constant score improved from a mean of 30.8 points preoperatively to a mean of 65.8 points at the time of follow-up. The adjusted Constant score improved from a mean of 38.2% to a mean of 79.8%. Active forward flexion improved from a mean of 82.1 degrees to a mean of 138.9 degrees. Active external rotation improved from a mean of 4.0 degrees to a mean of 38.6 degrees. Fifty patients rated the result as good or excellent. Negative prognosticators included an older age at the time of the initial dislocation and a rotator cuff tear. No significant differences in demographic factors, pre-arthroplasty function, post-arthroplasty function, pre-arthroplasty radiographic findings, post-arthroplasty radiographic findings, complication rate, or reoperation rate were noted between the patients treated with a prior operation for the anterior instability and those treated nonoperatively. CONCLUSIONS: This investigation documented the good results obtainable with shoulder arthroplasty for the treatment of arthritis following anterior shoulder instability. In addition, our findings suggest that capsulorrhaphy-induced arthropathy may be indistinguishable from arthritis following nonoperatively treated anterior shoulder instability.

Adolescent↗
PubMed2006

Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 100 shoulders.

BACKGROUND: There are few reports in the literature detailing arthroscopic treatment of unidirectional posterior shoulder instability. HYPOTHESIS: Arthroscopic capsulolabral reconstruction is effective in restoring stability and function and alleviating pain in athletes with symptomatic unidirectional posterior instability. This population has significant differences in glenoid and chondrolabral versions when compared with controls. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Ninety-one athletes (100 shoulders) with unidirectional recurrent posterior shoulder instability were treated with an arthroscopic posterior capsulolabral reconstruction and evaluated at a mean of 27 months postoperatively. A subset of 51 shoulders in contact athletes were compared with the entire group of 100 shoulders. Patients were evaluated prospectively with the American Shoulder and Elbow Surgeons scoring system. Stability, strength, and range of motion were evaluated preoperatively and postoperatively with standardized subjective scales. Forty-eight shoulders had magnetic resonance arthrograms performed and were available for review. The posterior inferior chondrolabral and bony glenoid versions were measured and compared with controls. RESULTS: At a mean of 27 months postoperatively, the mean American Shoulder and Elbow Surgeons score improved from 50.36 to 85.66 (P < .001). There were significant improvements in stability, pain, and function based on standardized subjective scales (P < .001). The contact athletes did not demonstrate any significant differences when compared with the entire cohort for any outcome measure. The results in the 71 shoulders followed for at least 2 years were similar to the overall group. On magnetic resonance arthrography, the shoulders with posterior instability were found to have significantly greater chondrolabral and osseous retroversion in comparison with controls (P < .001 and P = .008, respectively). CONCLUSION: Arthroscopic capsulolabral reconstruction is an effective, reliable treatment for symptomatic unidirectional recurrent posterior glenohumeral instability in an athletic population. Overall, 89% of patients were able to return to sport, with 67% of patients able to return to the same level postoperatively.

Adolescent↗
PubMedDate not supplied

Overutilization of shoulder magnetic resonance imaging as a diagnostic screening tool in patients with chronic shoulder pain.

This was a retrospective study of 101 consecutive patients (104 shoulders) with chronic, atraumatic shoulder pain who were evaluated by a fellowship-trained shoulder specialist. The patients were assessed with a complete history, physical examination, plain radiographs, Simple Shoulder Test, and visual analog scores of pain, shoulder function, and quality of life. Forty-one percent of the shoulders presented with shoulder magnetic resonance imaging (MRI). Data analysis was performed to determine the effect of pre-evaluation MRI on patient treatment and outcome. There were no statistically significant differences in age, sex, affected shoulder, insurance status, mechanism of injury, comorbid conditions, range of motion, treatment, initial outcome parameter assessments, or improvement of outcomes between the patients who had pre-evaluation MRI and those who did not. The majority of the pre-evaluation MRI scans had no impact on the outcome. Routine pre-evaluation with MRI does not appear to have a significant effect on the treatment or outcome and should not be used as a screening tool for atraumatic shoulder pain before a comprehensive clinical evaluation of the shoulder.

Adolescent↗
PubMed2004

Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life.

OBJECTIVE: To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. DESIGN: Prospective, open label design. SETTING: The outpatient services of a large teaching rehabilitation hospital in The Netherlands. SUBJECTS: Fifteen stroke survivors with chronic (> six months) hemiplegia and a therapy-resistant painful shoulder with subluxation. All patients suffered from clinically relevant shoulder pain, as assessed by a score of at least 4 out of 10 on a numerical rating scale. Shoulder subluxation was indicated by at least 1/2 fingerbreadth of glenohumeral separation on palpation. INTERVENTION: Six hours of P-NMES per day for a total of six weeks. MAIN OUTCOME MEASURES: Shoulder pain (Brief Pain Inventory), shoulder subluxation (clinical and radiographic), shoulder pain-free external rotation (hand-held goniometer), motor impairment (Fugl-Meyer Motor test) and quality of life (SF-36) were assessed before treatment, after six weeks of intramuscular stimulation, at three months and six months follow-up. RESULTS: A significant reduction in pain was found on the Brief Pain Inventory. Pain reduction was still present at six months follow-up. All domains, in particular bodily pain, of the SF-36 showed improvement in the short term. After six months of follow-up, bodily pain was still strongly and significantly reduced, whereas social functioning and role physical demonstrated a nonsignificant improvement of more than 10% compared with baseline. CONCLUSION: This pilot suggests that P-NMES potentially reduces shoulder pain in chronic hemiplegia. To establish the clinical value of P-NMES in treating hemiplegic shoulder pain a randomized controlled trial is needed.

Aged↗
PubMedDate not supplied

Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes mellitus: association with diabetic complications.

This study was done to examine the association between shoulder adhesive capsulitis and chronic diabetic complications and diseases closely related to diabetes in Akdeniz University Hospital. Shoulder adhesive capsulitis were evaluated in 297 consecutive type II diabetic patients attending an outpatient diabetic clinic. Shoulder adhesive capsulitis was detected in 86 patients (29%). There was a significant association between shoulder adhesive capsulitis and limited joint mobility (p = 0.006), shoulder adhesive capsulitis and Dupuytren's disease (p = 0.003). Odds ratios (OR) for carpal tunnel syndrome, limited joint mobility, and Dupuytren's disease with shoulder adhesive capsulitis were respectively 1.4, 2.1, and 2.4 [95% confidence interval (CI), respectively, 0.7-2.9, 1.2-3.69, and 1.3-4.4]. Also, shoulder adhesive capsulitis was associated with the age of patients (p = 0.000) and the duration of diabetes (p = 0.03). When other associations between shoulder adhesive capsulitis and diabetic complications were compared, it was associated with retinopathy [p = 0.014, OR = 2.2 (95% CI 1.1-4.2)], but there was no association with neuropathy or macroproteinuria. On the other hand, the degrees of passive abduction, internal rotation, external rotation motions of shoulder joints in the all patients were correlated with age of patients, duration of diabetes, neuropathy, and the other hands' problems (Dupuytren's disease, limited joint mobility) (p<0.05). The presence of shoulder adhesive capsulitis may indicate presence of organ involvement.

Adult↗
PubMedDate not supplied

Skin temperature of the shoulder: circadian rhythms in normal and pathologic shoulders.

Circadian rhythm of the shoulder skin temperature was studied in 21 shoulders of 20 patients with rotator cuff tears (average age, 58 years) and 4 shoulders of 4 patients with rotator cuff tendinitis (average age, 34 years). Fourteen of the 23 uninvolved shoulders with no abnormalities on magnetic resonance imaging were also studied as normal shoulders. With a portable thermometer with the probes attached to the anterior surface of both shoulders, the skin temperature was recorded every 5 minutes from 1:00 PM to 9:00 AM (20 hours). Both the normal and cuff tear shoulders showed a similar circadian rhythm with the temperature at night significantly lower than the temperature during the daytime (P < .0001). On the other hand, the tendinitis shoulders did not show this circadian rhythm; the temperature did not change significantly through the range of measurement. We conclude that the skin temperature shows a circadian rhythm in normal shoulders, and this rhythm may be affected by certain pathologic conditions of the shoulder.

Adult↗
PubMed1999

Internal impingement of the shoulder: comparison of findings between the throwing and nonthrowing shoulders of college baseball players.

The authors evaluated and compared the findings of gadolinium-enhanced magnetic resonance imaging (MRI) studies of throwing and nonthrowing shoulders in college baseball athletes and contrasted these findings with the clinical examination results. Ten throwing college baseball athletes were prospectively clinically examined for instability, range of motion, impingement signs, and relocation testing, then evaluated with bilateral gadolinium enhanced MRI using the nonthrowing shoulder as a control. All MRIs were performed on a 1.5-Tesla magnet and included routine adduction images and images obtained in abduction and external rotation (ABER). Studies were interpreted by a musculoskeletal radiologist and an orthopaedic surgeon specializing in shoulder surgery. In all shoulders, ABER imaging showed physical contact between the undersurface of the rotator cuff and the posterior superior glenoid. No imaging or physical examination abnormalities were identified in the nonthrowing shoulders. Three of 10 throwing shoulders had superior labral tears and adjacent paralabral cysts extending toward or into the spinoglenoid notch. Four of 10 throwing shoulders had abnormal signal change in the rotator cuff tendons. No correlation was identified between positive MRI findings and instability on physical examination. Physical contact between the rotator cuff undersurface and the subjacent labrum can be seen normally in the ABER position. Abnormalities of the rotator cuff and superior labrum are seen in asymptomatic throwing shoulders but not nonthrowing shoulders. MRI abnormalities consistent with internal impingement can be seen in asymptomatic patients. Treatment of these abnormalities in young throwing athletes should be approached with caution.

Adult↗
PubMed2005

Coracoid tip position on frontal radiographs of the shoulder: a predictor of common shoulder pathologies?

The coracoacromial arch is a static anterior-superior stabilizer of the humeral head. Thus coracoacromial arch inclination, which varies depending on coracoid tip position, may be related to shoulder pathologies. Therefore, we retrospectively analysed coracoid tip positions in the true anterior posterior view of different shoulder pathologies: reference shoulders (n=27), shoulders with rotator cuff tear (supraspinatus tear n=29; subscapularis tear n=21) and shoulders with anterior glenohumeral instability (traumatic n=17; atraumatic n=14). In supraspinatus tear shoulders, the coracoid tip projected onto inferior glenoid half in 86% of cases (type I coracoid), extending more inferiorly compared with reference group (p=0.0002) or subscapularis tear shoulders (p<0.0001). In contrast, 78% of cases with subscapularis tear show the coracoid tip projected onto the superior glenoid half (type II coracoid). Atraumatic glenohumeral instabilities had a more superior coracoid tip position than traumatic instabilities (p=0.04), but no differences were observed on basis of coracoid type or in comparison with normal controls. We conclude that coracoid tip position is highly variable. Since type I coracoids are predominant in shoulders with supraspinatus tears and type II coracoids in shoulders with subscapularis tears, coracoid tip position may thus provide a simple diagnostic complement for a probable site of rotator cuff tears.

Adolescent↗
PubMedDate not supplied

Subacromial space in the rheumatoid shoulder: a radiographic 15-year follow-up study of 148 shoulders.

A cohort of 74 patients with rheumatoid arthritis was monitored prospectively for 15 years. At the end of the study 148 shoulders were radiographed with a standard method. The subacromial space was examined from the radiographs with a method where the acromiohumeral interval was measured from the dense cortical bone marking the inferior aspect of the acromion to a point directly above the head of the humerus. The smallest distance was recorded, and negative values were used when the original articular surface of the humerus exceeded the inferior surface of the acromion. Destruction of the glenohumeral (GH) joints was assessed by the Larsen method on a scale of 0 to 5. The relation of subacromial space measurement to the grade of destruction of GH joints was examined. The mean subacromial space was 6.7 (SD 4.4), range from -13 to 12 mm: 6.1 mm (SD 5.6) in men and 6.9 mm (SD 4.0) in women. The mean of nonaffected (Larsen grade 0 or 1) shoulders (n = 77) was 8.6 mm (SD 1.5), and the corresponding mean of the affected (Larsen grade > or =2) shoulders (n = 71) was 4.6 mm (SD 5.5). Previously reported pathologic criterion (<6 mm) indicating rotator cuff involvement was fulfilled in 30 (20%) of 148 shoulders: in 8 (22%) of 36 shoulders in men and in 22 (20%) of 112 shoulders in women. All the shoulders with severe rheumatoid destruction (Larsen grade 4 or 5) fulfilled the pathologic limit. The subacromial space had a significant negative correlation with the GH joint destruction (Larsen grade) in both sides: right r = -.63 (95% CI -.75 to -.47), left r = -.71 (95% CI -.81 to -.58). Progressive upward migration is an inevitable consequence of rheumatoid destruction in the GH joint. A significant step in this process occurred between the Larsen grades of 3 and 4, where the mean distance turned negative, indicating rotator cuff disease. A patient with rheumatoid arthritis and painful shoulder and upward migration of the humerus on the shoulder radiograph should be evaluated by an orthopaedic surgeon. In indistinct cases with subacromial space diminution, imaging techniques like ultrasonography or magnetic resonance imaging may be required to determine the exact pathologic condition of the rotator cuff and to select optimal treatment.

Adolescent↗