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Background: Several tests have been suggested for screening and diagnosis of cervical spine and shoulder girdle conditions underlying shoulder pain with variable degrees of clinical accuracy. The present study aimed to test the reliability, clinical benefit and screening value of the Swimmer Arm-to-Shoulder (SAS) test; a new clinical test developed to differentiate shoulder impingement from cervical radiculopathy in patients with shoulder pain of ≤ 12 weeks. Methods: The study included 718 patients aged 40–65 years, with unilateral and localized shoulder girdle pain lasting for ≤ 12 weeks. Diagnosis based on clinical, electromyography and radiological findings was considered as the reference gold standard for test assessment. Results: Clinical diagnosis identified shoulder pathology in 288 patients (40.1%) and cervical spine pathology in 430 patients (59.9%). SAS test was positive in 274 patients (38.2%). The SAS test proved to be effective in distinguishing shoulder from cervical spine pathology with a sensitivity of 89.2% (95% CI: 85.0-92.6%), specificity of 96.1% (95% CI: 93.8–97.7%), PPV of 93.8% (95% CI: 90.5–96.0%), NPV of 93.0% (95% CI: 90.5–94.9%), LR + of 22.6% (95% CI: 14.1–36.0%), LR- of 0.11 (95% CI: 0.08–0.16) and accuracy of 93.3% (95% CI: 91.2–95.0%). Conclusions: SAS test is an easy to perform, patient dependent and reliable as a screening test and diagnosis confirmatory test. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively evaluate clinical outcomes, including function and pain, of patients after our all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis procedure; factors influencing results were also evaluated. Given the frequent association of rotator cuff tear with long head of biceps lesion and the need for effective combined treatment strategies, this study aims to evaluate the efficacy of our technique and compare it with established methods. We hypothesized that our technique would significantly improve function and reduce pain in patients with rotator cuff tears and biceps pathology. Methods: This is a retrospective study that included patients older than 20 years who underwent all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis procedures for concomitant rotator cuff tear and long head biceps pathology, from 2016 to 2020. Patients were evaluated preoperatively and at a minimum of 2 years of follow‐up using the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores paired t‐tests were used for analysis and statistical significance was set at p < 0.05(two‐tailed). The satisfaction rate and complications were also evaluated. Results: After an average follow‐up of 2.3 years, 118 patients demonstrated significant improvement in both the ASES score (from 36.13 to 95.01, p < 0.001) and VAS score (from 6.81 to 0.89, p < 0.001). Ninety‐four percent of the patients reported satisfaction with the surgical outcome. No complications related to Popeye deformity, biceps cramping pain, or ipsilateral shoulder reoperation were observed. Factors such as age, sex, body mass index (BMI), smoking status, alcohol consumption, hypertension, and diabetes did not influence the results. Patients showed significant improvement in both the ASES and VAS scores (p < 0.001). Conclusion: At a mean follow‐up time of 2.3 years, the all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis is a therapeutic and efficient procedure. The procedure revealed a satisfactory functional outcome, reduced pain, and minimal complications and reoperations. [ABSTRACT FROM AUTHOR]

Calcific tendinitis (CT) of the shoulder refers to the formation of calcium hydroxyapatite deposits in the rotator cuff and supraspinatus was mostly affected. CT can cause considerable pain and restriction. If left untreated, complications such as rotator cuff tears may occur. Acupuncture, a traditional Chinese medicine therapy, is now widely regarded as an effective approach to treat musculoskeletal problems, including shoulder pain, and is worth investigating for treating CT. A 67-year-old woman was diagnosed with shoulder CT via Magnetic resonance imaging(MRI) experienced substantial shoulder pain, restriction and difficulty performing daily tasks for 6 months. She underwent 12 sessions (twice a week) of localized acupuncture application based on her disease-affected meridian, averaging 12 needles per session. The pain scale and shoulder range of motion were continually monitored. After that, an MRI follow-up was performed. After the sessions ended. Her latest MRI showed the calcific deposits were resolved and her pain was significantly reduced and she could move her shoulder functionally and restriction in her daily activities was significantly reduced. We kept monitoring her condition for a further month, she only reported mild shoulder joint stiff left. She was advised to be discharged from treatment. Home exercise to further self-mobilize her shoulder joint was educated and encouraged. Localized acupuncture application based on disease-affected meridian effectively resolve the calcified deposit and improved patient's shoulder pain and range of motion. However, a larger study with a control group was suggested to substantiate the impact. • This case report examined how acupuncture may influence shoulder calcific tendinitis. • Acupuncture effectively reduced patient's shoulder pain and improved the shoulder range of motion. • Acupuncture can aid in the resolution of calcific deposits via MRI examination. [ABSTRACT FROM AUTHOR]

Abstract Background Several tests have been suggested for screening and diagnosis of cervical spine and shoulder girdle conditions underlying shoulder pain with variable degrees of clinical accuracy. The present study aimed to test the reliability, clinical benefit and screening value of the Swimmer Arm-to-Shoulder (SAS) test; a new clinical test developed to differentiate shoulder impingement from cervical radiculopathy in patients with shoulder pain of ≤ 12 weeks. Methods The study included 718 patients aged 40–65 years, with unilateral and localized shoulder girdle pain lasting for ≤ 12 weeks. Diagnosis based on clinical, electromyography and radiological findings was considered as the reference gold standard for test assessment. Results Clinical diagnosis identified shoulder pathology in 288 patients (40.1%) and cervical spine pathology in 430 patients (59.9%). SAS test was positive in 274 patients (38.2%). The SAS test proved to be effective in distinguishing shoulder from cervical spine pathology with a sensitivity of 89.2% (95% CI: 85.0-92.6%), specificity of 96.1% (95% CI: 93.8–97.7%), PPV of 93.8% (95% CI: 90.5–96.0%), NPV of 93.0% (95% CI: 90.5–94.9%), LR + of 22.6% (95% CI: 14.1–36.0%), LR- of 0.11 (95% CI: 0.08–0.16) and accuracy of 93.3% (95% CI: 91.2–95.0%). Conclusions SAS test is an easy to perform, patient dependent and reliable as a screening test and diagnosis confirmatory test.

Objective To retrospectively evaluate clinical outcomes, including function and pain, of patients after our all arthroscopic “whole layer” rotator cuff repair technique with simultaneous biceps tenodesis procedure; factors influencing results were also evaluated. Given the frequent association of rotator cuff tear with long head of biceps lesion and the need for effective combined treatment strategies, this study aims to evaluate the efficacy of our technique and compare it with established methods. We hypothesized that our technique would significantly improve function and reduce pain in patients with rotator cuff tears and biceps pathology. Methods This is a retrospective study that included patients older than 20 years who underwent all arthroscopic “whole layer” rotator cuff repair technique with simultaneous biceps tenodesis procedures for concomitant rotator cuff tear and long head biceps pathology, from 2016 to 2020. Patients were evaluated preoperatively and at a minimum of 2 years of follow‐up using the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores paired t‐tests were used for analysis and statistical significance was set at p

Studies addressing the anatomical values of the supraspinatus outlet area (SOA) and the available supraspinatus outlet area (ASOA) are insufficient. This study focused on precisely measuring the SOA and ASOA values in a sample from the Chinese population using 3D CT (computed tomography) reconstruction. We analyzed CT imaging of 96 normal patients (59 males and 37 females) who underwent shoulder examinations in a hospital between 2011 and 2021. The SOA, ASOA, acromiohumeral distance (AHD), coracohumeral distance (CHD), coracoacromial arch radius (CAR), and humeral head radius (HHR) were estimated, and statistical correlation analyses were performed. There were significant sex differences observed in SOA (men: 957.62 ± 158.66 mm2; women: 735.87 ± 95.86 mm2) and ASOA (men: 661.35 ± 104.88 mm2; women: 511.49 ± 69.26 mm2), CHD (men: 11.22 ± 2.24 mm; women: 9.23 ± 1.35 mm), CAR (men: 37.18 ± 2.70 mm; women: 33.04 ± 3.15 mm), and HHR (men: 22.65 ± 1.44 mm; women: 20.53 ± 0.95 mm). Additionally, both SOA and ASOA showed positive and linear correlations with AHD, CHD, CAR, and HHR (R: 0.304–0.494, all p < 0.05). This study provides physiologic reference values of SOA and ASOA in the Chinese population, highlighting the sex differences and the correlations with shoulder anatomical parameters.

Studies addressing the anatomical values of the supraspinatus outlet area (SOA) and the available supraspinatus outlet area (ASOA) are insufficient. This study focused on precisely measuring the SOA and ASOA values in a sample from the Chinese population using 3D CT (computed tomography) reconstruction. We analyzed CT imaging of 96 normal patients (59 males and 37 females) who underwent shoulder examinations in a hospital between 2011 and 2021. The SOA, ASOA, acromiohumeral distance (AHD), coracohumeral distance (CHD), coracoacromial arch radius (CAR), and humeral head radius (HHR) were estimated, and statistical correlation analyses were performed. There were significant sex differences observed in SOA (men: 957.62 ± 158.66 mm2; women: 735.87 ± 95.86 mm2) and ASOA (men: 661.35 ± 104.88 mm2; women: 511.49 ± 69.26 mm2), CHD (men: 11.22 ± 2.24 mm; women: 9.23 ± 1.35 mm), CAR (men: 37.18 ± 2.70 mm; women: 33.04 ± 3.15 mm), and HHR (men: 22.65 ± 1.44 mm; women: 20.53 ± 0.95 mm). Additionally, both SOA and ASOA showed positive and linear correlations with AHD, CHD, CAR, and HHR (R: 0.304–0.494, all p < 0.05). This study provides physiologic reference values of SOA and ASOA in the Chinese population, highlighting the sex differences and the correlations with shoulder anatomical parameters. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Shoulder impingement syndrome (SIS) is one of the most frequent causes of shoulder pain. Evidence supported the use of conservative treatment for SIS. Clinical practice guidelines (CPGs) indicated that physical therapy interventions, including therapeutic exercises, manual therapy, patient education, and advice, were recommended for the treatment of SIS. This study's purpose was to investigate physical therapists' adherence to the CPGs for treating SIS. SUBJECTS AND METHODS: Physical therapists in Saudi Arabia were invited to participate in an online survey via the Saudi Physical Therapy Association between May and December 2022. The developed online survey consisted of 36 questions, divided into five sections: eligibility, demographics, clinical practice regarding the treatment of SIS, barriers, and facilitators for the use of CPGs. Descriptive and logistic regression analysis were employed to analyze study data. RESULTS: A total of 313 physical therapists completed the entire survey. In general, physical therapists were aligned with CPGs. Physical therapists advised their patients, utilized therapeutic exercises and manual therapy techniques, and used electrotherapy modalities despite being not recommended. Key challenges indicated by physical therapists for the use of CPGs include low patient adherence to therapists' instructions, lack of adequate knowledge, and limited clinical time. CONCLUSIONS: Overall, physical therapists in Saudi Arabia followed the CPGs for treating SIS. Therapeutic exercises combined with manual therapy were the most common treatment options. However, further research should consider exploring adherence to such guidelines over time. [ABSTRACT FROM AUTHOR]

Scapular dyskinesis (SD) indicates dysfunction of the scapular muscle activity during the arm elevation, resulting in altered scapular kinematics. This study examined whether SD alters scapular muscle activity and kinematics during swim stroke motion. Seventeen swimmers (mean age: 13 ± 1 years) were divided into SD (n = 8) and control (n = 9) groups. Scapular muscle activity (the upper, middle, and lower trapezius and the serratus anterior muscle) and kinematics data were collected and time-normalised (0–100%) during swim stroke motion by swim-bench on land. Scapular kinematics were calculated for upward rotation, internal rotation, posterior tilt, and arm elevation angles. To compare patterns of muscle activity and kinematics with and without SD, statistical parametric mapping unpaired t-test was used. The scapular upward rotation angle was decreased in SD compared to control in the 0–10% of the swim stroke phase (p = 0.041, t* = 3.018), and the internal rotation angle was increased in 0–15% of the phase (p = 0.033, t* = 2.994). Scapular posterior tilt and muscle activity showed no significant differences. These results suggested that SD altered scapular upward rotation and internal rotation at the initial phase of the swim stroke motion in adolescent swimmers and might potentially provoke a risk of subacromial impingement. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of intra-bursal injection of single-dose platelet-rich plasma (PRP) against corticosteroids under ultrasonography guidance in shoulder impingement syndrome (SIS). Materials and methods: This single-blind randomized controlled trial was conducted on 60 participants with a clinical diagnosis of SIS from a selected orthopedic clinic. Thirty participants in each arm were given a single dose of either PRP or triamcinolone acetonide into the subacromial sub-deltoid bursa (SASD) under ultrasonography guidance. The outcome variables assessed were the severity score of pain and the degree of shoulder abduction. Post-treatment follow-up was done in 1 week, 3 months, 6 months, and 1 year. Results: At 1 week, the triamcinolone arm showed a statistically significant reduction of pain (p = 0.039) when compared to PRP. In the long term, PRP showed statistically significant improvement in shoulder abduction, compared to the triamcinolone injection (p = 0.012). Conclusion: PRP and triamcinolone in the SASD bursa could be considered as safe treatment options for SIS under ultrasonography guidance. While triamcinolone was effective in short-term pain reduction, PRP was effective in long-term improvement in shoulder abduction. [ABSTRACT FROM AUTHOR]

The shoulder joint is a highly mobile joint that is prone to injuries. Shoulder impingement is a painful shoulder condition caused by injuries to the structures in the subacromial space. Symptoms include pain, disruptions in daily activities, and a decrease in the range of motion of the joint. The research aims to analyze the effects of the Mulligan Technique and Ultrasound on pain and functional ability in shoulder impingement conditions at EMC Sentul Hospital. The research method used is a quasi-experimental design with pre and post-test control groups. Thirty participants were divided into two groups: an intervention group receiving the Mulligan Technique and Ultrasound (15 participants) and a control group receiving TENS and conventional exercise therapy (15 participants). Each participant underwent six sessions per week, twice a week. Before and after the treatment, each participant's pain level was measured using the Numeric Rating Scale (NRS), and functional ability was assessed using the Shoulder Pain and Disability Index (SPADI). The analysis of the data showed that both treatments in the two groups reduced pain and improved functional ability in shoulder impingement conditions. However, there was a significant difference in the group receiving the Mulligan Technique and Ultrasound, with an average pain reduction from 6.6 NRS to 1.3 NRS and an increase in functional ability from 62.6% to 11.85%. In contrast, the group receiving TENS and conventional exercise therapy showed an average pain reduction from 3.6 NRS to 6.13 NRS and an increase in functional ability from 61.3% to 40.2%. In conclusion, the study suggests that the application of the Mulligan Technique and Ultrasound is more effective in reducing pain and improving functional ability compared to TENS and conventional exercise therapy in shoulder impingement conditions. [ABSTRACT FROM AUTHOR]

Key points 1. L-GF uses a standardized number of allogenic pathogen-free platelets instead of autologous platelets used in PRP as a source of growth factors. 2. L-GF injection in patients with SIS has resulted in significant improvement both clinically and sonographically, signifying its potential beneficial effects on tendon healing. 3. L-GF injection could be a mini-invasive intervention for SIS treatment that gives hopeful results.

Background: Bone marrow edema syndrome (BMES), previously referred to as transient osteoporosis, is an uncommon and underdiagnosed self-limiting condition typically affecting the weight-bearing joints of the hip and lower limb. Its occurrence in upper limb or non-weight bearing joints is particularly rare. Case presentation: We report the case of an otherwise healthy 42-year-old man who gradually developed severe and disabling left shoulder pain over the course of 6 months. Nine months after onset, he presented clinically with bilateral involvement and radiologically (magnetic resonance imaging, MRI) with diffuse BME associated with a subchondral insufficiency fracture, suggestive of proximal humeral avascular necrosis. Clinical evidence of subacromial shoulder impingement and MRI findings of bilateral subchondral bursitis and tenosynovitis with effusion of the biceps tendons likely resulted from primary BME, as musculoskeletal sonography confirmed the absence of rotator cuff tears. Repeated MRI findings at 2, 12, and 18 months documented near complete resolution of both edema and fracture, consistent with BMES of the proximal humerus. During this time, the patient reported a gradual improvement in both pain symptoms and range of motion. The clinical picture of insidious shoulder pain, exacerbated by activity and improved by load relief, in the absence of predisposing factors for osteonecrosis or antecedent trauma in patients of middle age, should indicate the possibility of the diagnosis of BMES. Conclusions: This unprecedented report documents a rare case of bilateral BMES of the humeral head mimicking avascular necrosis. The correct diagnosis of BMES within an atypical anatomical location avoids invasive measures in the affected bone. The misdiagnosis of secondary BME and idiopathic osteonecrosis can be avoided by recognizing the characteristics of BME and subchondral fractures of the humeral head in the absence of rotator cuff tears, as well as their evolution on serial MRI. [ABSTRACT FROM AUTHOR]

Background: Conservative therapy is currently the elective treatment for shoulder impingement syndrome according to the scientific literature. The success of conservative therapy is due to physiotherapy and the application of its methods. The aim of this systematic review was to evaluate low-level laser therapy, a physiotherapeutic method for pain reduction and increasing the range of motion. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The screening of the literature was carried out on the Cochrane, PEDro, PubMed/Medline, and Scopus databases up until December 2021. All studies were randomized controlled trials (RCTs), and five articles met the inclusion criteria and were included in this study. The risk of bias was evaluated with PEDro and Jadad scales. Results: In this study, we reviewed five RCTs that compared low-level laser therapy with other physiotherapy treatments to reduce pain and improve range of motion in patients with shoulder impingement syndrome. Conclusions: Low-level laser therapy for shoulder impingement syndrome requires further investigation in future studies. [ABSTRACT FROM AUTHOR]

Objective The authors of this systematic review with meta-analysis evaluated the evidence for the effectiveness of various applications of dry needling (DN) combined with other conservative treatments for subacromial pain syndrome (SAPS). Methods Six databases (PubMED, CINAHL, Biosis, Web of Science, SPORTDiscus, and Cochrane Central Register of Controlled Trials) were searched after the study had been registered in PROSPERO. The authors included randomized clinical trials investigating the clinical effects of DN in combination with other conservative interventions for SAPS. Outcomes included pain and disability. Results Eight studies were selected. All eight studies involving 10 comparisons were included in the analyses (N = 538). A random-effects model was used to analyze between-group effects. Dry needling performed in combination with other conservative interventions produced favorable outcomes at all time points for pain and disability. Standard mean differences ranged from –0.57 (moderate) to –1.29 (large) for pain and –0.69 (moderate) to –1.07 (large) for disability, favoring groups receiving DN in addition to conservative treatment. Four of the eight studies were rated as having unclear or high risk of bias. Conclusion The meta-analysis suggests that various applications of DN performed with other conservative interventions are more effective than conservative treatment alone for reducing pain and disability in patients with SAPS. Direct-comparison studies are needed to determine whether one application of DN is superior to another. [ABSTRACT FROM AUTHOR]

Background: Platelet-derived lyophilized growth factors (L-GFs) use a standardized number of allogenic pathogen-free platelets instead of autologous platelets used in PRP as a source of growth factors. This study aimed to evaluate the efficacy of L-GF injection versus placebo in subacromial impingement (SIS) treatment. Methods: The current randomized double-blind placebo-controlled study included sixty patients (40 females and 20 males, aged between 24 and 75 years) diagnosed with SIS (both clinically and sonographically). Patients were randomly assigned to two equal groups. Under ultrasound guidance, group 1 received subacromial saline injection, and group 2 received L-GF injection. Clinical examination, pain visual analogue scale (VAS), shoulder pain and disability index (SPADI) and shoulder ultrasound were performed before and at the 8th week after injection. Results: Follow-up assessment showed statistically significant improvement in the L-GF group regarding active flexion, active and passive internal rotation and extension, SPADI-disability scale, VAS and thickness of the supraspinatus tendon by US. Regression analysis showed that group 1 was approximately 30 times more likely than the L-GF group to experience painful arc at follow-up. Both groups showed statistically significant improvement in SPADI-pain scale and SPADI-total, flexion and abduction (still the mean value of abduction was significantly higher in the L-GF group). Conclusions: L-GF injection resulted in clinically significant reductions in pain and functional disability outcomes in patients with SIS. An objective significant reduction in the thickness of the supraspinatus tendon, measured by ultrasound, in the L-GF group hopefully encourages proper healing and functioning in SIS. Trial registration: The identification number is NCT04330027, date of first registration (01/04/2020). Unique on 21/11/2019, Protocol ID: 0106178. Key points: L-GF uses a standardized number of allogenic pathogen-free platelets instead of autologous platelets used in PRP as a source of growth factors. L-GF injection in patients with SIS has resulted in significant improvement both clinically and sonographically, signifying its potential beneficial effects on tendon healing. L-GF injection could be a mini-invasive intervention for SIS treatment that gives hopeful results. [ABSTRACT FROM AUTHOR]

Subcoracoid impingement occurs due to mechanical encroachment of the subscapularis tendon in the subcoracoid space between the coracoid process and lesser tuberosity of the humerus. Although physical therapy is known to have a crucial role in managing this condition, to the best of our knowledge, there is no established physical therapy program in the literature. This case report aims to provide a detailed presentation and diagnosis of a subcoracoid impingement case and to investigate the effects of physical therapy on pain, disability, performance, muscle strength, and ultrasound measurements over a one-year follow-up period. The patient was a 24-year-old male working as a jeweler who had been suffering from dull anterior left shoulder pain for five years. The modified Hawkins-Kennedy test was positive. Additionally, palpation was pain-free, except for severe pain in the coracoid area. The patient was injected with xylocaine into the subcoracoid space and demonstrated a spontaneous relief of pain. Ultrasound imaging showed a narrower coracohumeral distance from full internal rotation on the affected side (0.85 cm) compared to the non-affected side (1.22 cm). Six weeks of multimodal physical therapy program was delivered to the patient. It consisted of electrophysical agents, manual therapy, and therapeutic exercise. Electrophysical agents included conventional transcutaneous electrical nerve stimulation, ice, and phonophoresis. Manual therapy included shoulder mobilization, myofascial release, thoracic mobilization, and posterior capsule stretches. Additionally, scapular muscle-strengthening and Rotator cuff strengthening exercises were delivered to the patient. The patient received 18 sessions for 6 weeks, at a rate of three times per week. Shoulder pain, function, and performance were measured by a numeric rating pain scale, shoulder pain and disability index, and timed push-up test, respectively. The shoulder muscle's peak isometric strength was measured by a hand-held dynamometer. Acromiohumeral distance, coracohumeral distance, supraspinatus thickness, and subscapularis thickness were measured by ultrasound imaging. Six weeks of multimodal physical therapy is a successful intervention for patients with subcoracoid impingement. It resulted in improvements in pain, function, performance, and muscle strength. An increase in coracohumeral distance from full internal rotation was observed at the end of the intervention, as well as after three months and one year., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gamiel et al.)

Shoulder impingement is the main cause of shoulder pain. Manual therapy is one of the proposed therapeutic strategies. In this context, the Mulligan maneuver implies anterior axial rotation of the clavicle, emulating the action of the subclavius muscle, which hypothetically would increase the subacromial space. However, there are no antecedents that provide experimental support for this hypothesis. The objective of the present study was to explore whether the axial rotation of the clavicle, produced by the Mulligan maneuver, has an effect on the pressure registered in the subacromial space, with the purpose of having methodological antecedents that can contribute to the design of future studies that address the problem exposed and consider a larger sample size. Through an ex-vivo exploratory study, two anatomical preparations comprising the scapula, clavicle, and proximal two-thirds of the humerus, both with glenohumeral and acromioclavicular joint sparing, were evaluated. In these, the pressure in the subacromial space and the axial rotation of the clavicle were recorded, all during the performance of an anterior clavicular axial rotation maneuver. Pressure differences between a basal condition and during the maneuver were analyzed, as well as the maximum axial rotation of the clavicle. These variables were recorded using a pressure sensor and a movement analysis system. The pressure in the subacromial space during the maneuver decreased in all repetitions in a range between 21-51% of the basal pressure. The maximum axial rotation recorded was between 3.9-10°. The results of this exploratory study give rise to the hypothesis that the anterior axial rotation maneuver of the clavicle produces a decrease in subacromial pressure, in the area immediately below the acromion. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of muscle shortening manoeuvre (MSM) by sonography (US) in professional water polo players with shoulder impingement syndrome (SIS). Methods: Twenty-four professional water polo players (mean age: 22.13 ± 3.34) with SIS were assigned to one of 2 different treatment interventions: Group (1) MSM: a series of fast accelerations in the upward direction was applied to the upper limb that's connected to a spring through a metal plate with a ring. The ring was linked to a pulley system that was submitted to forces acting in the opposite direction (added mass). Group (2) Simple traction: the series of fast accelerations were performed without the springs. Pain intensity, Yocum and Hawkins tests for SIS, Neer's impingement sign, range of motion, muscle strength and shoulder US were assessed. The examination was performed before, immediately after and 30 days after each treatment to study the US width of subacromial-subdeltoid bursa (SSB), thickness of supraspinatus (ST), long biceps tendons (LBT); hypoechoic halo of surrounding the long biceps (LBH) and subscapular tendons (STH); width of acromio-clavicular joint capsule (ACJ) and the distance between bone heads (ACD). Impingement sign (IS) was evaluated by dynamic examination. Results: Immediately after treatment with MSM, pain was much reduced (p = 0.002); Yocum and Hawkins tests were decreased (p = 0.008, p = 0.031); Neer's impingement sign was negative; range of motion and muscle strength were increased. US showed that the following parameters were significantly reduced: SSB (p = 0.001), LBT (p = 0.014), LBH (p = 0.014), SSH (p = 0.002), ACJ (p = 0.004), ACD (p = 0.001). IS was no more detected. After 30 days, the improvement of clinical and US findings was maintained. In the control group, after simple traction, no clinical amelioration of US parameters was found immediately after the procedure. Conclusion: These data show that MSM could be significantly and rapidly effective against pain and the loss of function due to shoulder impingement in water polo players. [ABSTRACT FROM AUTHOR]

BackgroundRehabilitation is the key to management of patients with subacromial impingement syndrome to prevent disability and loss of function. While point-of-care musculoskeletal ultrasound aids clinical diagnosis of subacromial impingement syndrome, many patients do not demonstrate the classic findings of dynamic supraspinatus tendon impingement beneath the acromion on ultrasound. The objective of this study was to establish the most reliable shoulder ultrasound measurements for subacromial impingement, by evaluating the intra-rater and inter-rater reliability of measurements in asymptomatic participants.MethodsEighteen participants (9 women, 9 men, mean ± standard deviation: 34.6 ± 7.9 years of age) underwent bilateral shoulder ultrasound evaluations with measurements for subacromial impingement (acromiohumeral distance, acromion-greater tuberosity distance, supraspinatus tendon, subacromial-subdeltoid bursa, and subacromial-subdeltoid bursal fluid thickness) performed by two sports medicine physicians. Intra-class coefficients were calculated to determine the intra- and inter-rater reliability of shoulder ultrasound images and measurements.ResultsIntra-rater reliability for acromiohumeral distance (0.76–0.79), supraspinatus tendon (0.91–0.95), subacromial-subdeltoid bursa (0.76–0.84), and subacromial-subdeltoid bursal fluid thickness (0.75–0.81) was found to be good to excellent, whereas inter-rater reliability ranged from poor to moderate.ConclusionsAcromiohumeral distance in neutral position and short axis ultrasound measurements of supraspinatus tendon, subacromial-subdeltoid bursa, and subacromial-subdeltoid bursal fluid thickness in the modified Crass position were the most reliable for subacromial impingement in asymptomatic participants. We recommend validation of these measurements in a symptomatic population to aid diagnosis and direct rehabilitation of patients with suspected subacromial impingement, and to increase point-of-care ultrasound uptake, availability, and training among rehabilitation professionals across health systems.

Introduction: Subacromial Impingement Syndrome (SIS) is compression and mechanical abrasion of the rotator cuff structures as they pass beneath the coracoacromial arch during elevation of the arm. Aim: To study the efficacy of scapular stabilisation exercise program in patients with subacromial impingement syndrome. Materials and Methods: The electronic databases such as PubMed and Cochrane Library, Physiotherapy Evidence Database (PEDro) and additional articles were searched according to Patient/ Population, Intervention, Comparison and Outcomes (PICO) strategies and references of the relevant articles from 2011 till date. The appropriate keywords were used relevant to the condition and outcome measures. Fourteen Randomised Controlled Trial (RCTs) were selected based on the inclusion and exclusion criteria in which scapular stabilisation exercises alone or with conventional treatment were used for management of subacromial impingement syndrome. Results: According to PEDro soring, one study was of excellent quality, 10 of good quality and three were fair in quality. The sample size in these studies ranged from 7 to 120 participants from different countries. Following this, full-text screening of 942 articles was performed, out of which 13 were finally included. Finally, 14 articles consisting of 630 participants who had subacromial impingement syndrome were selected for analysis. Conclusion: Scapular oriented exercise is effective in reducing pain and disability for patients with shoulder impingement syndrome. [ABSTRACT FROM AUTHOR]

Abstract Background The objective of the study was to compare the effects of neuromobilization (NM) techniques and routine physiotherapy on pain and functional disability in patients having shoulder impingement syndrome (SIS). Present study was aimed to discover evidence based conservative and cost effective remedy on pain and functional disability. Study design Single blinded randomized control clinical trial. Methods A total of 80 patients with SIS were randomly assigned into care and experimental groups (40 in each group). After the baseline assessment routine physiotherapy was executed on both groups, while NM was applied additionally to experimental group. Pain and functional disability score were evaluated by Visual Analogue Scale and University of California at Los Angeles rating score at baseline, 5th and 11th week. Differences in outcome between groups were evaluated with clinical improvement. Results The experimental group compared with care group at 11th week had lower mean pain score 2.15(1.66–2.64) vs 4.90(4.41–5.40); between group difference, 1.82; 95% (CI), − 2.38 to − 1.25; P < 0.001 and Partial ƞ2 = 0.33, similarly functional disability score 28.58(27.32–29.83) vs 20.10(18.84–21.36); between group difference,5.62; 95%CI, (4.32–6.92); P< 0.001 and Partial ƞ2 = 0.49 respectively. In experimental group NM was a more effective technique to reduce the pain severity and disability in SIS patients as compare to care group. Conclusion Neuromobilization techniques in addition to routine physiotherapy were significantly effective for the treatment of SIS. Trial registration IRCT20190121042445N1 , Registered 19 February 2019.

Background: Posterior shoulder tightness, which is a problem mainly seen in patients with shoulder impingement syndrome, disrupts the scapulohumeral rhythm between the humerus and scapulae. Objects: The aim of this study was to compare the effects of joint mobilization and stretching on shoulder muscle activity and internal rotation range of motion (ROM) of the glenohumeral joint in patients with impingement syndrome with posterior shoulder tightness. Methods: The research subjects included 22 in-patients with impingement syndrome with posterior shoulder tightness. They were randomly divided into two groups: one group (12 patients) was treated with joint mobilization and the other group (10 patients) was treated with stretching for the posterior shoulder tightness. Each treatment was performed five times a week for two weeks, and there were 15 sessions for each treatment. The ROM of the internal rotation and muscle activities of shoulder joint were evaluated pretest and posttest in each group. Electromyography data were collected from the upper, middle, and lower trapezius and serratus anterior during shoulder abduction of 90°, 120°, and 150°. Results: Both the joint mobilization and stretching groups showed significant decreases in muscle activity in the upper, middle, and lower trapezius on the posttest (p < 0.05). There was a significant difference in serratus anterior at 150° (p < 0.05), but there was no significant difference between group in post-hoc analysis (p > 0.025). The internal rotation ROM was significantly increased in the stretching group compared to that in the joint mobilization group (p < 0.025). Conclusion: This study found that both joint mobilization and stretching for posterior shoulder tightness were effective in muscle activity during arm abduction, also in order to increase internal rotation ROM of shoulder joint, stretching was effective in patients with impingement syndrome with posterior tightness.

Background: Conservative therapy is currently the elective treatment for shoulder impingement syndrome according to the scientific literature. The success of conservative therapy is due to physiotherapy and the application of its methods. The aim of this systematic review was to evaluate low-level laser therapy, a physiotherapeutic method for pain reduction and increasing the range of motion. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The screening of the literature was carried out on the Cochrane, PEDro, PubMed/Medline, and Scopus databases up until December 2021. All studies were randomized controlled trials (RCTs), and five articles met the inclusion criteria and were included in this study. The risk of bias was evaluated with PEDro and Jadad scales. Results: In this study, we reviewed five RCTs that compared low-level laser therapy with other physiotherapy treatments to reduce pain and improve range of motion in patients with shoulder impingement syndrome. Conclusions: Low-level laser therapy for shoulder impingement syndrome requires further investigation in future studies.

Studies addressing the anatomical values of the supraspinatus outlet area (SOA) and the available supraspinatus outlet area (ASOA) are insufficient. This study focused on precisely measuring the SOA and ASOA values in a sample from the Chinese population using 3D CT (computed tomography) reconstruction. We analyzed CT imaging of 96 normal patients (59 males and 37 females) who underwent shoulder examinations in a hospital between 2011 and 2021. The SOA, ASOA, acromiohumeral distance (AHD), coracohumeral distance (CHD), coracoacromial arch radius (CAR), and humeral head radius (HHR) were estimated, and statistical correlation analyses were performed. There were significant sex differences observed in SOA (men: 957.62 ± 158.66 mm 2 ; women: 735.87 ± 95.86 mm 2 ) and ASOA (men: 661.35 ± 104.88 mm 2 ; women: 511.49 ± 69.26 mm 2 ), CHD (men: 11.22 ± 2.24 mm; women: 9.23 ± 1.35 mm), CAR (men: 37.18 ± 2.70 mm; women: 33.04 ± 3.15 mm), and HHR (men: 22.65 ± 1.44 mm; women: 20.53 ± 0.95 mm). Additionally, both SOA and ASOA showed positive and linear correlations with AHD, CHD, CAR, and HHR (R: 0.304-0.494, all p < 0.05). This study provides physiologic reference values of SOA and ASOA in the Chinese population, highlighting the sex differences and the correlations with shoulder anatomical parameters.

In this study, we aimed to determine if electromyography (EMG) normalization to maximal voluntary isometric contractions (MVIC) was influenced by subacromial pain in patients with subacromial impingement syndrome. Patients performed MVICs in unique testing positions for each shoulder muscle tested before and after subacromial injection of local anesthetic. In addition to collection of MVIC data, EMG data during an arm elevation task were recorded before and after injection. From a visual analog pain scale, patients had a 64% decrease in pain following the injection. Significant increases in MVICs were noted in 4 of the 7 shoulder muscles tested: anterior, middle and posterior deltoid, and lower trapezius. No significant differences were noticed for the upper trapezius, latissimus dorsi, or serratus anterior. MVIC condition (pre and post injection) had a significant influence on EMG normalization for the anterior deltoid and lower trapezius muscle. Results indicate that subacromial pain can influence shoulder muscle activity, especially for the deltoid muscles and lower trapezius. In addition, normalization to MVIC in the presence of pain can have unpredictable results. Caution should be taken when normalizing EMG data to MVIC in the presence of pain. [ABSTRACT FROM AUTHOR]

Background: Subacromial impingement syndrome (SIS) is considered the most prevailing cause of shoulder pain. Although Mulligan's technique may be useful in treating shoulder impingement, its significance in areas of range of movement (ROM), pain, and function is still debated. Objective: To systematically review and summarize the best evidence on treating subacromial impingement syndrome using mobilization with movement. Patients and Methods: Databases Cochrane Library Web search, PEDro and PubMed were searched for RCTs published in English language from inception to September 2019, updated later to 7th of July 2021. Reference lists of relevant publications were also screened. Two reviewers separately identified relevant papers based on the inclusion criteria. The identified papers by both authors were obtained in full text. To evaluate methodological quality and risk of bias, the Cochrane risk of bias tool was used. We used the random-effects model in all analyses for meta-analyses. Results: A total of 11 RCTs with a total number of 358 adults with subacromial shoulder pain were included. They examined the effect of mobilization with movement (MWM) combined with exercise with or without taping against rotator cuff strengthening, ROM exercises, isometric strengthening, shoulder joint mobilization, and sham techniques. Meta-analysis was done comparing MWM against exercise and found a significant difference in VAS and a non-significant difference in SPADI. Conclusion: Shoulder mobilization with movement combined with a supervised exercise program (ROM, and functional limitations) has a better impact on pain than exercise alone or sham in short-term with similar improvement to exercise in the long-term. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff tears may result from repeated mechanical deformation of the cuff tendons, and internal impingement of the supraspinatus tendon against the glenoid is one such proposed mechanism of deformation. Purpose: To (1) describe the changing proximity of the supraspinatus tendon to the glenoid during a simulated overhead reaching task and (2) determine the relationship between scapular morphology and this proximity. Additionally, the patterns of supraspinatus-to-glenoid proximity were compared with previously described patterns of supraspinatus-to-coracoacromial arch proximity. Study Design: Descriptive laboratory study. Methods: Shoulder models were created from magnetic resonance images of 20 participants. Standardized kinematics were imposed on the models to simulate functional reaching, and the minimum distances between the supraspinatus tendon and the glenoid and the supraspinatus footprint and the glenoid were calculated every 5° between 0° and 150° of humerothoracic elevation. The angle at which contact between the supraspinatus and the glenoid occurred was documented. Additionally, the relationship between glenoid morphology (version and inclination) and the contact angle was evaluated. Descriptive statistics were calculated for the minimum distances, and glenoid morphology was assessed using Pearson correlation coefficients and simple linear regressions. Results: The minimum distances between the tendon and the glenoid and between the footprint and the glenoid decreased as elevation increased. Contact between the tendon and the glenoid occurred in all participant models at a mean elevation of 123° ± 10°. Contact between the footprint and the glenoid occurred in 13 of 20 models at a mean of 139° ± 10°. Less glenoid retroversion was associated with lower tendon-to-glenoid contact angles (r = –0.76; R 2 = 0.58; P <.01). Conclusion: This study found that the supraspinatus tendon progressively approximated the glenoid during simulated overhead reaching. Additionally, all participant models eventually made contact with the glenoid by 150° of humerothoracic elevation, although anatomic factors influenced the precise angle at which contact occurred. Clinical Relevance: Contact between the supraspinatus and the glenoid may occur frequently within the range of elevation required for overhead activities. Therefore, internal impingement may be a prevalent mechanism for rotator cuff deformation that could contribute to cuff pathology. [ABSTRACT FROM AUTHOR]

Background: There are currently many treatment options for patients with subacromial shoulder conditions (SSCs). Clinical decision-making regarding the best treatment option is often difficult. This study aims to evaluate the comparative effectiveness of treatment options for relieving pain and improving function in patients with SSCs. Methods: Eight databases [including MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Database of Systematic Reviews and World Health Organization (WHO) International Clinical Trials Registry] were searched from inception until April 2020. Randomised clinical/controlled trials of adult patients investigating the effects of nonsurgical (e.g. corticosteroid injections, therapeutic exercise, shockwave therapy) and surgical treatment for SSCs, compared with each other, placebo, usual care or no treatment, were retrieved. Pairs of reviewers screened studies independently, quality appraised eligible studies using the Cochrane risk of bias tool, extracted and checked data for accuracy. Primary outcomes were pain and disability in the short term (⩽3 months) and long term (⩾6 months). Direct and indirect evidence of treatment effectiveness was synthesised using random-effects network meta-analysis. Results: The review identified 177 eligible trials. Summary estimates (based on 99 trials providing suitable data, 6764 patients, 20 treatment options) showed small to moderate effects for several treatments, but no significant differences on pain or function between many active treatment comparisons. The primary analysis indicated that exercise and laser therapy may provide comparative benefit in terms of both pain and function at different follow-up time-points, with larger effects found for laser in the short term at 2–6 weeks, although direct evidence was provided by one trial only, and for exercise in the longer term [standardised mean difference (SMD) 0.39, 95% confidence interval (CI) 0.18, 0.59 at 3–6 months] compared with control. Sensitivity analyses excluding studies at increased risk of bias confirmed only the comparative effects of exercise as being robust for both pain and function up until 3-month follow-up. Conclusion: Current evidence shows small to moderate effect sizes for most treatment options for SSCs. Six treatments had a high probability of being most effective, in the short term, for pain and function [acupuncture, manual therapy, exercise, exercise plus manual therapy, laser therapy and Microcurrent (MENS) (TENS)], but with low certainty for most treatment options. After accounting for risk of bias, there is evidence of moderate certainty for the comparative effects of exercise on function in patients with SSCs. Future large, high-quality pragmatic randomised trials or meta-analyses are needed to better understand whether specific subgroups of patients respond better to some treatments than others. [ABSTRACT FROM AUTHOR]

The purpose of the study was to identify genetic variants associated with rotator cuff disease by performing a genome-wide association study (GWAS) for shoulder impingement using the UK Biobank (UKB) cohort and then combining the GWAS data with a prior GWAS for rotator cuff tears. The loci identified by the GWAS and meta-analysis were examined for changes in expression following rotator cuff tearing using RNA sequencing. A GWAS was performed using data from UKB with 3864 cases of shoulder impingement. The summary statistics from shoulder impingement and a prior study on rotator cuff tears were combined in a meta-analysis. Also, the previous association of 2 single-nucleotide polymorphisms (SNPs) with shoulder impingement from a published GWAS using the UKB was tested. Rotator cuff tendon biopsies were obtained from 24 patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair (cases) and 9 patients who underwent open reduction internal fixation for a proximal humeral fracture (controls). Total RNA was extracted and differential gene expression was measured by RNA sequencing for genes with variants associated with rotator cuff tearing. The shoulder impingement GWAS identified 4 new loci: LOC100506457, LSP1P3, LOC100506207, and MIS18BP1/LINC00871. Combining data with a prior GWAS for rotator cuff tears in a meta-analysis resulted in the identification of an additional 7 loci: SLC39A8/UBE2D3, C5orf63, ASTN2, STK24, FRMPD4, ACOT9/SAT1, and LINC00890/ALG13. Many of the identified loci have known biologic functions or prior associations with diseases, suggesting possible biologic pathways leading to rotator cuff disease. RNA sequencing experiments show that expression of STK24 increases whereas expression of SAT1 and UBE2D3 decreases following rotator cuff tearing. Two SNPs previously reported to show an association with shoulder impingement from a prior UKB GWAS were not validated in our study. This is the first GWAS for shoulder impingement in which new data from UKB enabled the identification of 4 loci showing a genetic association. A meta-analysis with a prior GWAS for rotator cuff tearing identified an additional 7 loci. The known biologic roles of many of the 11 loci suggest plausible biologic mechanisms underlying the etiology of rotator cuff disease. The risk alleles from each of the genetic loci can be used to assess the risk for rotator cuff disease in individual patients, enabling preventative or restorative actions via personalized medicine. [ABSTRACT FROM AUTHOR]

Abstract Background Subacromial impingement is the most frequent cause of shoulder pain, accounting for up to 60% of all shoulder complaints; dynamic high-resolution ultrasonography can be used in the detection of different abnormalities causing and related to shoulder impingement. This is compared to MRI, which we considered as a standard in our cases. Results Fifty patients presented with symptoms of painful shoulder with 42 patients of them having limited movements of their shoulders. All patients had a conventional B-mode ultrasound examination, and dynamic sonographic examination was also performed in all patients. The results were compared to the MRI examination results of those patients. The addition of dynamic ultrasound examination for diagnosis of the painful shoulder showed the highest sensitivity in the assessment of impingement syndrome and for detection of different abnormalities affecting the shoulder joint (e.g., 85.7% for rotator cuff partial-thickness tear, 90% for rotator cuff full-thickness tear). Conclusion Based on our results, the static US combined with dynamic study can be a helpful tool in detecting different abnormalities of the painful shoulder especially impingement syndrome and its different causes.

Os acromiale is a developmental defect which results from the lack of an osseous union between the ossification centers of the acromion, leading to the fibrocartilaginous tissue connection. The prevalence of os acromiale is 1% to 15%, and is quite common in the African American population. Os acromiale in adults is easily diagnosed by symptoms and X‐ray, particularly on the axillary view; however, the differential diagnosis of adolescents may require MRI or SPECT–CT. Generally, nonoperative therapy for symptomatic os acromiale should be started, including physiotherapy, nonsteroidal anti‐inflammatory drugs, and injections. Surgical treatment is indicated after failed conservative treatment. In symptomatic patients with fixable acromiale, the tension band technique should be used to make the anterior aspect of the acromion elevated from the humerus head. In patients with small fragments which are unsuitable for reattachment, excision might be the best therapeutic option and lead to good outcomes. Whether using internal fixation or resection, the arthroscopic technique results in a better outcome and fewer complications, especially in older patients or athletes with overhead movement, because of the high incidence of shoulder impingement or rotator cuff tears which can be treated concurrently.

What are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain? Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis. A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region. Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks. The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant's perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers. There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE −2 (95% CI −9 to 5), GE minus HE −2 (95% CI −9 to 5) and HE minus IE 1 (95% CI −6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens' effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups. In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs. ClinicalTrials.gov: NCT03055117 [ABSTRACT FROM AUTHOR]

Coracoid impingement syndrome is an increasingly recognized etiology of anterior shoulder pain. Numerus studies have documented the coracohumeral distance (CHD) as a primary or secondary measurement in symptomatic individuals, but there lacks an evaluation of CHD in a large cohort of asymptomatic individuals. The purpose of this study was to quantify a normative distribution of the CHD in a large cohort of healthy, asymptomatic subjects with no history of impingement or shoulder instability. Incoming first-year students in the United States Military Academy were offered enrollment in this study as part of a prospective cohort to assess the normal anatomic relationships of the shoulder girdle. Magnetic resonance images were obtained, and a board-certified, fellowship-trained musculoskeletal radiologist performed measurements of the smallest distance from the coracoid to the humeral head on axial images. Magnetic resonance images of 714 subjects were available for analysis, including 630 males and 84 females, with a total of 1120 individual shoulders with images of adequate quality. The mean CHD for all shoulders imaged was 13.7 mm. The mean CHD in male shoulders was 13.8 mm, and in female subjects the average was 12.4 mm. This study is the largest of its kind to evaluate the CHD in asymptomatic, healthy shoulders to date and demonstrates a mean CHD of 13.7 mm for all subjects. This information can help to standardize "normal" ranges and act as a comparison for future work, when taken in the context of age and imaging in neutral rotation. [ABSTRACT FROM AUTHOR]

Introduction Subacromial impingement (SAI) is a prevalent shoulder condition characterized by mechanical compression within the subacromial region. It presents with symptoms like shoulder pain and restricted motion, impacting a significant portion of the population. Neer's classification delineates three progressive stages of SAI, ranging from bursa edema to chronic rotator cuff tears. The etiology involves intrinsic and extrinsic factors, leading to altered kinematics and impingement. The study aims to determine the effect of mobilization with movement (MWM) on the glenohumeral joint positional fault in patients with SAI. Materials and methods The study comprised 80 participants diagnosed with SAI, selected based on the inclusion and exclusion criteria, and randomly divided into two groups, each consisting of 40 subjects. Group A received conventional therapy, while Group B received MWM in addition to conventional therapy. Treatment sessions, lasting 45 minutes, were administered five times weekly for four weeks. Pre- and post-treatment assessments included the visual analog scale (VAS), range of motion (ROM), acromion humeral distance (AHD), and acromion tuberosity index (ATI). Results The results demonstrated that there was an extremely significant improvement in VAS, shoulder ROM, and ADH in both groups, with a p-value of 0.0001, except for the ATI, which showed significant improvement in Group B with a p-value of 0.0001 compared to Group A. Conclusions Based on statistical analysis, the study found that MWM significantly improved joint positioning fault and has been beneficial in reducing pain and improving ROM., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of Institutional Ethics Committee of Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, India issued approval 105/2022-2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dalvi et al.)

Clinical Scenario: It has been suggested that posterior shoulder tightness is a common contributor to shoulder impingement in overhead-throwing athletes. The incidence of shoulder pain in the general population has been reported to be as high as 27%, and as many as 74% of the patients who were seen for shoulder issues had signs of impingement. Particularly regarding physically active adults, shoulder impingement is frequent among overhead-throwing athletes and may lead to lost participation in sport, as well as other injuries including labral pathologies. Therefore, finding an effective mechanism to reduce posterior shoulder tightness in overhead athletes is important and may help prevent impingement-type injuries. Typically, posterior shoulder tightness is identified by measuring horizontal humeral adduction; although another clinical measure that is commonly used is the bilateral measurement of glenohumeral internal-rotation (IR) range of motion (ROM). It is important to note, however, that the measurement of glenohumeral IR ROM specifically aims to identify glenohumeral IR ROM deficits (GIRD). Although GIRD is believed to be a leading contributor to posterior shoulder tightness, this measure alone may not capture the full spectrum of posterior shoulder tightness. While treatment interventions to correct any ROM deficits typically include a stretching protocol to help increase IR, joint mobilizations have been found to produce greater mobility of soft tissue and capsular joints. However, it is unclear whether the combination of both joint mobilizations and a stretching protocol will produce even larger gains of ROM that will have greater longevity for the patient suffering from posterior shoulder tightness. Focused Clinical Question: Does the use of joint mobilizations combined with a stretching protocol more effectively increase glenohumeral IR ROM in adult physically active individuals who participate in overhead sports and are suffering from posterior shoulder tightness, compared with a stretching protocol alone? [ABSTRACT FROM AUTHOR]

Abstract Background To explore patient characteristics predictive of a poor response to multidisciplinary non-surgical rehabilitation of three common orthopaedic conditions within a tertiary care service. Methods A retrospective audit of medical records of patients who had undergone multidisciplinary non-surgical management of their knee osteoarthritis (KOA, n = 190), shoulder impingement syndrome (SIS, n = 199), or low back pain (LBP, n = 242) within a multisite tertiary care service was undertaken. Standardised clinical measures recorded by the service at the initial consultation were examined using a base binary logistic regression model to determine their relationship with a poor response to management (ie. not achieving a minimal clinically important improvement in the condition disability measure pre-post management). Results Factors predictive of a poor response following non-surgical management included;; higher levels of anxiety (OR 1.11, P

Background: The objective of the study was to compare the effects of neuromobilization (NM) techniques and routine physiotherapy on pain and functional disability in patients having shoulder impingement syndrome (SIS). Present study was aimed to discover evidence based conservative and cost effective remedy on pain and functional disability.Study Design: Single blinded randomized control clinical trial.Methods: A total of 80 patients with SIS were randomly assigned into care and experimental groups (40 in each group). After the baseline assessment routine physiotherapy was executed on both groups, while NM was applied additionally to experimental group. Pain and functional disability score were evaluated by Visual Analogue Scale and University of California at Los Angeles rating score at baseline, 5th and 11th week. Differences in outcome between groups were evaluated with clinical improvement.Results: The experimental group compared with care group at 11th week had lower mean pain score 2.15(1.66-2.64) vs 4.90(4.41-5.40); between group difference, 1.82; 95% (CI), - 2.38 to - 1.25; P < 0.001 and Partial ƞ2 = 0.33, similarly functional disability score 28.58(27.32-29.83) vs 20.10(18.84-21.36); between group difference,5.62; 95%CI, (4.32-6.92); P< 0.001 and Partial ƞ2 = 0.49 respectively. In experimental group NM was a more effective technique to reduce the pain severity and disability in SIS patients as compare to care group.Conclusion: Neuromobilization techniques in addition to routine physiotherapy were significantly effective for the treatment of SIS.Trial Registration: IRCT20190121042445N1 , Registered 19 February 2019. [ABSTRACT FROM AUTHOR]

Objective: Pectoralis Minor Index (PMI) is a proposed parameter to evaluate the pectoralis minor length (PML), eliminating the effect of subject's variability of height. Neither a PMI standard value nor any cutoff value to label a shortened pectoralis minor (PM) has been accepted yet, which can be applied to every individual. Moreover, the length of the PM has never been correlated to any fixed reference in the body. Hence, we estimated the PML in the Indian population and investigated its correlation to the individual's hand length. Methodology: A cross-sectional study was conducted including 100 adult subjects without any shoulder pathology. Subjects with history of fracture/treatment involving upper limb/spine were excluded. Two assessors evaluated the height, PM length and hand length of subjects. PMI and hand correlation was evaluated using their mean values. Results: Mean PML and PMI for dominant and non-dominant shoulder were calculated to be 18.11/18.21 cm and 10.53/10.59, respectively. Mean hand length of dominant and non-dominant hand was found to be 18.27 cm and 18.31 cm, respectively. Pearson correlation coefficient between right/left PML with right/left hand length was 0.67 and 0.63, respectively, suggesting a good correlation (p < 0.01). Conclusions: PMI varies in different ethnic groups, which makes PMI a less reliable indicator for managing shoulder pain in ethnic groups where reference values are yet not available. Contralateral PMI can be used as a reference value in unilateral shoulder pathologies with short PML. Hand length can become an important parameter in evaluating painful shoulders even in bilateral pathologies. Hand length can be used as an easy and quick technique to compare the PML and effect of physiotherapy in patients with diagnosis of short PML, attending follow-up OPD. Though, a study comparing PML of normal subjects and patients with shoulder pain will be further required in different ethnic groups for further validation of this study. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the effects of soft tissue mobilization (STM) and proprioceptive neuromuscular facilitation (PNF) on pain level and shoulder range of motion (ROM) patient with shoulder impingement syndrome (SIS). Case Report: A single case study of a 42-year-old female patient with the left SIS was included in the study. The patient complained of difficulty in overhead activities such as grooming and wearing clothes reaching up and reaching behind back. Results and Discussion: The patient received STM of subscapularis and PNF contract-relax technique for shoulder abductors, internal rotators, and external rotators for 15 days. The outcome measure was estimated by visual analog scale (VAS) to assess pain, ROM measured using goniometer, and muscle strength using manual muscle testing. After completing 15 sessions, there was a significant reduction in VAS score, improved overhead reach and ROM of shoulder. Conclusion: The patient showed a significant reduction in pain level. The values for shoulder abduction, internal rotation, and external rotation showed a significant improvement. The value for overhead reaches also significantly increased. The combination of STM and contract-relax PNF technique for the shoulder was found to be effective in reducing pain and improving glenohumeral ROM and muscle strength of the left shoulder. [ABSTRACT FROM AUTHOR]

This study's primary aim is to address two questions. Firstly; what evidence exists regarding the inclusion of increasing thoracic movement within the management of subacromial impingement syndrome SIS?; and secondly, what proportion of Society of Musculoskeletal Medicine (SOMM) physiotherapists use this form of treatment within SIS management? An online survey was conducted using a questionnaire incorporating a vignette describing a patient with chronic SIS. The SOMM physiotherapy members were sampled using convenience sampling. This study has identified some evidence supporting increasing movement of the thoracic spine in the management of patients with SIS. No study or guideline protocols have been identified that advocate the use of this form of treatment, nor research identified that investigates physiotherapists' use of this form of treatment within SIS management. Of the 1340 physiotherapists surveyed, 52 responded of which 79% stated that they would use treatment aimed at increasing movement of the thoracic spine within SIS management. Chi Square analysis suggests no significant association between using this treatment and number of years experience (p value = 0.15) or courses attended (p = 0.62). Evidence suggests it is beneficial to include treatment to increase thoracic spine mobility within SIS management. This study highlights the need for the clinician to be aware of the role of the thoracic spine in relation to the biomechanics of the shoulder complex. Of the sample of SOMM physiotherapists obtained, the majority stated that they would use this form of treatment. Further research is recommended. [ABSTRACT FROM AUTHOR]

Context: The literature does not present a consistent pattern of altered scapular kinematics in patients with shoulder-impingement syndrome (SIS). Objectives: To perform meta-analyses of published comparative studies to determine the consistent differences in scapular kinematics between subjects with SIS and controls. In addition, the purpose was to analyze factors of the data-collection methods to explain the inconsistencies in reported kinematics. The results of this study will help guide future research and enable our understanding of the relationship between scapular kinematics and SIS. Evidence Acquisition: A search identified 65 studies; 9 papers met inclusion criteria. Sample sizes, means, and SDs of 5 scapular-kinematic variables were extracted or obtained from each paper's lead author. Standard difference in the mean between SIS and controls was calculated. Moderator variables were plane of arm elevation, level of arm elevation (ARM) and population (POP). Evidence Synthesis: Overall, the SIS group had less scapular upward rotation (UR) and external rotation (ER) and greater clavicular elevation (ELE) and retraction (RET) but no differences in scapular posterior tilt (PT). In the frontal plane, SIS subjects showed greater PT and ER, and in the scapular plane, less UR and ER and greater ELE and RET. There was also greater ELE and RET in the sagittal plane. There was less UR at the low ARM and greater ELE and RET at the high ARM with SIS. Athletes and overhead workers showed less UR, while athletes showed greater PT and workers showed less PT and ER. The general population with SIS had greater ELE and RET only. Conclusions: Subjects with SIS demonstrated altered scapular kinematics, and these differences are influenced by the plane, ARM, and POP. Athletes and overhead workers have a different pattern of scapular kinematics than the general population. The scapular plane is most likely to demonstrate altered kinematics. These factors should be considered when designing futures studies to assess the impact of altered kinematics in patients with SIS. [ABSTRACT FROM AUTHOR]

Context: Scapular strength deficits have been linked to shoulder dysfunction. Objective: To establish normative data on the scapulothoracic musculature in normal subjects using a handheld dynamometer. Design: Descriptive normative data study. Setting: Field research. Subjects: 172 subjects with varying levels of overhead activity. Methods: A handheld dynamometer was used to test the upper, middle, and lower trapezius; rhomboids; and serratus anterior. Main Outcome Measures: A 2-factor ANOVA was performed for each of the muscles by activity level and unilateral ratio by activity-level analyses. Post hoc analysis included multiple pairwise comparisons, using the Dunn-Bonferroni correction method. Results: Activity level did not significantly affect the unilateral ratios: Elevation:depression was 2.5:1, upward:downward rotation was 1.5:1, and protraction:retraction was 1.25:1. A rank order from strongest to weakest was established through significant comparisons. Conclusion: The unilateral ratios along with the rank order should be considered when discussing scapular rehabilitation protocols. [ABSTRACT FROM AUTHOR]

Os acromiale is a developmental defect which results from the lack of an osseous union between the ossification centers of the acromion, leading to the fibrocartilaginous tissue connection. The prevalence of os acromiale is 1% to 15%, and is quite common in the African American population. Os acromiale in adults is easily diagnosed by symptoms and X‐ray, particularly on the axillary view; however, the differential diagnosis of adolescents may require MRI or SPECT–CT. Generally, nonoperative therapy for symptomatic os acromiale should be started, including physiotherapy, nonsteroidal anti‐inflammatory drugs, and injections. Surgical treatment is indicated after failed conservative treatment. In symptomatic patients with fixable acromiale, the tension band technique should be used to make the anterior aspect of the acromion elevated from the humerus head. In patients with small fragments which are unsuitable for reattachment, excision might be the best therapeutic option and lead to good outcomes. Whether using internal fixation or resection, the arthroscopic technique results in a better outcome and fewer complications, especially in older patients or athletes with overhead movement, because of the high incidence of shoulder impingement or rotator cuff tears which can be treated concurrently. [ABSTRACT FROM AUTHOR]

There is strong evidence for managing shoulder subacromial impingement syndrome (SAIS) through exercise rehabilitation. This case study examines the effects of an eight-week exercise rehabilitation programme on a 17-year old elite male gymnast with SAIS. Clinical assessment tests that allow for diagnosis and identification of the cause of SAIS were completed before and after the exercise rehabilitation programme. These tests included: validated outcome measures such as quality of life questionnaire, video analysis, ultrasound, glenohumeral and scapulothoracic assessment measures. The most informative tests post exercise rehabilitation included; the alignment of the scapulothoracic joint with the lateral slide test (1cm decrease in scapula upward rotation), video analysis on dysfunctional movement patterns and stability control under functional loads (cross position on rings apparatus), joint range of motion tests identifying shoulder joint restrictions, internal rotation range (increased by 55 degrees) improving posterior capsule mobility, "dynamic ultrasound" testing confirmed improved glenohumeral head stability (8.0mm in posterior views) and disability of arm, shoulder hand (DASH) questionnaire (50% improvement on symptom score). The main test results showed scapula dyskinesia with medial and inferior scapula border winging and anterior translation of the glenohumeral head contributed to SAIS. The key exercises to correct this targeted the scapulothoracic joint stabilisers (lower and middle fibres trapezius, serratus anterior) and glenohumeral joint stabilisers (infraspinatus, subscapularis). Importantly, the programme combined these groups with full kinetic chain (lumbopelvic) stabiliser activation, proprioceptive retraining and motor control endurance-based exercises. The findings from this comprehensive SAIS exercise rehabilitation programme based on correction of the identified dysfunctional kinetic chain movement patterns, scapulothoracic and glenohumeral joint deficits, indicates surgical intervention was not necessary and symptom free loading was achieved. [ABSTRACT FROM AUTHOR]