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      Subacromial impingement syndrome

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          Abstract

          Subacromial impingement syndrome (SAIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. However, the etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections, and, for some patients, surgery. No high-quality randomized controlled trials are available so far to provide possible evidence for differences in outcome of different treatment strategies. There remains a need for high-quality clinical research on the diagnosis and treatment of SAIS.

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          The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders.

          Leesa Galatz, Gary Middleton, C Hildebolt … (2006)
          Very little comparative information is available regarding the demographic and morphological characteristics of asymptomatic and symptomatic rotator cuff tears. This information is important to provide insight into the natural history of rotator cuff disease and to identify which factors may be important in the development of pain. The purpose of the present study was to compare the morphological characteristics and prevalences of asymptomatic and symptomatic rotator cuff disease in patients who presented with unilateral shoulder pain. Five hundred and eighty-eight consecutive patients in whom a standardized ultrasonographic study had been performed by an experienced radiologist for the assessment of unilateral shoulder pain were evaluated with regard to the presence and size of rotator cuff tears in each shoulder. The demographic factors that were analyzed included age, gender, side, and cuff thickness. All of these factors were evaluated with regard to their correlation with the presence of pain. Of the 588 consecutive patients who met the inclusion criteria, 212 had an intact rotator cuff bilaterally, 199 had a unilateral rotator cuff tear (either partial or full thickness), and 177 had a bilateral tear (either partial or full thickness). The presence of rotator cuff disease was highly correlated with age. The average age was 48.7 years for patients with no rotator cuff tear, 58.7 years for those with a unilateral tear, and 67.8 years for those with a bilateral tear. Logistic regression analysis indicated a 50% likelihood of a bilateral tear after the age of sixty-six years (p < 0.01). In patients with a bilateral rotator cuff tear in whom one tear was symptomatic and the other tear was asymptomatic, the symptomatic tear was significantly larger (p < 0.01). The average size of a symptomatic tear was 30% greater than that of an asymptomatic tear. Overall, patients who presented with a full-thickness symptomatic tear had a 35.5% prevalence of a full-thickness tear on the contralateral side. There is a high correlation between the onset of rotator cuff tears (either partial or full thickness) and increasing age. Bilateral rotator cuff disease, either symptomatic or asymptomatic, is common in patients who present with unilateral symptomatic disease. As the size of a tear appears to be an important factor in the development of symptoms, we recommend surveillance at yearly intervals for patients with known rotator cuff tears that are treated nonoperatively.
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            Anatomical and biomechanical mechanisms of subacromial impingement syndrome

            Lori Michener, Philip W McClure, Andrew Karduna (2003)
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              Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests.

              C T Moorman, Skylar Cook, José Morin … (2008)
              To compile and critique research on the diagnostic accuracy of individual orthopaedic physical examination tests in a manner that would allow clinicians to judge whether these tests are valuable to their practice. A computer-assisted literature search of MEDLINE, CINAHL, and SPORTDiscus databases (1966 to October 2006) using keywords related to diagnostic accuracy of physical examination tests of the shoulder. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to critique the quality of each paper. Meta-analysis through meta-regression of the diagnostic odds ratio (DOR) was performed on the Neer test for impingement, the Hawkins-Kennedy test for impingement, and the Speed test for superior labral pathology. Forty-five studies were critiqued with only half demonstrating acceptable high quality and only two having adequate sample size. For impingement, the meta-analysis revealed that the pooled sensitivity and specificity for the Neer test was 79% and 53%, respectively, and for the Hawkins-Kennedy test was 79% and 59%, respectively. For superior labral (SLAP) tears, the summary sensitivity and specificity of the Speed test was 32% and 61%, respectively. Regarding orthopaedic special tests (OSTs) where meta-analysis was not possible either due to lack of sufficient studies or heterogeneity between studies, the list that demonstrates both high sensitivity and high specificity is short: hornblowers's sign and the external rotation lag sign for tears of the rotator cuff, biceps load II for superior labral anterior to posterior (SLAP) lesions, and apprehension, relocation and anterior release for anterior instability. Even these tests have been under-studied or are from lower quality studies or both. No tests for impingement or acromioclavicular (AC) joint pathology demonstrated significant diagnostic accuracy. Based on pooled data, the diagnostic accuracy of the Neer test for impingement, the Hawkins-Kennedy test for impingement and the Speed test for labral pathology is limited. There is a great need for large, prospective, well-designed studies that examine the diagnostic accuracy of the numerous physical examination tests of the shoulder. Currently, almost without exception, there is a lack of clarity with regard to whether common OSTs used in clinical examination are useful in differentially diagnosing pathologies of the shoulder.
              Article 0 comments Cited 89 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Orthop Rev (Pavia)
                Journal ID (iso-abbrev): Orthop Rev (Pavia)
                Journal ID (pmc): OR
                Journal ID (publisher-id): OR
                Title: Orthopedic Reviews
                Publisher: PAGEPress Publications (Pavia, Italy )
                ISSN (Print): 2035-8164
                ISSN (Electronic): 2035-8237
                Publication date (Electronic): 31 May 2012
                Publication date Collection: 09 May 2012
                Volume: 4
                Issue: 2
                Electronic Location Identifier: e18
                Affiliations
                Orthopaedic Surgery Department, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan
                Author notes
                Correspondence: Irfan Qadir, Orthopaedic Surgery Department, Aga Khan University Hospital, Stadium Road, Room 211, Male hostel, Aga Khan University Hospital, Karachi 74800, Pakistan. Tel. +92.3007321600 E-mail: muhamad_irfan_qadir@ 123456yahoo.com

                Contributions: MU, IQ, literature review and manuscript preparation; MA, help in literature research.

                Conflict of interests: the authors report no potential conflict of interests.

                Article
                Publisher ID: or.2012.e18
                DOI: 10.4081/or.2012.e18
                PMC ID: 3395987
                PubMed ID: 22802986
                SO-VID: bd6c50b9-5d2a-4f97-9ada-46c6b28168f0
                Copyright © ©Copyright M. Umer et al., 2012
                License:

                This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0).

                Licensee PAGEPress, Italy

                History
                Date received : 01 February 2012
                Date accepted : 16 April 2012
                Categories
                Subject: Review

                ScienceOpen disciplines: Orthopedics
                Keywords: shoulder pain,rotator cuff tendinopathy.,subacromial impingement syndrome,subacromial bursitis
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: shoulder pain, rotator cuff tendinopathy., subacromial impingement syndrome, subacromial bursitis

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