scholarly journals Quantitative Ultrasonographic Analysis of Changes of the Suprascapular Nerve in the Aging Population With Shoulder Pain

2021 ◽  
Vol 9 ◽  
Author(s):  
Wei-Ting Wu ◽  
Lan-Rong Chen ◽  
Hsiang-Chi Chang ◽  
Ke-Vin Chang ◽  
Levent Özçakar
Keyword(s):  
Rotator Cuff ◽  
Older People ◽  
Brachial Plexus ◽  
Shoulder Pain ◽  
Supraspinatus Tendon ◽  
Suprascapular Nerve ◽  
Control Group ◽  
Full Thickness ◽  
Cross Sectional ◽  
Rotator Cuff Lesions

BackgroundOlder people are vulnerable to painful shoulder syndromes, the majority of which are derived from degenerative rotator cuff pathologies. The suprascapular nerve (SSN) is closely related to the rotator cuff complex, and its role in shoulder pain has recently been highlighted. This study aimed to explore the differences in SSN among older people with and without shoulder pain, and to investigate the potential factors influencing the nerve size using ultrasound (US) imaging.MethodsParticipants aged ≥60 years were enrolled in the study. A systematic and bilateral US examination of the rotator cuff tendons was performed. The SSN was examined from its origin in the brachial plexus to the spinoglenoid notch of the infraspinatus fossa. The association between the nerve’s cross-sectional area (CSA) and rotator cuff lesions was analyzed using the generalized estimation equation.ResultsAmong the 94 participants, 45 (with bilaterally asymptomatic shoulders) were classified into the control group, whereas 49 (with at least one-sided shoulder pain) were classified into the group with shoulder pain. The average CSAs of the SSN at the level of the brachial plexus, supraspinatus fossa, and infraspinatus fossa were comparable between the patients in the control group and those with shoulder pain. There was a higher prevalence of rotator cuff lesions and enlarged distal SSNs in the painful shoulders than in the asymptomatic shoulders of patients with unilateral involvement. A full-thickness tear of the supraspinatus tendon was associated with swelling of the SSN in the supraspinatus fossa (β coefficient = 4.068 mm2, p < 0.001).ConclusionIn the older population, full-thickness tears of the supraspinatus tendon are independently associated with enlargement of the distal SSN. In cases with large rotator cuff tendon tears with poor response to conservative treatments, possible SSN entrapment should be considered and managed accordingly.

scholarly journals Does the Interval Slide Procedure Reduce Supraspinatus Tendon Repair Tension?: A Biomechanical Cadaveric Study

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110668
Author(s):  
Felix Porschke ◽  
Philip Christian Nolte ◽  
Christian Knye ◽  
Christel Weiss ◽  
Stefan Studier-Fischer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Intervention Group ◽  
Tendon Repair ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Full Thickness ◽  
Time Points ◽  
Tendon Tears ◽  
And Control

Background: The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial. Purpose: The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon. Study Design: Controlled laboratory study. Methods: A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t1) was evaluated. In the intervention group, AIS (t2), PIS (t3), and CR (t4) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention. Results: A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t1 vs t4: 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t1 vs t2: 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t2 vs t3: 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t3 vs t4: 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001). Conclusion: The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally. Clinical Relevance: These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure.

scholarly journals Chronic non-traumatic shoulder pain: evaluation with ultrasonography and conventional mr imaging

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M M N Elaassar ◽  
A Emadeldin ◽  
D Z Zidan ◽  
H M Sakr ◽  
H Abdelazim
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Shoulder Joint ◽  
Supraspinatus Tendon ◽  
Radiology Department ◽  
Dominant Hand ◽  
Full Thickness ◽  
Duration Of Symptoms ◽  
Partial Thickness ◽  
Chronic Shoulder Pain

Abstract Background Shoulder pain is a common and disabling complaint. It is responsible for approximately 16 % of all musculoskeletal disorders1 Shoulder pain is defined as chronic when it has been present for longer than six months, regardless of whether the patient has previously sought treatment2. The most common causes of chronic shoulder pain are reported to be rotator cuff disorders, acromioclavicular joint (ACJ) disease and glenohumeral joint (GHJ) disorders3 Aim of the Work The aim of this study is to evaluate the role of both ultrasonography and conventional MRI imaging in diagnosing various causes of chronic shoulder pain not caused by trauma. Patients and Methods 101 patients were evaluated for chronic shoulder pain ranging in age from 20 to 70-years-old. They were referred to the radiology department (Ultrasound unit and MRI unit) at Ain Shams University hospitals during the period between September 2016 and June 2018, from orthopaedic, rheumatology and physical medicine departments. Once a patient satisfied the inclusion and exclusion criteria for this study, an elaborate history was taken from all the patients which was followed by a thorough clinical evaluation, in which duration of symptoms, affected side, dominant hand, range of movement was checked. Patients were subjected to sonographic evaluation of the shoulder joint followed by MRI of the affected shoulder with mean interval between sonography and MRI about 10 days (range, 5-15 days). Results Total of 101 patients with chronic shoulder joint pain were enrolled in our study. 58 % of the patients were in the age group of 41-55 years with mean age of 48 years. Majority (42 %) of patients had chronic shoulder pain over 6-9 months. Complaints mainly resided in the form of tenderness (65 %) and night pain (25 %). Females constituted most of the patients around 68% of the cases. Majority (72%) patients in our study had right hand dominance. 57 % of the sampled patients gave positive history of heavy use of the affected shoulder. 78 % of patients demonstrated acromion morphological changes that had a direct impact on the rotator cuff findings. Amongst the rotator cuff tendons, Supraspinatus tendon was the most common tendon to be involved in our study in both USG and MRI. USG detected 92 patients and MRI detected 96 patients with supraspinatus tendon pathologies which included tendinosis, tears and calcifications and other non-rotator-cuff related findings. Total of 53 were diagnosed as rotator cuff-tear, followed by subacromial-subdeltoid bursitis (n = 32), supraspinatus impingement (n = 14), calcific tendinitis (n = 7) respectively. Supraspinatus tendinopathy was the most common diagnoses (n = 51) followed by Partial thickness tear of supraspinatus (n = 19) then full thickness of supraspinatus (n = 17). USG showed a sensitivity of 52.6% and specificity of 87.8 %, NPV of 88.9 % and PPV of 50 % with 78.8 % MRI agreement for partial thickness tears. USG showed 88 % sensitive, 97% specific, had 97 % PPV, 100% NPV, and was 96 % accurate in diagnosing complete tendon tear. MRI had a higher efficacy for both full thickness as well as partial thickness tears, whereas USG had a higher efficacy for full thickness tears only. Our study shows MRI to be a highly sensitive as well as specific technique for differentiation among different shoulder pathologies.

The “bridging sign”: A MR finding for combined full-thickness tears of the subscapularis tendon and the supraspinatus tendon

2013 ◽  
Vol 54 (1) ◽  
pp. 83-88 ◽  
Author(s):  
Jin Young Jung ◽  
Young Cheol Yoon ◽  
Dong Ik Cha ◽  
Jae-Chul Yoo ◽  
Jee Young Jung
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Rotator Cuff Tear ◽  
Supraspinatus Tendon ◽  
Subscapularis Tendon ◽  
Full Thickness ◽  
Tendon Tear ◽  
Anterior Portion ◽  
Cuff Tear ◽  
Sensitivity Specificity

Background In daily practice, we discovered one of the secondary magnetic resonance (MR) findings of the subscapularis (SSC) tendon tear, the “bridging sign”, which has not been previously described. Purpose To describe the “bridging sign” on shoulder MR imaging and its radiological and clinical significance in patients with SSC tendon tear. Material and Methods Twenty-nine patients who had undergone shoulder arthroscopy and had full-thickness tear of the subscapularis tendon were enrolled. The medical records of the 29 patients were retrospectively reviewed for the duration of shoulder pain, rotator cuff tears, and associated arthroscopic findings: biceps tendon abnormality and superior glenoid labral tear. Then, preoperative shoulder MR images were retrospectively reviewed for the presence or absence of the “bridging sign” and associated MR findings: periarticular fluid and fatty atrophy of the supraspinatus and subscapularis muscles. The type of rotator cuff tear associated with the “bridging sign” was assessed and the sensitivity, specificity, and accuracy of the “bridging sign” for the diagnosis of a certain type of rotator cuff tear were calculated. Associated arthroscopic and MR findings and mean duration of the shoulder pain between the patients with and without the “bridging sign” were compared. Results The “bridging sign” was seen in 17 of 29 patients and corresponded to a complex of the torn and superomedially retracted subscapularis tendon, coracohumeral ligament, and superior glenohumeral ligament, adhered to the anterior margin of the torn supraspinatus (SSP) tendon on arthroscopy. All patients with the “bridging sign” had combined full-thickness tear (FTT) of the cranial 1/2 portion of the subscapularis tendon and anterior 1/2 portion of the SSP tendon. The sensitivity, specificity, and accuracy of the “bridging sign” for the diagnosis of combined FTTs of the SSC tendon and anterior portion of the SSP tendon were 81.0%, 100%, and 86.2%, respectively. The patients with the “bridging sign” had longer duration of shoulder pain and more frequent associated arthroscopic and MR findings than the patients without the “bridging sign”. Conclusion The “bridging sign” is a highly specific finding for combined full-thickness tears of the subscapularis tendon and anterior portion of the supraspinatus tendon, associated with more chronic shoulder pain and more sever rotator cuff tear.

scholarly journals The influence of the Kinesio Taping on selected ultrasonography measurements, and quality of life in patients with rotator cuff lesions

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Aneta Bac ◽  
Magdalena Wróbel ◽  
Katarzyna Ogrodzka-Ciechanowicz ◽  
Edyta Michalik ◽  
Anna Ścisłowska-Czarnecka
Keyword(s):  
Quality Of Life ◽  
Rotator Cuff ◽  
Statistical Significance ◽  
Control Group ◽  
Subacromial Space ◽  
Kinesio Taping ◽  
Significant Difference ◽  
Rotator Cuff Lesions ◽  
Significant Change

Abstract The assessment of the six-week influence of Kinesio Taping combined with a rehabilitation on selected ultrasonography measurements, the level of disability, and the quality of life in patients with rotator cuff lesions. 60 participants were randomly assigned into a taping group (KT combined with a six-week rehabilitating protocol) and a control group (only rehabilitation protocol). In all patients the following assessments were performed twice: USG, UEFI and NHP questionnaires. In the examination of the subacromial space and the subacromial bursa in the taping group, no statistical significance was observed. A statistically significant change in the thickness of the muscles was obtained only for the thickness of the infraspinatus in the taping group. A statistically significant change was obtained in the assessment of tendinopathy only for the supraspinatus muscle in both groups. Within both groups a statistically significant difference was observed in the average UEFI and NHP scores; however, the differences in the scores obtained between the groups were not statistically significant. The use of KT with a rehabilitation program did not yield statistically significantly better results in the improvement of selected shoulder region indicators, the function of the upper limb and the quality of life.

Atelocollagen Enhances the Healing of Rotator Cuff Tendon in Rabbit Model

2017 ◽  
Vol 45 (9) ◽  
pp. 2019-2027 ◽  
Author(s):  
Dong-Sam Suh ◽  
Jun-Keun Lee ◽  
Ji-Chul Yoo ◽  
Sang-Hun Woo ◽  
Ga-Ram Kim ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rapid Development ◽  
Rabbit Model ◽  
Supraspinatus Tendon ◽  
Histological Evaluation ◽  
Control Group ◽  
Patch Type ◽  
Load To Failure ◽  
Cuff Repair ◽  
Experimental Group

Background: Failure of rotator cuff healing is a common complication despite the rapid development of surgical repair techniques for the torn rotator cuff. Purpose: To verify the effect of atelocollagen on tendon-to-bone healing in the rabbit supraspinatus tendon compared with conventional cuff repair. Study Design: Controlled laboratory study. Methods: A tear of the supraspinatus tendon was created and repaired in 46 New Zealand White rabbits. They were then randomly allocated into 2 groups (23 rabbits per group; 15 for histological and 8 for biomechanical test). In the experimental group, patch-type atelocollagen was implanted between bone and tendon during repair; in the control group, the torn tendon was repaired without atelocollagen. Each opposite shoulder served as a sham (tendon was exposed only). Histological evaluation was performed at 4, 8, and 12 weeks. Biomechanical tensile strength was tested 12 weeks after surgery. Results: Histological evaluation scores of the experimental group (4.0 ± 1.0) were significantly superior to those of the control group (7.7 ± 2.7) at 12 weeks ( P = .005). The load to failure was significantly higher in the experimental group (51.4 ± 3.9 N) than in the control group (36.4 ± 5.9 N) ( P = .001). Conclusion: Histological and biomechanical studies demonstrated better results in the experimental group using atelocollagen in a rabbit model of the supraspinatus tendon tear. Clinical Relevance: Atelocollagen patch could be used in the cuff repair site to enhance healing.

scholarly journals Three-dimensional Capsular Volume Measurements in Multidirectional Shoulder Instability

2018 ◽  
Vol 21 (3) ◽  
pp. 134-137
Author(s):  
Yong Cheol Jun ◽  
Young Lae Moon ◽  
Moustafa I Elsayed ◽  
Jae Hwan Lim ◽  
Dong Hyuk Cha
Keyword(s):  
Rotator Cuff ◽  
Surface Area ◽  
Three Dimensional ◽  
Volume Measurement ◽  
Control Group ◽  
Two Dimensional ◽  
Cross Sectional ◽  
Volume Measurements ◽  
Glenoid Surface ◽  
3D Software

BACKGROUND: In a previous study undertaken to quantify capsular volume in rotator cuff interval or axillary pouch, significant differences were found between controls and patients with instability. However, the results obtained were derived from two-dimensional cross sectional areas. In our study, we sought correlation between three-dimensional (3D) capsular volumes, as measured by magnetic resonance arthrography (MRA), and multidirectional instability (MDI) of the shoulder.METHODS: The MRAs of 21 patients with MDI of the shoulder and 16 control cases with no instability were retrospectively reviewed. Capsular areas determined by MRA were translated into 3D volumes using 3D software Mimics ver. 16 (Materilise, Leuven, Belgium), and glenoid surface area was measured in axial and coronal MRA views. Then, the ratio between capsular volume and glenoid surface area was calculated, and evaluated with control group.RESULTS: The ratio between 3D capsular volume and glenoid surface area was significantly increased in the MDI group (3.59 ± 0.83 cm³/cm²) compared to the control group (2.53 ± 0.62 cm³/cm²) (p < 0.01).CONCLUSIONS: From these results, we could support that capsular volume enlargement play an important role in MDI of the shoulder using volume measurement.

scholarly journals Effectiveness of Suprascapular Nerve Block in the Treatment of Hemiplegic Shoulder Pain: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Yajing Hou ◽  
Yong Wang ◽  
Xiaojing Sun ◽  
Yake Lou ◽  
Ying Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Shoulder Pain ◽  
Nerve Block ◽  
External Rotation ◽  
Meta Analysis ◽  
Suprascapular Nerve ◽  
Cochrane Library ◽  
Control Group ◽  
Suprascapular Nerve Block ◽  
Secondary Endpoints

Purpose: We aimed to investigate the effectiveness of suprascapular nerve block (SSNB) in patients with hemiplegic shoulder pain (HSP).Background: SSNB is widely used in various shoulder pains, but whether it is effective in HSP remains unknown.Methods: PubMed, Cochrane Library, and Embase databases were searched to identify potential citations. Randomized controlled trials meeting the eligible criteria were included in our analysis. The primary endpoint was Visual Analog Scale (VAS) with a maximum value of 100 and a minimum value of 0. Secondary endpoints were passive range of motion (PROM) that pain starts, and the PROM mainly included abduction, flexion, and external rotation. In addition, the upper extremity Fugl-Meyer assessment (FMA) was also included in our secondary endpoints.Results: Eight studies with 281 patients were included in our analysis. For VAS, there was no obvious difference between SSNB group and control group regardless of the follow-up period (&lt;4 weeks or ≥4 weeks), which were −6.62 (−15.76, 2.53; p = 0.16) and 1.78 (−16.18, 19.74; p = 0.85). For shoulder function, the PROM of abduction, flexion, and external rotation was similar between groups. However, motor function indicator FMA is lower in SSNB control than that in control group, with a mean difference (and 95% CI) of −2.59 (−4.52, −0.66; p = 0.008).Conclusion: SSNB is an effective way for HSP patients.Systematic Review Registration: Registration ID: CRD42021252429.

Is rotator cuff related shoulder pain a multidimensional disorder? An exploratory study

2020 ◽  
Vol 20 (2) ◽  
pp. 297-305 ◽  
Author(s):  
Luca Maestroni ◽  
Michele Marelli ◽  
Massimiliano Gritti ◽  
Fabio Civera ◽  
Martin Rabey
Keyword(s):  
Rotator Cuff ◽  
Pain Intensity ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Future Research ◽  
Multivariable Model ◽  
Cross Sectional ◽  
Need To Evaluate ◽  
Symptom Persistence ◽  
Multivariable Regression Models

AbstractBackground and aimsRotator cuff related shoulder pain has been associated with factors from multiple dimensions such as strength changes, psychosocial measures, comorbidities and level of education. However, to date little research has been undertaken to evaluate which factors explain the greatest variance in pain and disability levels in people with rotator cuff related shoulder pain. The objective of this study was therefore to evaluate which multidimensional examination findings were associated with higher pain and disability in a primary care cohort with rotator cuff related shoulder pain.MethodsThis was an exploratory cross-sectional cohort study. Sixty-seven participants with rotator cuff related shoulder pain were assessed for: pain intensity, disability; demographic, psychological, social and lifestyle characteristics, and isometric strength of shoulder internal and external rotator muscles. Univariable associations between pain intensity/disability and each variable were assessed using linear regression. Variables with univariable associations (p < 0.1) were entered into backwards stepwise multivariable regression models.ResultsThe multivariable model for pain intensity included sleep and perceived persistence and explained 46.5% of the variance (37.6% uniquely by sleep, 5.4% uniquely by perceived persistence). The multivariable model for disability included sleep and sex and explained 26.8% of the variance (4.5% shared by predictors, 16.4% uniquely by sleep, 5.9% uniquely by sex).ConclusionsRotator cuff-related shoulder pain and disability are associated with sleep disturbance, perceived symptom persistence and sex. Rotator cuff related shoulder pain may be considered a multidimensional disorder.ImplicationsClinicians need to evaluate sleep and perceived symptom persistence in people with rotator cuff related shoulder pain. Future research may examine whether management strategies for RCRSP directed towards these factors afford improved treatment outcomes.

scholarly journals Prevalence and Site of Rotator Cuff Lesions in Shoulders With Recurrent Anterior Instability in a Young Population

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711984987 ◽  
Author(s):  
Yusuke Ueda ◽  
Hiroyuki Sugaya ◽  
Norimasa Takahashi ◽  
Keisuke Matsuki ◽  
Morihito Tokai ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Anterior Border ◽  
Level Of Evidence ◽  
Rotator Cuff Lesions

Background: Partial articular supraspinatus tendon avulsion (PASTA) lesions are often seen in shoulders of throwing athletes. PASTA lesions in anterior instability are also found in recurrent anterior glenohumeral instability. Purpose: To investigate the prevalence and location of rotator cuff tears (RCTs), including PASTA lesions, in shoulders with recurrent anterior instability. Study Design: Case series; Level of evidence, 4. Methods: A total of 842 shoulders in 801 patients with recurrent anterior instability (647 men, 154 women; mean age, 24 years; age range, 13-40 years) who underwent arthroscopic surgery at the age of 40 years or younger were enrolled. During surgery, the thickness and the sites of RCTs as well as patient factors associated with RCTs were examined. Results: RCTs were found in 57 shoulders (7%) in 56 patients. There were 4 shoulders with full-thickness RCTs and 53 shoulders with PASTA lesions. All lesions but 1 involved the anterior border of the supraspinatus (SSP). Participation in high-level athletics and older age at injury were associated with RCTs. Conclusion: The incidence of RCTs was 7% in shoulders with recurrent anterior instability at age 40 years or younger. Most RCTs were PASTA lesions that involved the anterior border of the SSP.

A case series of suprascapular nerve block (with an historical comparator) for shoulder pain in motor neurone disease

2020 ◽  
Vol 34 (8) ◽  
pp. 1127-1133
Author(s):  
E Michael Shanahan ◽  
Karen Glaezter ◽  
Tiffany Gill ◽  
Catherine Hill ◽  
Scott Graf ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Nerve Block ◽  
Case Series ◽  
Suprascapular Nerve ◽  
Motor Neurone ◽  
Motor Neurone Disease ◽  
Control Group ◽  
Placebo Control ◽  
Time Interval ◽  
Suprascapular Nerve Block

Background: Shoulder pain is a distressing but under-reported and poorly managed symptom in people with motor neurone disease. Objectives: This study aimed to assess the efficacy of suprascapular nerve block for the management of shoulder pain in patients with motor neurone disease. Methods: A total of 27 patients with motor neurone disease and shoulder pain were offered a suprascapular nerve block. Ten of these patients had bilateral shoulder pain and both were injected, making a total of 37 shoulders. The patients were followed up for a total of 3 months, or until death. Shoulder pain was measured using the pain scale (out of 100) of the shoulder pain and disability index and compared with baseline scores and a placebo control group from an earlier study using the same methodology (ACTRN12619000353190). Results: Following the nerve block there was a significant improvement of pain scores from baseline (58.4) at week 1 (20.8, p < 0.000), week 6 (17.6, p < 0.000) and week 12 (30.4, p = 0.001) and a significant improvement compared with the control group across each time interval. Conclusion: Suprascapular nerve block is a safe, effective therapy for patients with chronic shoulder pain.

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