Diagnostic Accuracy of Clinical Tests for the Different Degrees of Subacromial Impingement Syndrome

Park, Hyung Bin; Yokota, Atsushi; Gill, Harpreet; Rassi, George El; McFarland, Edward G.

doi:10.2106/jbjs.d.02335

Cited by 273 publications

(171 citation statements)

References 24 publications

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“…Patients were rated as having normal scapular motion, subtle abnormalities, or obvious abnormalities, with the abnormalities being winging or dysrhythmia. 60,82 Special tests were performed for impingement (Neer's, 67 Hawkin's, 31 empty-can 35 ), labral tears (crank test, 51 biceps I, 43 biceps II, 42 anterior slide 41 ), instability 70 ).…”

Section: 63mentioning

confidence: 99%

Comprehensive Impairment-Based Exercise and Manual Therapy Intervention for Patients With Subacromial Impingement Syndrome: A Case Series

Tate¹,

McClure²,

Young³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

108

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Study Design Case series. Background Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period. Case Description Ten patients (age range, 19–70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks. Outcomes Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least “moderately better.” At 6 weeks, 6 of 10 patients had a successful (mean ± SD) DASH outcome score (initial, 33.9 ± 16.2; 6 weeks, 8.1 ± 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 ± 14; 12 weeks, 8.3 ± 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients). Discussion A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional improvement in 8 of 10 patients in 6 to 12 weeks. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2010;40(8):474–493. doi:10.2519/jospt.2010.3223

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Section: 63mentioning

confidence: 99%

Comprehensive Impairment-Based Exercise and Manual Therapy Intervention for Patients With Subacromial Impingement Syndrome: A Case Series

Tate¹,

McClure²,

Young³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

108

View full text Add to dashboard Cite

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“…True assessment of the supraspinatus requires adequate scapular stabilization and the arm in a position outside of the impingement zone, such as the described champagne toast test [41,42]. Impingement signs such as Neer and Hawkins may be positive; however, these signs are less specific for isolated rotator cuff pathology [43,44]. The classic "shrug sign" which usually depicts weakness of the rotator cuff may be present when a patient elevates their scapula during shoulder abduction particularly in full thickness tears [45].…”

Section: Physical Exammentioning

confidence: 99%

Treatment of Partial Thickness Rotator Cuff Tears in Overhead Athletes

Liu

Garcia

Gowd

et al. 2018

Curr Rev Musculoskelet Med

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Purpose of Review To review the etiology, classification, presentation, evaluation, treatment strategy, and outcomes in overhead athletes with partial thickness rotator cuff tears. Recent Findings Despite advances in surgical repair techniques, return to play following surgical repair of partial rotator cuff tears remains modest at best. Summary Overhead athletes may be particularly prone to rotator cuff pathology due to the supraphysiological strains within the tendon during the throwing motion, as well as mechanical stress with contact between the undersurface of the rotator cuff and the glenoid. The true prevalence of partial tears may be underestimated given the high incidence of asymptomatic tears. Both dynamic ultrasound and enhanced contrast MRI have improved our understanding of this pathology. For most overhead athletes, nonoperative management is the most common course. Despite advances in imaging, diagnosis, and surgical techniques, our ability to return these patients to their elite level is modest at best when nonoperative management fails and surgical treatment is performed. If a surgical route is needed, debridement alone is the most frequent procedure given concerns of over constraint and poor return to play with surgical repair of the partial thickness rotator cuff tear.

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“…The HawkinsKennedy, painful arc of motion, and infraspinatus muscle tests were included as a test-item cluster for subacromial impingement syndrome. 34 The negative likelihood ratio for the patient not having the condition when all 3 tests are negative is 0.17. The only positive test was the Hawkins-Kennedy, which elicited 5/10 pain in both the P1 and P2 regions.…”

Section: Examination/evaluationmentioning

confidence: 99%

“…23 The clinical course of adhesive capsulitis has been well described as a continuum of 4 stages, 23,32 with stage 2 lasting from 3 to 9 months and characterized by a gradual loss of motion in all directions due to pain. 23,32 Subacromial impingement syndrome was ruled out secondary to 2 of 3 tests being negative in the test-item cluster described by Park et al 34 Referral of pain from pathology at the cervical spine was ruled out, based on a detailed examination of that region, with all measures and tests being negative.…”

Section: Diagnosis/prognosismentioning

confidence: 99%

Trigger Point Dry Needling as an Adjunct Treatment for a Patient With Adhesive Capsulitis of the Shoulder

Clewley¹,

Flynn²,

Koppenhaver³

2014

J Orthop Sports Phys Ther

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A dhesive capsulitis is a common shoulder condition of unknown etiology that is often treated by physical therapists. 26,47 The incidence rate of adhesive capsulitis is higher in women than in men and higher among middleaged individuals. 47 The risk factors associated with adhesive capsulitis are type 1 or 2 diabetes mellitus, thyroid disease, an age of between 40 and 65 years, trauma, prolonged immobilization, autoimmune disease, and myocardial infarction. 23 In individuals with diabetes, the incidence rate is upward of 20%, compared to 2% to 5% in individuals without diabetes. 15,37The economic burden and the impact of adhesive capsulitis on health care expenditures are significant. 9,43 The condition has been described as self-limiting, typically resolving in 1 to 3 years, with long-term range of motion (ROM) deficits lasting up to 10 years. 27 However, the prognosis associated with adhesive capsulitis improves with a lesser number of comorbidities. 48There are a number of invasive and conservative options for managing adhesive capsulitis. 7,8,13,23,44 Invasive interventions include intra-articular steroid injection, surgery, and manipulation under anesthesia. Manipulation under anesthesia is commonly used but carries the risk of humeral fracture, dislocation, rotator cuff injuries, labral tears, and brachial plexus injury.13 Acetaminophen and nonsteroidal anti-inflammatory medications are common first-line nonsurgical treatments for adhesive capsulitis, but there is little evidence for their effectiveness. 44 Oral corticosteroids might provide short-term benefit in pain relief and improved ROM in patients with adhesive capsulitis.7 However, they have not been proven to reduce the duration of adhesive capsulitis. 8Early physical therapy intervention that includes joint mobilization directed at the shoulder joint complex has been T T STUDY DESIGN: Case report. T T BACKGROUND:Prognosis for adhesive capsulitis has been described as self-limiting and can persist for 1 to 3 years. Conservative treatment that includes physical therapy is commonly advised. T T CASE DESCRIPTION:The patient was a 54-year-old woman with primary symptoms of shoulder pain and loss of motion consistent with adhesive capsulitis. Manual physical therapy intervention initially consisted of joint mobilizations of the shoulder region and thrust manipulation of the cervicothoracic region. Although manual techniques seemed to result in some early functional improvement, continued progression was limited by pain. Subsequent examination identified trigger points in the upper trapezius, levator scapula, deltoid, and infraspinatus muscles, which were treated with dry needling to decrease pain and allow for higher grades of manual intervention. T T OUTCOMES:The patient was treated for a total of 13 visits over a 6-week period. After trigger point dry needling was introduced on the third visit, improvements in pain-free shoulder range of motion and functional outcome measures, assessed with the Shoulder Pain and Disability Index and the shortened form...

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Diagnostic Accuracy of Clinical Tests for the Different Degrees of Subacromial Impingement Syndrome

Abstract: The severity of the impingement syndrome affects the diagnostic values of the commonly used clinical tests. The variable accuracy of these tests should be taken into consideration when evaluating patients with symptoms of rotator cuff disease.

Cited by 273 publications

References 24 publications

Comprehensive Impairment-Based Exercise and Manual Therapy Intervention for Patients With Subacromial Impingement Syndrome: A Case Series

Comprehensive Impairment-Based Exercise and Manual Therapy Intervention for Patients With Subacromial Impingement Syndrome: A Case Series

Treatment of Partial Thickness Rotator Cuff Tears in Overhead Athletes

Trigger Point Dry Needling as an Adjunct Treatment for a Patient With Adhesive Capsulitis of the Shoulder

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