Published Evidence Relevant to the Diagnosis of Impingement Syndrome of the Shoulder

Papadonikolakis, Anastasios; McKenna, Mark; Warme, Winston J.; Martin, Brook I.; Matsen, Frederick A.

doi:10.2106/jbjs.j.01748

Cited by 98 publications

(82 citation statements)

References 20 publications

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“…Ozaki et al [25], by studying partial articular tears in cadaveric specimens, proposed that age-related degenerative changes in the RC are the cause of the subsequent tears. Several other authors are in favour of an intrinsic degenerative aetiology as the main cause for RC pathology [26,27].…”

Section: Discussionmentioning

confidence: 99%

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The acromial index is not predictive for failed rotator cuff repair

Meleán

Lichtenberg²,

Montoya

et al. 2013

International Orthopaedics (SICOT)

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Background The main objective of this study was to evaluate the association between the acromial index (AI) and the incidence of recurrent tears of the rotator cuff (RC) in a cohort of patients with full thickness tears who underwent arthroscopic primary repair. Methods A prognostic study of a prospective case series of 103 patients with full thickness RC tears was undertaken. The average age was 59.5 years (39-74) and follow-up was 30.81-months (12-72). True anterior-posterior X-rays were obtained during the pre-operative evaluation. Pre and post-operative magnetic resonance imaging (MRI) were recorded. Results Eighteen cases with recurrent tears (17.4 %) were seen on post-operative MRI. The average AI for patients with recurrent tears was 0.711±0.065 and for patients without recurrent tears 0.710±0.064 (p<0.05). A positive association between age and recurrent tears of the RC was noted (average ages: recurrent tears group 63±5.9 years; group without recurrent tears 58.8±7.5 years) (r=−0.216; p=0.029). We did not find an association between size of the primary tear and recurrent tears (r=−0.075; p<0.05) or between degrees of retraction of the primary and recurrent tears of the cuff (r=−0.073; p<0.05). We observed that 38.9 % of the recurrent tears cases presented with more than one tendon affected before the arthroscopy. At follow-up, none of these recurrent tears showed more than one tendon affected on MRI evaluation. ConclusionIn this study, we found that the AI radiological measurement is not a predictor for recurrent tears of the RC after primary arthroscopic repair.

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Section: Discussionmentioning

confidence: 99%

“…Others favour an extrinsic theory, where the RC tendons are chronically damaged by an impingement phenomenon, mainly under the anterior and lateral part of the acromion. This matter could be considered in the aetiology for recurrent tears of the RC after primary repair [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

The acromial index is not predictive for failed rotator cuff repair

Meleán

Lichtenberg²,

Montoya

et al. 2013

International Orthopaedics (SICOT)

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“…Operative treatment is commonly used for shoulder impingement syndrome, even though its effectiveness has not been proven in the literature (Papadonikolakis et al 2011, Diercks et al 2014, Saltychev et al 2015). The fact that the diagnosis is merely clinical also makes comparison of different studies difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, the term impingement syndrome is used to refer to a full range of rotator cuff abnormalities, being still a diagnosis based on physical examination (Papadonikolakis et al 2011). Diercks et al (2014) highlighted the need for a combination of clinical tests in the diagnosis, and suggested the use of an imaging test after prolonged symptoms (of more than 6 weeks) to rule out rotator cuff tears.…”

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Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

et al. 2015

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Background and purpose — Shoulder impingement syndrome is common, but treatment is controversial. Arthroscopic acromioplasty is popular even though its efficacy is unknown. In this study, we analyzed stage-II shoulder impingement patients in subgroups to identify those who would benefit from the operation.Patients and methods — In a previous randomized study, 140 patients were either treated with a supervised exercise program or with arthroscopic acromioplasty followed by a similar exercise program. The patients were followed up at 2 and 5 years after randomization. Self-reported pain was used as the primary outcome measure.Results — Both treatment groups had less pain at 2 and 5 years, and this was similar in both groups. Duration of symptoms, marital status (single), long periods of sick leave, and lack of professional education appeared to increase the risk of persistent pain despite the treatment. Patients with impingement with radiological acromioclavicular (AC) joint degeneration also had more pain. The patients in the exercise group who later wanted operative treatment and had it did not get better after the operation.Interpretation — The natural course probably plays a substantial role in the outcome. Based on our findings, it is difficult to recommend arthroscopic acromioplasty for any specific subgroup. Regarding operative treatment, however, a concomitant AC joint resection might be recommended if there are signs of AC joint degeneration. Even more challenging for the development of a treatment algorithm is the finding that patients who do not recover after nonoperative treatment should not be operated either.

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Shoulder measurements on MRI: Statistical analysis of patients without and with rotator cuff tears and predictive modeling

2019

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This study aims to determine significant differences between various measurements of shoulder structures and relationships in patients with and without rotator cuff tears and identify a subset of these measurements that may merit further investigation. Shoulder MRIs of 120 patients with rotator cuff tears (RCT group) and 80 patients with normal examinations (No RCT group) were retrospectively identified. Numerous measurements of shoulder anatomy and relationships and pathology characterization were performed for each study. The mean and ranges of measurements for each group were identified, and P-values were calculated to assess differences between the two groups. Classification and Regression Tree (CART) identified prediction models for separating the two groups based on these shoulder MRI measurements. Statistically significant differences were observed for 9 of 18 of the shoulder measurements between the two groups (P < 0.05). Using long head of biceps tendon tear, tendinosis, and subacromial-subdeltoid bursal fluid, the prediction model from CART demonstrated 99.5% accuracy in separating the two groups. Subacromial distance, subacromial spur size, and acromioclavicular osteophyte could also separate the two groups with 97.5% accuracy. Other measures less commonly associated with impingement and rotator cuff tears could also be used to separate the two groups with up to 81.5% accuracy. This study introduces new measures and clarifies ranges for existing measurements on shoulder MRI. Abnormalities of some of these measurements may be associated with subacromial impingement, and combinations of these parameters may be useful for separating patients with or without rotator cuff tears. Clin. Anat. 33:173-186, 2020.

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Published Evidence Relevant to the Diagnosis of Impingement Syndrome of the Shoulder

Cited by 98 publications

References 20 publications

The acromial index is not predictive for failed rotator cuff repair

The acromial index is not predictive for failed rotator cuff repair

Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

Shoulder measurements on MRI: Statistical analysis of patients without and with rotator cuff tears and predictive modeling

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