BackgroundPain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments in strength and ROM to patient-reported shoulder function is not well described, even though testing of strength is recommended in clinical guidelines.The purpose of this study was, first, to investigate impairments in glenohumeral and scapulothoracic strength and in abduction and internal rotation ROM in patients with SIS. Secondly, to investigate the influence of these impairments on patient-reported shoulder function.MethodsCross-sectional study based on a consecutive cohort of 157 patients referred to specialist examination and diagnosed with shoulder impingement (SIS) using predefined validated diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia.ResultsSignificant impairments were found for all impairment tests, but most pronounced for glenohumeral strength and abduction ROM (29–33% deficits), and less for scapulothoracic strength and internal rotation ROM (8–18% deficits). Pain variables influenced SPADI and SPADI-F score to a high degree (R2 = 23.4–31.6%, p < 0.001), while strength and ROM did not.ConclusionSubstantial strength and ROM impairments were found in patients with SIS. Only pain significantly influenced patient-reported function, while impairments did not. As SPADI score does not reflect the substantial strength and ROM impairments in external rotation and abduction observed in patients with SIS, supplemental assessment of these impairments seems important.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1667-1) contains supplementary material, which is available to authorized users.
Background:Biomechanical studies show varying results regarding the elongation of adjustable fixation devices. This has led to growing concern over the stability of the ToggleLoc with ZipLoop used in anterior cruciate ligament (ACL) reconstruction (ACLR) in vivo.Purpose/Hypothesis:The purpose of this study was to compare passive knee stability 1 year after ACLR in patients in whom the Endobutton or ToggleLoc with ZipLoop was used for femoral graft fixation. The hypothesis was that the ToggleLoc with ZipLoop would be inferior in knee stability to the Endobutton 1 year after primary ACLR.Study Design:Cohort study; Level of evidence, 2.Methods:Data from 3175 patients (Endobutton: n = 2807; ToggleLoc with ZipLoop: n = 368) were included from the Danish Knee Ligament Reconstruction Registry (DKRR) between June 2010 and September 2013. Data were retrieved from standardized ACL forms filled out by the operating surgeon preoperatively, during surgery, and at a clinical examination 1 year after surgery. Passive knee stability was evaluated using 1 of 2 arthrometers (Rolimeter or KT-1000 arthrometer) and the pivot-shift test. Using the same database, the number of reoperations performed up to 4 years after primary surgery was examined.Results:Full data were available for 1654 patients (Endobutton: n = 1538; ToggleLoc with ZipLoop: n = 116). ACLR with both devices resulted in increased passive knee stability (P < .001). Patients who received the ToggleLoc with ZipLoop were found to have a better preoperative (P = .005 ) and postoperative (P < .001) pivot-shift test result. No statistically significant difference regarding the number of reoperations (P = .086) or the time to reoperation (P = .295) was found.Conclusion:Patients who underwent fixation with the ToggleLoc with ZipLoop had improved passive knee stability 1 year after surgery, measured by anterior tibial translation and pivot-shift test results, similar to patients who underwent fixation with the Endobutton. No difference was seen in knee stability or reoperation rates between the 2 devices.
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
Key MessagesAlthough a standardized guideline for a complete shoulder examination is not available, experienced shoulder surgeons showed a high degree of agreement about which SPE tests should be used for 12 most frequent shoulder pathologies. The recommendation of experienced shoulder surgeons could therefore be used as a foundation for standardized guidelines. IntroductionEffective treatment of shoulder pathologies depends on a correct diagnosis. To aid diagnosis at least 184 tests of Shoulder Physical Examination (SPE) have been described [1]. The large number of different tests and gap of knowledge may cause a communication problem between clinicians [2-4]. Large meta-analyses have not been able to suggest a standardized guideline shoulder examination [5,6].In the search of a standardized guideline for shoulder examination, we evaluated the clinical practice of shoulder examination among ten experienced shoulder surgeons. The aim was to identify the most used SPE tests and evaluate the usefulness of these tests in terms of sensitivity and specificity and present the preferred SPE used by experienced shoulder surgeons. Subjects and MethodsThe study was conducted as a questionnaire based survey. The questionnaire was sent to all shoulder surgeons at a specialized arthroscopic centre, Arthroscopic Centre Amager (ACA). ACA is a highly specialized centre for arthroscopic surgery. Ten surgeons are specialized in shoulder arthroscopy and are considered as experts in examination and treatment of shoulder diseases. The period of investigation was March to May 2014. Each of the ten participants received a questionnaire listing the following 12 pathologies and they were asked to name the SPE tests they usually apply to for each of the 12 pathologies. They were able to choose any SPE test they were familiar with and write in the questionnaire, no description to the tests were given to the surgeons. Subsequently, we performed a thorough literature search on Pubmed.com and the Cochrane library to investigate the sensitivity and specificity of the most reported test for each of the following 12 pathologies.The 12 pathologies were: 1) Acromioclavicular joint arthrosis, 2) Subacromial impingement syndrome, 3) Tear/lesion of the supraspinatus tendon, 4) Tear/lesion of the infraspinatus/teres minor tendon, 5) Tear/lesion of the subscapularis tendon, 6) Caput longum biceps pathology, 7) Superior Labrum Anterior-Posterior (SLAP) lesion, 8) Anterior instability, 9) Posterior instability, 10) Multi Directional Instability (MDI), 11) Adhesive capsulitis, and 12) Scapula alatae. ResultsTen out of 10 (100%) shoulder surgeons completed the questionnaire. The mean experience as shoulder surgeon was 10 years (range, 4-22 years). A total of 49 different SPE tests were reported. For HSOA Journal of Orthopedic Research and Physiotherapy Research Article AbstractContext: Shoulder problems constitute a major socioeconomic problem with lifetime prevalence up to 66.7%. To aid the diagnosis more than 184 tests have been described. Although a s...
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