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- Farfaras, Stefanos, et al.
(author)
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More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement
- 2018
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:1, s. 79-87
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Journal article (peer-reviewed)abstract
- Purpose: The purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability. Methods: Male patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope. Results: Eight patients, median age 53 (45–74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22–48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001). Conclusion: Male patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability. Clinical relevance: It appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients. Level of evidence: III.
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- Farfaras, Stefanos, et al.
(author)
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Subacromial Decompression Yields a Better Clinical Outcome Than Therapy Alone: A Prospective Randomized Study of Patients With a Minimum 10-Year Follow-up.
- 2018
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In: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 46:6, s. 1397-1407
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Journal article (peer-reviewed)abstract
- The long-term outcome after the treatment of subacromial impingement syndrome (SAIS) with either nonsurgical or surgical methods has not been thoroughly investigated. Hypothesis/Purpose: The purpose was to evaluate the long-term clinical outcome and the presence of rotator cuff injuries and osteoarthritis (OA) after the surgical and nonsurgical treatment of SAIS. The hypothesis was that, at a minimum 10 years after the initial treatment, patients who had undergone acromioplasty would have a better clinical outcome and run a lower risk of developing rotator cuff ruptures and OA as compared with those treated with physical therapy.Randomized controlled trial; Level of evidence, 2.Eighty-seven patients with SAIS were randomized to 3 groups: open acromioplasty (open surgery group [OSG]), arthroscopic acromioplasty (arthroscopic surgery group [ASG]), and nonsurgical treatment (physical therapy group [PTG]). The Constant score, the Watson and Sonnabend score, and the 36-Item Short Form Health Survey (SF-36) questionnaire were used as outcome measurements. Furthermore, bilateral ultrasound examinations were performed to detect rotator cuff ruptures and bilateral radiographs to detect OA. Sixty-six patients (76%) attended the clinical follow-up at least 10 years after the initial treatment.The groups were demographically comparable at baseline. The Constant score improved significantly at follow-up for the OSG ( P = .003) and ASG ( P = .011), while no significant improvement was detected for the PTG. The OSG revealed a significant improvement versus the PTG at follow-up ( P = .011); otherwise, no significant differences were found. For the Watson and Sonnabend score, the OSG revealed a significant improvement in 13 of 14 questions. The corresponding finding was made for the ASG and PTG in 9 of 14 questions ( P = .14). According to ultrasound, 1 of 20 patients in the OSG had a full-thickness rotator cuff rupture on the index side. The corresponding finding was made for 1 of 18 patients in the ASG and 4 of 28 in the PTG ( P = .29). Per the radiographs, 3 of 20 patients in the OSG had moderate or severe OA in the index shoulder. The corresponding finding was made for 1 of 18 patients in the ASG and 0 of 28 in the PTG ( P = .12).After a minimum 10 years of follow-up, the surgical treatment of SAIS appears to render better clinical results than physical therapy alone. No significant differences were found among the groups in terms of the presence of full-thickness rotator cuff ruptures and OA.
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- Hallström, Erling, 1953
(author)
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Shoulder Kinematics and Impingement. Dynamic Radiostereometric analysis of the shoulder
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Abstract This study aimed to evaluate the three-dimensional kinematics of the shoulder joint in patients with shoulder impingement and controls with focus on three well known diagnostic tests; painful arc test (active abduction), Neer sign (passive elevation) and Hawkins sign. The shoulder rhythm, the speed of motion and if successful treatment of impingement could be associated with changes of the shoulder kinematics were studied Dynamic radiostereometry (RSA) is feasible method to study rotations and translations of the gleonohumeral joint because of its high precision. In all studies the relative motions of the glenohumeral joint was analyzed. In one of them the contribution of the motions in this joint to the absolute or global motions of the shoulder (the shoulder rhythm) was delineated. The median age of the patients and controls varied between 49-51 and 30-36 years in the different studies. 25 patients and 12 controls without shoulder symptoms were studied during active abduction (painful arc test). The humeral centre displaced medially, proximally, and anteriorly. In the patient group, slightly more (1–1.5 mm) proximal translation was observed in the early phase of the arc of motion. 18 patients and 11 controls were tested at Neer sign and Hawkins sign. At Hawkins sign the centre of the humeral head was positioned more laterally and superiorly in the patients than in the controls. 30 patients and 11 controls were studied during active and 21 patients and 9 controls during passive abduction to evaluate the relative and absolute motion in order to analyze the shoulder rhythm and the speed of motion at active abduction. The patient group showed more scapular and trunk motions (p=0.04) and especially up to 40°. The distribution of motion between the glenohumeral joint and the trunk in both controls and patients with impingement was less than or equal to 1:1. 19 patients were randomized to three treatment options, physiotherapy (n=7), open surgery (n=7) or arthroscopic surgery (n=5). RSA studies and clinical evaluation were done before and median 29 and 24 months later. According to Constant-75 patients treated with surgery improved significantly more than those treated with physiotherapy (p<0.05). In the total material there was a tendency to increasing Constant score with increasing medial and posterior position of the humeral head center at test of Hawkins sign. In conclusion the patients showed at painful arc test an increased proximal translation and at Hawkins sign a more laterally and posterior position of the humeral head center. The glenohumeral-thoracoscapular ratio was less than or equal to 1:1 in patients and controls, where the patients had reduced glenohumeral motions in the early phase of active abduction. Correlation between changed humeral head translation after treatment during test of Hawkins sign and improvement of the Constant-75 score in the total patient material might represent causal relationship, but this findings needs to be further studied in larger patient groups.
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- Hallström, Erling, 1953, et al.
(author)
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Shoulder kinematics in 25 patients with impingement and 12 controls
- 2006
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In: Clin Orthop Relat Res. - 0009-921X. ; 448, s. 22-7
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Journal article (peer-reviewed)abstract
- We used dynamic radiostereometry to study the three-dimensional kinematics of the shoulder joint during active abduction. Twenty-five patients experiencing shoulder symptoms (Neer Stage 2) for more than 18 months, without total rotator cuff tears, participated. Eight men and four women without shoulder symptoms constituted controls. The rotation of the humeral head relative to a fixed scapula and the absolute rotation of the humerus (caused by humeral, scapular, and trunk motion) were measured. The rotations were calculated in the order of abduction/adduction (anteroposterior axis), internal/external rotation (longitudinal axis), and flexion/extension (transverse axis). The absolute abduction of the humerus in our patients did not differ from controls, nor did the abduction in the glenohumeral joint. During abduction, the humeral centre displaced medially, proximally, and anteriorly. In the patient group, slightly more (1-1.5 mm) proximal translation was observed. Presence of impingement syndrome was associated with increased proximal translation of the humeral head center, which occurred in the early phase of the arc of motion. LEVEL OF EVIDENCE: Diagnostic Level I. See Guidelines for Authors for a complete description of Levels of Evidence.
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