Rotator Cuff Tears: Clinical, Radiographic, and US Findings1
ABSTRACT Rotator cuff tears are a common cause of shoulder pain. Clinical and radiographic findings can suggest the presence of a rotator cuff tear. The most sensitive clinical findings are impingement and the "arc of pain" sign. Radiographic findings are usually normal in the acute setting, although the "active abduction" view may show decreased acromiohumeral distance. In more chronic cases, an outlet view may show decreased opacity and decreased size of the supraspinatus muscle due to atrophy. In late cases, the humeral head may become subluxated superiorly, and secondary degenerative arthritis of the glenohumeral joint may ensue. Ultrasonography (US), with over 90% sensitivity and specificity, can help confirm the diagnosis in clinically or radiographically equivocal cases. US can also reveal the presence of other abnormalities that may mimic rotator cuff tear at clinical examination, including tendinosis, calcific tendinitis, subacromial subdeltoid bursitis, greater tuberosity fracture, and adhesive capsulitis.
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- "All patients underwent shoulder sonography in a seated position in a wheelchair. Both shoulders were examined in all patients using the scanning techniques described above.3,11,12 In patients with limited motion in the hemiplegic shoulder joint, affected shoulder pain, or cognitive dysfunction, the shoulder girdle was examined placed in position similar to that used in the dynamic examination; however, passive movement was induced for these patients with the help of an assistant. "
ABSTRACT: To explore the relationship between a number of clinically relevant variables and sonographic imaging data in respect to the level of impairment experienced in the affected and unaffected shoulders of hemiplegic stroke patients. Fifty-one hemiplegic stroke patients (32 males, 19 females; 29 right-sided hemiplegics, 22 left-sided hemiplegics) participated in this study. A musculoskeletal radiologist conducted a sonographic exam on both the affected and unaffected shoulders of all patients and two physicians classified the severity of the injury on a six-point rating scale. Clinical variables including age, sex, duration of injury, spasticity and muscle power of the hemiplegic side, and level of functional activity of the shoulder were assessed. The sonographic rating scores of hemiplegic shoulders were positively correlated with age (p<0.01) and negatively correlated with level of muscle spasticity (p<0.05). The sonographic rating scores of unaffected shoulders were positively correlated with duration of injury (p<0.01). Affected shoulders received sonographic rating scores that reflected significantly more impairment than those of unaffected shoulders (p<0.001), and pre-morbid handedness did not affect the relationship between impairment rating and shoulder injury status. Hemiplegic stroke influences not only affected shoulders, but also unaffected sides. Proper management of spasticity, enhancement of motor recovery, and avoidance of unaffected shoulder overuse should be considered to prevent shoulder problems following strokes which result in hemiplegia.Annals of Rehabilitation Medicine 12/2012; 36(6):828-35. DOI:10.5535/arm.2012.36.6.828
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- "A variable alteration will be produced in the subacromial space as a result, with chronic compression of the cuff and of the underlying synovial structures (bursae). A series of inflammatory and degenerative events may be associated at this point.27 "
ABSTRACT: To study the shoulder of this group of patients using magnetic resonance imaging to detect clinical and subclinical disorders and establish a rehabilitation program. Nine patients with spinal cord injury followed in the Laboratory of Biomechanics and Rehabilitation of the Locomotive System at HC/UNICAMP were divided into two groups according to the presence of paraplegia and tetraplegia and were clinically assessed for correlation with the imaging exams. Normal results were found in 41% of the shoulders. Most common injuries were tendinopathy of the supraspinatus and acromioclavicular joint degeneration. Eighty percent of injured shoulders had combined lesions. A great variety of causes of shoulder pain was identified in paraplegic and tetraplegic subjects. Routine clinical assessment and imaging studies of the shoulder may contribute to the evolution of rehabilitation and reduction of pain and musculoskeletal disorders. Level of Evidence II, Development of Diagnostic Criteria on Consecutive Patients, With Universally Applied Reference "Gold" Standard.Acta Ortopédica Brasileira 03/2012; 20(5):291-6. DOI:10.1590/S1413-78522012000500009 · 0.19 Impact Factor
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- "A number of studies suggest that a diagnostic imaging test should be associated with the physical exploration [13,14]. US is a non-invasive method with a diagnostic precision  comparable to that of MRI for both, subacromial bursitis  and the different degrees of rotator cuff alteration [14,16]. Given the lack of clarity in clinical diagnosis, the existence of lesions in asymptomatic shoulders [17,18] and the scarce effectiveness of treatments [19,20], some authors consider that there may be another structure causing pain and dysfunction [21-23]. "
ABSTRACT: Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations, frequent difficulties in clinical diagnosis and lack of effectiveness in treatment. Based on clinical experience, we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction. The hypothesis of this study is to relate subacromial impingement syndrome (SIS) with myofascial pain syndrome (MPS), since myofascial trigger points (MTrPs) cause pain, functional limitation, lack of coordination and alterations in quality of movement, even prior to a tendinopathy. MTrPs can coexist with any degenerative subacromial condition. If they are not taken into consideration, they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective.The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and/or SIS. A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis, positive provocation test responses, the existence of active MTrPs and the results obtained with ultrasonography (US) and Magnetic Renonance Imaging (MRI). A randomized double blinded clinical trial will be carried out in experimental conditions: A Protocolized treatment based on active and passive joint repositioning, stabilization exercises, stretching of the periarticular shoulder muscles and postural reeducation. B. The previously described protocolized treatment, with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment. This study aims to provide a new vision of shoulder pain, from the perspective of MPS. This syndrome can, by itself, account for shoulder pain and dysfunction, although it can coexist with real conditions involving the tendons. ISRCTN Number: 30907460.BMC Musculoskeletal Disorders 08/2009; 10:92. DOI:10.1186/1471-2474-10-92 · 1.72 Impact Factor