Figure 1 - uploaded by Gulcan Harput
Content may be subject to copyright.
Measurement of the acromiohumeral distance using ultrasound. A, Positioning of the ultrasound transducer. B, Measurement of the acromiohumeral distance. The line illustrates the shortest distance between the acromion and humeral head.
Source publication
Context:
Performing shoulder-abduction exercises with scapular retraction has been theorized to reduce the potential for shoulder impingement. However, objective data to support this premise are lacking.
Objective:
To evaluate the influence of active scapular retraction on acromiohumeral distance (AHD) at 4 shoulder-abduction angles using real-t...
Contexts in source publication
Context 1
... ultrasonography (US) images of the subacro- mial space were obtained using an Applio 500 system (Toshiba, Otawara, Japan) with an 8-to 12-MHz linear transducer. All US images were obtained by a single investigator (U.T.) with 10 years of experience in US imaging of the shoulder. The US images of the subacromial space were obtained from the dominant limb, which was defined as the limb used to throw a ball. We placed the US transducer on the lateral and most anterior aspects of the acromion in line with the longitudinal axis of the humerus to visualize the anterior aspect of the subacromial space. 22 Using the US system's on-screen calipers, we measured the AHD as the linear distance between the superior aspect of the humeral head and the inferior aspect of the acromion (in millimeters; Figure ...
Context 2
... placed the US transducer on the lateral and most anterior aspects of the acromion in line with the longitudinal axis of the humerus to visualize the anterior aspect of the subacromial space. 22 Using the US system's on-screen calipers, we measured the AHD as the linear distance between the superior aspect of the humeral head and the inferior aspect of the acromion (in millimeters; Figure 1). ...
Context 3
... ultrasonography (US) images of the subacro- mial space were obtained using an Applio 500 system (Toshiba, Otawara, Japan) with an 8-to 12-MHz linear transducer. All US images were obtained by a single investigator (U.T.) with 10 years of experience in US imaging of the shoulder. The US images of the subacromial space were obtained from the dominant limb, which was defined as the limb used to throw a ball. We placed the US transducer on the lateral and most anterior aspects of the acromion in line with the longitudinal axis of the humerus to visualize the anterior aspect of the subacromial space. 22 Using the US system's on-screen calipers, we measured the AHD as the linear distance between the superior aspect of the humeral head and the inferior aspect of the acromion (in millimeters; Figure ...
Similar publications
Objectives
To use the extended theory of planned behaviour (TPB) to predict smoking cessation counsellors’ intentions to offer smoking cessation support.
Design
Cross-sectional study
Setting
Taiwanese military
Participants
A survey of 432 smoking cessation counsellors was conducted in 2017.
Primary and secondary outcome measures
All participant...
Citations
... The subacromial space is defined as the space between the upper side of the humerus head and the lower side of the acromion. 5 The width of this space usually varies from 10mm to 15mm under stable conditions and is reduced by 5mm to 6mm when the shoulder is stretched passively at 90°. If the subacromial space is less than 7mm, the supraspinatus tendon and subacromial bursa could impinge. ...
... In previous studies, to increase the subacromial space, this space was measured via ultrasonography while maintaining shoulder abduction at various angles (0°, 45°, 60°, and 90°) and scapular retraction with a moderate intensity of thera-band; however, there were no significant effects. 5 There are only a few previous studies in which the subacromial and costoclavicular spaces were measured simultaneously. Whereas many others compared the subacromial space according to the angle of shoulder abduction there are relatively few studies performed according to the resistance intensity. ...
... Since scapular retraction is mainly composed of a scapular posterior tilt and a scapular external rotation, scapular retraction increases the subacromial space5 and contracts the trapezius and rhomboids.4,26 Ryan et al.27 stated that strengthening exercises for scapular external rotators are routinely used in shoulder disease prevention and as rehabilitation exercises. ...
... Previous studies have demonstrated the initial effect of exercises on AHD. 17,19,35,42 According to their findings, SRE at different shoulder abduction positions, isometric pulldown exercise, and GRE increased AHD. 17,19,35,42 To add to previous findings, our main contribution is that applying those exercises over the long term could increase the AHD in patients with SPS. ...
... 17,19,35,42 According to their findings, SRE at different shoulder abduction positions, isometric pulldown exercise, and GRE increased AHD. 17,19,35,42 To add to previous findings, our main contribution is that applying those exercises over the long term could increase the AHD in patients with SPS. Since the GRE was the only difference between groups in exercise selection, the additional effect of these exercises may have improved AHD values in our study. ...
Background:
Although exercise interventions are recommended in the management of subacromial pain syndrome (SPS), there is a lack of data regarding the exercises focusing on the principal biomechanical deficiencies that cause symptoms.
Hypothesis:
Utilizing progressive scapula retraction exercises (SRE) and glenohumeral rotation exercises (GRE) in the scapula stabilization program may lead to more reduction in symptoms and greater acromiohumeral distance (AHD) values.
Study design:
A double-blind, randomized controlled trial.
Level of evidence:
Level 2.
Methods:
A total of 33 patients were assigned randomly to either SRE or SRE+GRE. Both groups received a 12-week supervised rehabilitation program, including manual therapy and exercises (stretching and progressive scapula stabilization exercises). In addition, the SRE+GRE group performed GRE exercises at gradual elevation angles. From 12 to 24 weeks, patients performed exercise programs less frequently (3 times per week). Disability (shoulder pain and disability index [SPADI]), AHD (at 5 active abduction angles), pain intensity (visual analogue scale [VAS]), and patient satisfaction were recorded at baseline, 12 weeks, and 24 weeks. A total of 16 healthy individuals were recruited as a control group to compare AHD values. Data were analyzed using mixed model analyses of variance.
Results:
A statistically significant group-by-time interaction was found for AHD values (F4,92 = 6.38; P = 0.001), a significant group-by-time interaction for SPADI-disability (F1,33 = 5.148; P = 0.01), SPADI-total (F1,32 = 4.172; P = 0.03), and for pain during activity (F2,62 = 3.204; P = 0.05). However, no significant group-by-time interaction for SPADI-pain (F1,33 = 0.533; P = 0.48), for pain at rest (F1,31 < 0.001; P = 0.99), and at night (F1,32 = 2.166; P = 0.15). Yet, a significant time effect was observed.
Conclusion:
Progressive SRE and GRE in the scapula stabilization program lessens symptoms and improves AHD values in patients with SPS. Moreover, this program could preserve outcomes and further increase AHD when applied less frequently.
Clinical relevance:
Utilizing SRE and GRE in the scapula stabilization program at gradual shoulder abduction angles provides better rehabilitation outcomes.
... Additionally,18 patients were excluded because they were younger than 20 years of age [33]. In addition, previous studies indicated that the distance between the scapula and humeral head would change based on the abduction angle of the upper limb [28,34]. Therefore, 150 patients with upper limb abduction angle (the angle between L1 and L2) and humeral rotation angle (the angle between L4 and L5) greater than or equal to 10 • were excluded. ...
... Additionally,18 patients were excluded because they were younger than 20 years of age [33]. In addition, previous studies indicated that the distance between the scapula and humeral head would change based on the abduction angle of the upper limb [28,34]. Therefore, 150 patients with upper limb abduction angle (the angle between L1 and L2) and humeral rotation angle (the angle between L4 and L5) greater than or equal to 10° were excluded. ...
... Compared results make us realize that different upper limb placements have an important role in influencing the length of the scapula-humeral head distance. This is in agreement with the findings reported by Evan et al. [28] and Harput et al. [34]. From a clinical aspect, variations in the subacromial and subcoracoid space can have an impact on the impingement of the rotator cuff tendons and bursa, which were first described by Neer [3] and Gerber [4]. ...
Accurate measurement of the minimum distance between bony structures of the humeral head and the acromion or coracoid helps advance a better understanding of the shoulder anatomical features. Our goal was to precisely determine the minimum acromiohumeral distance (AHD), coracohumeral distance (CHD), and glenohumeral distance (GHD) in a sample of the Chinese population as an in vivo anatomical analysis. We retrospectively included 146 patients who underwent supine computed tomography (CT) examination of the shoulder joint. The minimum AHD, CHD, and GHD values were quantitatively measured using three-dimensional (3D) CT reconstruction techniques. The correlation between minimum AHD, CHD, and GHD value and age with different sexes was evaluated using Pearson Correlation Coefficient. The mean value of minimum AHD in males was greater than that in females (male 7.62 ± 0.98 mm versus female 7.27 ± 0.86 mm, p = 0.046). The CHD among different sexes differed significantly (male 10.75 ± 2.40 mm versus female 8.76 ± 1.38 mm, p < 0.001). However, we found no statistical differences in GHD with different sexes (male 2.00 ± 0.31 mm versus female 1.96 ± 0.36 mm, p > 0.05). In terms of age correlation, a negative curve correlation existed between age and AHD among the different sexes (male R2 = 0.124, p = 0.030, female R2 = 0.112, p = 0.005). A negative linear correlation was found in CHD among the different sexes (male R2 = 0.164, p < 0.001, female R2 = 0.122, p = 0.005). There were no differences between age and minimum GHD in both sexes. The 3D CT reconstruction model can accurately measure the minimum AHD, CHD, and GHD value in vivo and is worthy of further investigation for standard clinical anatomical assessment. Aging may correlate with AHD and CHD narrowing for both sexes.
... 30,32 The general pattern of movements in scapula retraction exercise is external rotation and posterior tilt, both of which increase the subacromial space and are generally applied in patients with impingement syndrome. 18,33,34 The seated cable row exercise (SCRE) is most frequently prescribed by specialists for simultaneous improvement in conditioning and fixation of imbalance based on increased shoulder muscle strength through scapula stabilization. However, the SCRE is a basic multi-joint upper body exercise for improving the angles of the posterior shoulder, back, and elbow extensor muscles and can be performed by athletes and non-athletes. ...
... Recent studies have documented that scapula retraction and scapular-adduction exercises increase the AHD, while shoulder abduction decreases the AHD (Bdaiwi et al., 2015;Guney-Deniz et al., 2019;Harput et al., 2018;White et al., 2012). Along with the scapular muscles, it has also been reported that a stronger rotator cuff could be related to wider AHD when considering the force-coupling functioning of those muscles (Dyrna et al., 2018). ...
... Therefore, our findings are not generalized to patients with rotator cuff pathology. In addition, as the scapular positioning influences the subacromial space, we did not include the individuals with scapular dyskinesis that may affect the AHD negatively (Guney-Deniz et al., 2019;Harput et al., 2018;Leong et al., 2016). Second, we measured the AHD at the end of the shoulder ER and IR ROM. ...
To determine whether shoulder external (ER) and internal rotational (IR) exercises at five different shoulder abduction angles affect the acromiohumeral distance (AHD). Twenty recreational overhead ath- letes were included. AHD was measured using real-time ultrasound for each of the five shoulder conditions as follows: neutral shoulder rotation (active-hold) and during ER and IR exercises (isometric and concentric) at five different shoulder-abduction angles (0°, 30°, 45°, 60°, and 90° of abduction). A two-way ANOVA was used to analyze AHD values. Shoulder abduction angle × exercise interaction for AHD was found (F16,304 = 10.92; p < .001; η2 = 0.37). For both isometric and concentric conditions, AHD increased during IR exer- cises (p < .05) yet decreased during ER exercises (p < .05) when compared with each active-hold positions. Shoulder ER and IR exercises influence the AHD in recreational overhead athletes. A larger AHD was observed during shoulder IR exercises, whereas ER exercises failed to maintain the AHD.
Keywords
Shoulder; acromiohumeral distance; real-time ultrasound; rotator cuff; exercise
... Ölçümler sırasında farklı kol pozisyonlarının ve üst gövde postürlerinin tercih edilmesi elde edilen sonuçları değiştirebilir. 17,26,[30][31][32][33] Çünkü omuz çevresinde yer alan yumuşak dokuların boyları ve AHM ölçümleri yerçekimine, kol pozisyonlarına ve üst gövde postürüne bağlı değişebilmektedir. 17,26,[30][31][32][33][34] Örneğin; PM kası kol gövde yanından tam elevasyona getirildiğinde kendi boyunun ortalama %67'si kadar uzayabilmektedir. ...
... 17,26,[30][31][32][33] Çünkü omuz çevresinde yer alan yumuşak dokuların boyları ve AHM ölçümleri yerçekimine, kol pozisyonlarına ve üst gövde postürüne bağlı değişebilmektedir. 17,26,[30][31][32][33][34] Örneğin; PM kası kol gövde yanından tam elevasyona getirildiğinde kendi boyunun ortalama %67'si kadar uzayabilmektedir. 33 Anatomik lokalizasyonu nedeniyle PM kasının boyundaki değişimler subakromiyal aralığı etkileyebilmektedir. ...
Amaç: Bu çalışmanın amacı, subakromiyal ağrı sendromlu hastalardaki omuz çevresi yumuşak doku esneklik kaybının araştırılması ve akromiyohumeral mesafe (AHM) arasındaki ilişkinin ortaya koyulması idi.Yöntem: Bu araştırmaya subakromiyal ağrı sendromu tanısı konulan 22 hasta (12 kadın, 10 erkek, ortalama yaş: 31,2±8,6 yıl, ortalama VKİ: 22,8±2,8 kg/m2) dahil edildi. Hastaların eklem hareket açıklıkları standart gonyometre, skapular diskinezi “var/yok yöntemi”, posterior kapsül esnekliği “Horizontal Adduksiyon Testi” ve pectoralis minor esnekliği “Pectoralis Minor Uzunluk Testi” kullanılarak ölçüldü. AHM ölçümleri hastaların istirahat postürlerinde ultrasonografi kullanılarak yapıldı. İstatistiksel analizde, etkilenen ve sağlam omuz arasındaki yumuşak doku esneklik farkı “bağımlı gruplarda t-testi”, yumuşak doku esneklikleri ile AHM arasındaki ilişki Pearson Korelasyon Katsayısı kullanılarak analiz edildi.Bulgular: Hastaların sağlam omuzları ile kıyaslandığında etkilenen omuzlarında posterior kapsül esnekliği (p=0,008) ve pectoralis minor esnekliği (p<0,001) arasında fark vardı. Ancak hastaların omuz çevresi yumuşak doku esneklikleri ile AHM arasında bir ilişki gözlenmedi (p>0,05).Sonuç: Genel olarak bakıldığında subakromiyal ağrı sendromlu hastaların etkilenen omuzlarının yumuşak doku esnekliklerinin sağlam tarafa göre azaldığı bulundu. Ancak hem etkilenen hem sağlam taraf pectoralis minor ve posterior kapsül esnekliklerinin istirahat AHM ölçümleri ile ilişkili olmadığı sonucuna varıldı. Bu sonuçlara göre omuz çevresi yumuşak doku esneklik kaybı istirahat AHM değişimleri üzerinde önemli bir rolü olmadığı, subakromiyal sıkışmaya neden olabilecek diğer faktörlerin göz önünde bulundurulması gerektiği düşüncesindeyiz.
... The qualitative assessment included characteristics based on detailed methodology (Table 2 [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Extracted data were dissected in a standardised data-extraction sheet. ...
... Ninety percent of the studies fared well in terms of reporting complete outcome data, i.e., minimal attrition bias followed by 'low risk' in selective reporting (80%). [28] Acr Rotator cuff muscles 5-12 L -Cha (2016) [29] Max IO, EO, Rf, Mf ---Dabholkar (2016) [30] Acr Supraspinatus, AHD, SST 7 L -Grooms (2013) [31] Max TrA, IO, EO 8 L -Harput (2018) [32] Acr AHD 8-12 L B Lariviere (2019) [33] Max TrA, IO, EO 5-2 CL -Lee (2016) [34] Max TrA, IO, EO 5-10 L B Nuzzo (2014) [35] Max TrA, IO, EO, Mf 5 CL -Pamboris (2018) [36] Gastrocnemius Gastrocnemius 4-15 L B Park (2013) [37] Max TrA, IO, EO 7.5 L -Pulkovski (2012) [38] Max TrA, IO, EO 2-5 L M Shivani CS (2016) [39] -TrA, IO, EO ---Sutherlin (2018) [40] Mcv, interspinous process TrA, Mf 8 L -Tahan (2016) [41] Mcv TrA, IO, EO 7.5 L B Yang (2018) [42] Acr GHS, AGT, ALT, AHD, SST, DMT 6-10 L - ...
... RCTs described the methods in terms of midaxillary versus midclavicular probe position. This could easily serve as a standardised point as the midaxillary point in line with the umbilicus just above the iliac crest produces [28] S -N N Th Cha (2016) [29] Hk -Y EMG Th Dabholkar (2016) [30] S -N N Th Grooms (2013) [31] Hk -N EMG Th, ratios Harput (2018) [32] S -N N Th, ratios Lariviere (2019) [33] Hk 8 weeks N N Th, ratios Lee (2016) [34] Hk -Y PBU Th Nuzzo (2014) [35] Hk, Pr -N N Th Pamboris (2018) [36] St -N N Th Park (2013) [37] Hk -N N Th, ratios Pulkovski (2012) [38] Hk -N N Th, ratios Shivani CS (2016) [39] Hk 6 weeks N N Th Sutherlin (2018) [40] Hk, Pr, S, St -N N Th Tahan (2016) [41] Hk -N N Th Yang (2018) [42] S -N N Th a consistent image with the thoracolumbar fascia on the top left of the image. Selection bias was observed in 35% studies, highlighting the lacuna in random sequencing, which was not described in sufficient detail. ...
Optimising ultrasonography imaging (UI) applications for clients is a highly specific and sensitive add-on method. The aim of this meta-analysis was to systematically evaluate the clinical utilisation of UI in musculoskeletal conditions by rehabilitation providers in the past decade. Two reviewers independently assessed relevant research articles from five databases electronically (Medline, Cochrane Library, EMBASE, ProQuest, EBSCO) and screened titles and abstracts based on predefined eligibility criteria (2010- 2020). A total of 147 articles were screened for eligibility by two reviewers independently, and any disagreements were resolved by another reviewer using Rayyan QCRI software. Ninety-seven duplicates were removed, and after excluding 21 studies, 16 randomized controlled trials were included and full texts retrieved. Data were synthesised using Revman 5.4 software for qualitative analysis and risk-of-bias assessment. Four similar studies were statistically analysed for heterogeneity of abdominal muscle contraction ratios. Two interventional studies were also analysed to assess the effect of feedback. The diagnostic application of UI was investigated using a consistent amount of literature, though from a rehabilitation perspective the literature is inconclusive. The clinical utility of UI in rehabilitation by physical therapists is conclusive and has potential to advance clinical practice. Further well-designed randomized controlled trials minimising selection biases will help improve the quality in this domain. Critical reflection, clinical reasoning, and mutual goal setting will help practising physical therapists to scrutinize the clinical practice more objectively.
... Specifically, protracting the shoulder with the arm at the side resulted in an average reduction in acromiohumeral distance of 26% in asymptomatic participants. However, the results of a more recent ultrasound study by Harput et al. 36 challenge these findings. Although significant changes in acromiohumeral distance were found (0.7 mm), the authors concluded that active scapular retraction had minimal to no meaningful influence on acromiohumeral distance during shoulder abduction in young asymptomatic individuals. ...
Background:
Alterations in glenohumeral and scapulothoracic kinematics have been theorized to contribute to rotator cuff pathology by impacting the magnitude of the subacromial space.
Objective:
The purpose of this review is to summarize what is currently known about the relationship between shoulder kinematics and subacromial proximities.
Conclusions:
A variety of methods have been used to quantify subacromial proximities including photographs, MR imaging, ultrasonography, and single- and bi-plane radiographs. Changes in glenohumeral and scapulothoracic kinematics are associated with changes in subacromial proximities. However, the magnitude and direction of a particular motion's impact on subacromial proximities often vary between studies, which likely reflects different methodologies and subject populations. Glenohumeral elevation angle has been consistently found to impact subacromial proximities. Plane of humeral elevation also impacts subacromial proximities but to a lesser degree than the elevation angle. The impact of decreased scapulothoracic upward rotation on subacromial proximities is not absolute, but instead depends on the angle of humerothoracic elevation. The effects of scapular dyskinesis and humeral and scapular axial rotations on subacromial proximities are less clear. Future research is needed to further investigate the relationship between kinematics and subacromial proximities using more homogenous groups, determine the extent to which compression and other factors contribute to rotator cuff pathology, and develop accurate and reliable clinical measures of shoulder motion.
... Scapular retraction exercises are widely used among clinicians aiming to improve the scapular kinematics by restoring the activity of the scapular muscles (Castelein et al., 2016b;Cools et al., 2007b;Oyama et al., 2010). The general movement pattern of the scapula during scapular retraction exercises is external rotation and posterior tilt (Oyama et al., 2010), which is thought to enhance the subacromial space (Graichen et al., 2005;Harput et al., 2018;Oyama et al., 2010;Solem-Bertoft et al., 1993;Tate et al., 2008). Therefore, scapular retraction exercises are generally suggested for the patients with SAIS (Chester et al., 2010;Kibler et al., 2013;Oyama et al., 2010). ...
... However, the same movement can be done in different scapular positions. For instance, GH abduction can be performed holding the scapula in a retracted position as well as in a protracted position (Guney-Deniz, Harput, Toprak, & Duzgun, 2018;Harput et al., 2018;Lee, Moon, & Lee, 2016;Malmström, Olsson, Baldetorp, & Fransson, 2015). Moreover, the elevation of the humerus can be preceded by a scapular elevation induced by the activation of the UT. ...
... However, information about the pattern of activation of the shoulder girdle muscles in healthy conditions is more limited. In particular, to our knowledge, only few studies had been conducted in healthy subjects to assess the activation strategies of the shoulder girdle muscles during GH movements in different scapular positions Harput et al., 2018;Lee et al., 2016;Malmström et al., 2015;Picco, Fischer, & Dickerson, 2010). Moreover, no study had analyzed the same movements together with voluntary scapular elevation. ...
According to scapulohumeral rhythm, shoulder abduction is followed through scapular upward rotation to ensure joint mobility and stability. Of interest, the shoulder abduction can be performed holding the scapula in different positions and in association with scapular elevation, with possible effects on shoulder muscle activity. Therefore, the aim of the study was to analyze the activity of relevant shoulder muscles and the activity ratios between the scapulothoracic muscles, during shoulder abduction performed in different combinations of scapular position (neutral, retracted, protracted) and scapular elevation.
The electromyographic activity of middle deltoid, serratus anterior, upper, middle and lower fibers of trapezius was recorded during shoulder abduction movements executed holding the scapula in neutral, retracted and protracted position, and subsequently a shoulder elevation movement. The activation of each muscle and the scapulothoracic muscles activity ratios were determined every 15 degrees, from 15° to 120° of abduction.
Scapular retraction led to higher activation of the entire trapezius muscle, whereas protraction induced higher upper trapezius, middle deltoid and serratus anterior activity, along with lower activity of middle and lower trapezius. Shoulder elevation led to higher activity of the upper trapezius and middle deltoid. Moreover, it induced lower activation of the serratus anterior and middle and lower trapezius, thus leading to high ratios between the upper trapezius and the other scapulothoracic muscles, especially between 15 and 75 degrees of abduction.
This study highlights that shoulder abduction performed with scapular protraction and in combination with scapular elevation leads to increased activity of the middle deltoid and upper trapezius, resulting in imbalances between the scapulothoracic muscles that could hamper the optimal scapulohumeral rhythm. The abduction performed in the aforementioned scapular conditions also induce potential reciprocal inhibition effects between the movers and stabilizers muscles of scapula, suggesting different motor control strategies of integrating a common shoulder movement with various modification of the scapular position.
