Contribution of clinical tests to the diagnosis of rotator cuff disease: A systematic literature review (original) (raw)
Related papers
2020
Background Underlying muscle weakness may explain the inconsistency in the development of rotator cuff tendinopathy in population with similar activity levels. This systematic review aims to assess existing prospective studies to evaluate whether muscle weakness is a risk factor to the development of rotator cuff tendinopathy. Methods A systematic search was performed using the PRISMA guidelines. Prospective studies measuring muscle strength or stiffness and the incidence of rotator cuff tendinopathy will be included. Quality assessment was performed with the Newcastle-Ottawa Quality Assessment Scale. Results The search yielded 6 studies, with a total of 523 trained overhead athletes followed up for 1 season. External and internal rotation strength was described as protective factors for the development of rotator cuff tendinopathy, with an odds ratio of 0.940 (p < 0.05) and 0.946 (p < 0.01) respectively for each N/m increased in force generated. Limited range of motion of <106 o for shoulder external rotation was also described as a risk factor with an odds ratio of 1.12 (p < 0.001). Imbalance between external and internal rotation strength was reported as a risk factor for shoulder injuries in 2 studies, with a relative risk of 2.57 (p < 0.05) reported in 1 of them. Supraspinatus weakness was also reported as a risk factor for shoulder injuries in 1 study, with no odds ratio or relative risk provided. Due to insu cient data, combination into a meta-analysis was not possible. Conclusions Limited evidence support that weakness of the external rotators, weakness in the internal rotators, and limited range of motion in external rotation are risk factors to the development of rotator cuff tendinopathy. Very limited evidence support that imbalance in external rotator and internal rotator strength, and supraspinatus weakness are risk factors for rotator cuff tendinopathies. Future cohort studies may improve on existing evidence with investigations on more muscle groups, a longer follow-up time, clearly documented injury history, and a stringent diagnosis to rotator cuff tendinopathy. Background Rotator cuff tendinopathy is an umbrella term describing pain and loss of function in the rotator cuff tendon. Entities including tendinosis, tendinitis, subacromial impingement, subacromial bursitis are often regarded under the term rotator cuff tendinopathy.(1) As reported in previous studies, rotator cuff tendinopathy affects more than 50% of the population over the age of 60, contributing to the loss of function and poor quality of life.(2) As a consequence, rotator cuff tendinopathy also leads to large socioeconomical impacts.(3) The pathogenesis of tendinopathy is believed to involve a failed healing process, of which etiology is multifactorial(4). Overload or overuse of the rotator cuff tendons was suggested to be one of the factors leading to the development of rotator cuff tendinopathy. To explain the association of tendinopathy with overuse, previous studies have demonstrated that tendon loading, in terms of compression or tensile loads, would induce apoptosis and in ammation to tendon cells.(5,6) An increased activity level would increase tendon loading. However, the fact that athletes with similar training load present inconsistently with tendinopathy suggest that some factors may play a role in the modulation of tendon loading under given training load. Muscle weakness may be a factor modulating tendon loading. It is a relative term referring to the failure to generate a desired or expected force.(7) The mechanism of how weakness in rotator cuff muscles may lead to rotator cuff tendinopathies has been hypothesized by multiple groups. As suggested by previous studies, rotator cuff muscles prevent humeral head elevation, which will decrease the size of subacromial space and increase the risk of supraspinatus impingement.(8),(9) The reduction of subacromial space in patients with rotator cuff tendinopathy was also demonstrated by a previous retrospective study.(10) Another study suggested that external rotation strength is crucial for the deceleration of arm swinging movements.(11) Its weakness in athletes with repetitive forceful arm swings is hypothesized lead to strains and tears to the tendon.(12) Muscle stiffness was also suggested to lead to weaken muscles via reciprocal inhibition from a tight antagonist(8). The stiffness of upper trapezius muscles was demonstrated in patients with rotator cuff tendinopathy in a previous retrospective study(13). There is a possibility that muscle stiffness of the shoulder may be one of the causes leading to muscle weakness and the development of rotator cuff tendinopathies. In summary, expert opinions have suggested that muscle weakness and stiffness may lead to an increased risk of the development of tendinopathies.(14,15) This suggestion has been supported by several authors reviewing retrospective and cadaveric studies.(10,16-19) However, as these parameters are readily in uenced by the presence of pain, the association between muscle imbalance and the development of tendinopathy is yet to be established. Purpose of this review This review aims to examine existing prospective studies on identifying the association between muscle weakness and rotator cuff tendinopathy. Muscle weakness would be identi ed by direct measurements of muscle strength, while associated factors like muscle stiffness may suggest a cause to the 20 De cit 21 Strength 22 Stiffness 23 Flexibility 24 Range of Motion 25 18 OR 19 OR 20 OR 21 OR 22 OR 23 OR 24 26 3 AND 17 AND 25 restricted to English language, full text, human studies Eligibility criteria Clinical studies were included if ALL the followings are met (i) prospective data containing the measurement of muscle strength or muscle stiffness were documented. (ii) Incidence of tendinopathy was documented. (iii) Patients were described to have rotator cuff tendinopathy / tendinosis / tendinitis / tear, or subacromial impingement / bursitis. A study was excluded if (i) patients were treated with any interventions, and (ii) the study was an animal study. Study selection and data collection Studies from the systematic search were merged in EndNote X9 (Thomson, New York), with duplicates removed. Application of exclusion and inclusion criteria was performed by screening the titles and abstracts, followed by retrieval of full texts of included studies. Two reviewers (CKK and MCK) independently screened all the titles and abstracts, and reviewed the identi ed studies for inclusion. Disagreements were resolved by consensus between 2 reviewers. A third reviewer (FSC) was available to resolve further disagreements. A PRISMA-owchart of the selection process is shown in Fig. 1.
The Journal of Bone and Joint Surgery (American), 2006
Background: Very little comparative information is available regarding the demographic and morphological characteristics of asymptomatic and symptomatic rotator cuff tears. This information is important to provide insight into the natural history of rotator cuff disease and to identify which factors may be important in the development of pain. The purpose of the present study was to compare the morphological characteristics and prevalences of asymptomatic and symptomatic rotator cuff disease in patients who presented with unilateral shoulder pain.
BMC Musculoskeletal Disorders, 2010
Background: Shoulder pain is common with rotator cuff disease as the most frequently used clinical diagnosis. There is a wide range of treatment options for this condition, but limited evidence to guide patients and clinicians in the choice of treatment strategy. The purpose of this study was to investigate possible prognostic factors of short-term outcome after corticosteroid injection for rotator cuff disease. Methods: We performed analyses of data from 104 patients who had participated in a randomized controlled study. Socio-demographic, clinical and radiographic baseline factors were assessed for association with outcome at six-weeks follow-up evaluated by Shoulder Pain and Disability Index (SPADI) and patient perceived outcome. Factors with significant univariate association were entered into multivariate linear and logistic regression analyses. Results: In the multivariate analyses; a high SPADI score indicating pain and disability at follow-up was associated with decreasing age, male gender, high baseline pain and disability, being on sick-leave, and using regular pain medication. A successful patient perceived outcome was associated with not being on sick-leave, high active abduction, local corticosteroid injection and previous cortisone injections. Structural findings of rotator cuff tendon pathology on MRI and bursal exudation or thickening on ultrasonography did not contribute to the predictive model. Conclusions: Baseline characteristics were associated with outcome after corticosteroid injection in rotator cuff disease. Sick-leave was the best predictor of poor short-term outcome. Trial registration: Clinical trials NCT00640575.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2013
The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff-and impingement-specific clinical tests. Updates in the understanding of acromion morphology, the insertional anatomy of the rotator cuff, and the role of suprascapular nerve release may require changes to current classification systems and surgical strategies. Although initial management focuses on nonoperative protocols, discussion continues on whether surgery for isolated impingement is clinically more beneficial than rehabilitation. However, clear indications have yet to be established for the use of single-versus double-row repair because evidence confirms neither is clinically efficacious than the other. Biceps tenodesis, however, in non-isolated cuff tears has proven more successful in addressing the etiology of shoulder pain and yields improved outcomes over tenotomy. Data reviewing the benefits of tendon transfers, shoulder prostheses, and mechanical scaffolds, as well as new research on the potential benefit of platelet-rich plasma, pluripotential stem cells, and gene therapies, will also be presented.
2020
A review was conducted to synthesize the available research literature on the pathogenesis of rotator cuff tendinopathy. Musculoskeletal disorders of the shoulder are extremely common. An understanding of the anatomy and biomechanics of the rotator cuff may provide some insight into the pathologic process involved in this tendinopathy. The patho etiology of rotator cuff failure is multifactorial and results from a combination of intrinsic, extrinsic and environmental factors. Profound changes within the subacromial bursa are strongly related to the pathology and resulting symptoms. A considerable body of research is necessary to more fully understand the etiology and pathogenic factors of rotator cuff tendinopathy Profound changes within the subacromial bursa are strongly related to the pathology and resulting symptoms. A considerable body of research is necessary to more fully understand the etiology and pathohistology of rotator cuff tendinopathy and its relationship with bursal pathology.
Journal of Clinical Ultrasound, 2015
Purpose. Rotator cuff (RC) tendinopathy has been widely ascribed to impingement of the supraspinatus tendon (SsT) in the subacromial space, measured as the acromiohumeral distance (AHD). Ultrasound (US) is suitable for measuring AHD and SsT thickness, but few reliability studies have been carried out in symptomatic populations, and interrater reliability is unconfirmed. This study aimed to examine the intrarater and interrater reliability of US measurements of AHD and SsT thickness in asymptomatic control subjects and patients with RC tendinopathy. Methods. Seventy participants were recruited and grouped as healthy controls (n 5 25) and RC tendinopathy (n 5 45). Repeated US measurements of AHD and SsT thickness were obtained by one rater in both groups and by two raters in the RC tendinopathy group. Results. Intrarater and interrater reliability coefficients were excellent for both measurements (intraclass correlation > 0.92), but the intrarater reliability was superior. The minimal detectable change values in the symptomatic group were 0.7 mm for AHD and 0.6 mm for SsT thickness for a single experienced examiner; the values rose to 1.2 mm and 1.3 mm, respectively, for the pair of examiners. Conclusions. The results support the reliability of US for the measurement of AHD and SsT thickness in patients with symptomatic RC tendinopathy and provide minimal detectable change values for use in future research studies. V
Journal of orthopaedic surgery and research, 2014
It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of rotator cuff tears. This study aimed to determine the diagnostic value of nine individual clinical tests for evaluating rotator cuff tear and to develop a prediction model for diagnosing rotator cuff tear. This prospective cohort study included 169 patients with shoulder complaints. Patients who reported a previous shoulder dislocation were excluded from the analysis (N = 69). One experienced clinician conducted 25 clinical tests of which 9 are specifically designed to diagnose rotator cuff pathology (empty can, Neer, Hawkins-Kenney, drop arm, lift-off test, painful arc, external rotation lag sign, drop sign, infraspinatus muscle strength test). The final diagnosis, based on magnetic resonance arthrography (MRA), was determined by consensus between the clinician and a radiologist, who were blinded to patient information. A prediction model was developed by logistic regress...
Lag signs in the diagnosis of rotator cuff rupture
Journal of Shoulder and Elbow Surgery, 1995
We assessed the relative value of lag signs for the evaluation of rotator cuff rupture in a prospective study of 100 consecutive painful shoulders with impingement syndrome, stages 1 to 3. Lag signs were compared with the Jobe and lift-off signs. Three tests were designed to assess the main components of the rotator cuff: the external rotation lag sign (ERLS) for the supraspinatus and the infraspinatus tendons, the drop sign for the infraspinatus, and the internal rotation lag sign flRLS) for the subscapularis tendon. For assessment of the supraspinatus and infraspinatus the ERLS was less sensitive but more specific than the Jobe sign. The drop sign was the least sensitive but was as specific as the ERLS. Partial ruptures of the supraspinatus remained concealed to the ERLS. For assessment of the subscapularis the IRLS was as specific but more sensitive than the lift-off sign. Partial ruptures of the subscapularis tendon could be missed by the lift-off sign but were detected by the IRLS. The magnitude of the lag correlated with the size of the rupture for both the ERLS and the IRLS. Clinical testing for lag signs was efficient, reproducible, and reliable. In patients with little or no restriction of motion it enhanced the accuracy of clinical diagnosis in rotator cuff lesions. (.I SHOULDER ELBOW SURG 1996;5:307-13.) The clinical diagnosis of rotator cuff rupture is based on the history and physical examination. Although large ruptures can be diagnosed with confidence, small lesions affecting a single tendon may remain concealed when standard physical signs are considered. At present the most useful test for rupture of the posterosuperior rotator cuff is considered to be the Jobe sign,'* which assesses the ability (i.e., strength) of the affected shoulder to maintain the arm in a position of 90 ~ elevation in internal rotation againt a force applied by the examiner. False-positive results may occur because From the