Kolk Arjen, Henseler Jan Ferdinand, de Witte Pieter Bas, van Arkel Ewoud R A, Visser Cornelis P J, Nagels Jochem, Nelissen Rob G H H, de Groot Jurriaan H
Department of Orthopaedics, Leiden University Medical Center, Postzone J11R, PO Box 9600, 2300RC Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Postzone J11R, PO Box 9600, 2300RC Leiden, the Netherlands.
Department of Orthopaedics, Leiden University Medical Center, Postzone J11R, PO Box 9600, 2300RC Leiden, the Netherlands; Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Postzone J11R, PO Box 9600, 2300RC Leiden, the Netherlands.
Man Ther. 2016 Dec;26:31-37. doi: 10.1016/j.math.2016.07.002. Epub 2016 Jul 17.
Subacromial pain syndrome (SAPS) and scapular dyskinesis are closely associated, but the role of pain is unknown. We hypothesized that pain results in asymmetrical scapular kinematics, and we expected more symmetrical kinematics after infiltration of subacromial anaesthetics.
To investigate the effect of subacromial anaesthetics on scapular kinematics in patients with SAPS.
Observational cohort study.
We evaluated shoulder kinematics in 34 patients clinically and radiologically (magnetic resonance arthrography) identified with unilateral SAPS using three-dimensional electromagnetic motion analysis (Flock of Birds). Scapular internal rotation, upward rotation and posterior tilt of the affected shoulder were compared with the kinematics of the unaffected shoulder and following subacromial anaesthetics. Additionally, the association of pain (Visual Analogue Scale, VAS) and scapular rotation was analysed.
Compared with the contralateral healthy shoulder, 5° more (95% CI 0.4-9.7, p = 0.034) scapular internal rotation was observed in the affected shoulder at 110-120° of abduction. Following subacromial anaesthetics in the affected shoulder, internal rotation increased (2°, 95% CI 0.5-3.9, p = 0.045) and posterior tilt decreased (3°, 95% CI 1.5-5.0, p = 0.001) at 110-120° of abduction. Less scapular upward rotation was significantly associated with higher pain scores before infiltration (R = 0.45, p = 0.013).
More scapular internal rotation was observed in affected shoulders of patients with SAPS compared with unaffected shoulders. Subacromial infiltration did not restore kinematics toward symmetrical scapular motion. These findings suggest that subacromial anaesthesia is not an effective means to instantly restore symmetry of shoulder motion.
肩峰下疼痛综合征（SAPS）与肩胛运动障碍密切相关，但疼痛的作用尚不清楚。我们假设疼痛会导致肩胛运动不对称，并且预期在肩峰下注射麻醉剂后运动更加对称。
研究肩峰下麻醉剂对SAPS患者肩胛运动的影响。
观察性队列研究。
我们使用三维电磁运动分析（飞鸟系统）对34例经临床和影像学（磁共振关节造影）确诊为单侧SAPS的患者的肩部运动进行了评估。将患侧肩部的肩胛内旋、上旋和后倾与未受影响肩部以及肩峰下注射麻醉剂后的运动情况进行比较。此外，还分析了疼痛（视觉模拟评分法，VAS）与肩胛旋转之间的关联。
与对侧健康肩部相比，患侧肩部在110 - 120°外展时肩胛内旋多5°（95%可信区间0.4 - 9.7，p = 0.034）。患侧肩部注射肩峰下麻醉剂后，在110 - 120°外展时内旋增加（2°，95%可信区间0.5 - 3.9，p = 0.045），后倾减少（3°，95%可信区间1.5 - 5.0，p = 0.001）。注射前肩胛上旋较少与较高的疼痛评分显著相关（R = 0.45，p = 0.013）。
与未受影响的肩部相比，SAPS患者患侧肩部观察到更多的肩胛内旋。肩峰下注射并未使运动恢复到肩胛运动对称的状态。这些发现表明肩峰下麻醉不是立即恢复肩部运动对称性的有效方法。
