Sports Orthopedic Research Center - Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager & Hvidovre, Denmark.
Department of Physiotherapy and Occupational Therapy, University College Copenhagen, Copenhagen, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2505-2511. doi: 10.1007/s00167-018-4894-6. Epub 2018 Mar 17.
Subacromial impingement syndrome (SIS) is associated with low self-reported shoulder function, impairments in shoulder strength and range of motion (ROM), and pain. It is not known how the symptomatology associated with SIS is reflected in the choice of treatment. This study compares self-reported shoulder function, shoulder strength, ROM, and pain in patients with SIS considered candidates and non-candidates for subacromial decompression (SAD).
Self-reported shoulder function (Q-DASH and SPADI), maximum isometric muscle strength in shoulder abduction (Abd-strength) and external rotation (ER-strength), active abduction ROM (Abd-ROM) and passive internal rotation ROM (IR-ROM) were measured in a consecutive cohort of patients with SIS referred to an orthopedic outpatient clinic. Additionally, pain during each test and pain levels during the last week were reported. Patients were categorized as candidates or non-candidates for SAD based on their consultation with an orthopedic specialist blinded to test results and self-reported shoulder function. All outcomes and age, gender, weight and duration of symptoms were compared using the unpaired t test or Mann-Whitney's U test as appropriate.
One-hundred and fifty-seven patients were included. 25 patients were candidates for SAD, while 132 were not. SAD candidates had significantly lower Abd-ROM (87° vs. 112°, p = 0.011, effect size = 0. 15) and IR-ROM (114° vs. 123°, p = 0.026, effect size = 0.58) additional to higher pain during test of Abd-strength (5.3 vs. 3.7, p = 0.02, effect size = 0.21). No other differences were found between the groups.
A decrease in abduction and internal rotation range of motion, and increased pain during maximal abduction strength effort are associated with being considered a candidate for subacromial decompression, while self-reported shoulder function, pain during the last week, and rotator cuff strength are not. As SAD candidates primarily differentiates from non-candidates by having more pronounced ROM deficits, it might be important to address ROM in pre- and postsurgical evaluations, but as the overall differences between the two groups seem minor, the relation between impairments and the choice of treatment needs further clarification.
IV.
肩峰下撞击综合征（SIS）与自我报告的肩部功能降低、肩部力量和活动范围（ROM）受损以及疼痛有关。目前尚不清楚与 SIS 相关的症状如何反映在治疗选择中。本研究比较了 SIS 患者中被认为是和不是肩峰下减压（SAD）候选者的自我报告的肩部功能、肩部力量、ROM 和疼痛。
对连续就诊于骨科门诊的 SIS 患者进行自我报告的肩部功能（Q-DASH 和 SPADI）、肩部外展（Abd-strength）和外旋（ER-strength）的最大等长肌肉力量、主动外展 ROM（Abd-ROM）和被动内旋 ROM（IR-ROM）的测量。此外，还报告了每项测试时的疼痛和过去一周的疼痛水平。根据与一位对测试结果和自我报告的肩部功能不知情的骨科专家的咨询，将患者分为 SAD 的候选者和非候选者。使用独立样本 t 检验或 Mann-Whitney U 检验比较所有结果以及年龄、性别、体重和症状持续时间。
共纳入 157 例患者。25 例患者为 SAD 候选者，132 例患者不是。SAD 候选者的 Abd-ROM（87°比 112°，p=0.011，效应量=0.15）和 IR-ROM（114°比 123°，p=0.026，效应量=0.58）明显更低，Abd-strength 测试时的疼痛更高（5.3 比 3.7，p=0.02，效应量=0.21）。两组之间没有其他差异。
在考虑接受肩峰下减压术时，外展和内旋范围的减小以及最大外展力量测试时的疼痛增加与被认为是候选者有关，而自我报告的肩部功能、过去一周的疼痛以及肩袖力量则没有。由于 SAD 候选者主要通过更明显的 ROM 缺陷与非候选者区分开来，因此在术前和术后评估中解决 ROM 可能很重要，但由于两组之间的总体差异较小，因此损伤与治疗选择之间的关系需要进一步澄清。
IV。
