Yano Yuichiro, Hamada Junichiro, Hagiwara Yoshihiro, Karasuno Hiroshi, Tamai Kazuya, Suzuki Kazuaki
Department of Orthopaedic Surgery, Tochigi Medical Center, Tochigi, Japan.
Department of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, Fukushima, Japan.
JSES Int. 2020 Apr 27;4(2):333-340. doi: 10.1016/j.jseint.2020.02.003. eCollection 2020 Jun.
The pathophysiology of atraumatic rotator cuff tears (ATTs) has not been fully understood. Adduction restriction of the glenohumeral joint can cause pain and disability in patients with ATTs. We aimed to use our adduction test (pushing the humerus toward the side in the coronal plane with scapular fixation) to fluoroscopically measure the glenohumeral adduction angle (GAA) and to assess the effectiveness of adduction manipulation.
Fifty-five patients with ATTs were included in the study. The GAAs of the patients vs. healthy subjects without ATTs were measured fluoroscopically and compared. During the test, patients showed restriction and expressed pain. The visual analog scale (VAS) score, passive range of motion (ROM), and the American Shoulder and Elbow Surgeons score at the initial visit were compared with those after adduction manipulation.
Of the patients, 41 (75%) had positive adduction test results. A higher percentage of positive adduction test results was observed in smaller tears. The average GAA was -21.4° on the affected side, which was smaller than that on the unaffected side, at -2.8° ( < .001), and that in healthy subjects, at 4.8° ( < .001). After manipulation, the GAA was -0.8° ( < .001) and the VAS score, the American Shoulder and Elbow Surgeons score, and all ROM values significantly improved up to the level on the unaffected side.
Adduction restriction of the glenohumeral joint was identified in 75% of all the patients with ATTs. Adduction manipulation significantly reduces the VAS score and restores the ROM. Adduction restriction is considered a crucial pathophysiology of ATTs.
非创伤性肩袖撕裂（ATTs）的病理生理学尚未完全明确。肩关节内收受限可导致ATTs患者出现疼痛和功能障碍。我们旨在使用内收试验（在固定肩胛骨的情况下，在冠状面将肱骨向身体一侧推）通过荧光透视测量肩关节内收角度（GAA），并评估内收手法的有效性。
本研究纳入了55例ATTs患者。通过荧光透视测量患者与无ATTs的健康受试者的GAA并进行比较。在测试过程中，患者表现出受限并诉说疼痛。将初次就诊时的视觉模拟量表（VAS）评分、被动活动范围（ROM）以及美国肩肘外科医师学会评分与内收手法治疗后的结果进行比较。
41例（75%）患者内收试验结果为阳性。在较小的撕裂中观察到更高比例的阳性内收试验结果。患侧平均GAA为-21.4°，小于未患侧的-2.8°（P<0.001），也小于健康受试者的4.8°（P<0.001）。手法治疗后，GAA为-0.8°（P<0.001），VAS评分、美国肩肘外科医师学会评分以及所有ROM值均显著改善，达到未患侧水平。
在所有ATTs患者中，75%存在肩关节内收受限。内收手法可显著降低VAS评分并恢复ROM。内收受限被认为是ATTs的关键病理生理学表现。
