Brage Karen, Juul-Kristensen Birgit, Hjarbaek John, Boyle Eleanor, Kjaer Per, Ingwersen Kim Gordon
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Health Sciences Research Centre, UCL University College, Odense, Denmark.
Orthop J Sports Med. 2020 Dec 16;8(12):2325967120965185. doi: 10.1177/2325967120965185. eCollection 2020 Dec.
Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing.
To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy.
Controlled laboratory study.
A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of "standard care" exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale).
No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping.
Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases.
In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy.
NCT03425357 (ClinicalTrials.gov identifier).
肩部疼痛很常见，终生患病率高达67%。关于肩部影像学检查结果与疼痛之间的证据存在矛盾。超声弹性成像可用于评估组织硬度，可能是一种用于诊断和监测肌腱愈合的临床相关技术。
使用应变弹性成像（SEL）评估冈上肌腱病患者单侧肩部锻炼12周后冈上肌腱硬度的变化，以及与患者报告结局、冈上肌腱厚度和肌腱病分级变化之间的关联。
对照实验室研究。
23例单侧临床冈上肌腱病患者进行了12周的“标准护理”锻炼。在基线和随访时，使用SEL双侧测量冈上肌腱硬度，并与磁共振成像扫描的肌腱病分级以及使用传统超声测量的肌腱厚度进行比较。患者报告的结局指标包括手臂、肩部和手部功能障碍问卷中的身体功能和症状以及疼痛评分（视觉模拟量表）。
组内或组间（无症状与有症状肌腱）的SEL均无显著变化。所有患者报告的结局从基线到随访均有显著改善，但肌腱病分级和肌腱厚度无变化。除睡眠不适外，在SEL和患者报告结局中，超过最小可检测变化的患者比例无显著差异。
尽管组内或组间的SEL无显著变化，但患者报告的结局有显著改善。在SEL中超过最小可检测变化的患者与患者报告结局测量之间存在可接受的一致性。进一步的研究应探讨在不同肌腱病阶段的亚组中，使用SEL检测肌腱修复和长期训练后的变化。
短期内，使用SEL无法观察到冈上肌腱的结构变化，这表明为了观察结构变化需要更长的时间跨度，在恢复运动之前应予以考虑。基于肌腱病阶段进行亚组划分对于评估冈上肌腱病患者随时间推移的SEL变化也可能很重要。
NCT03425357（ClinicalTrials.gov标识符）
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