Singh Sardar Jaideep, Aiyanna N C Karthik, Prakash K Mithun, Subramanian Jeash Narayan Kanthalu, Sreedhar Sreehari, Subramanian Kanthalu Narayanan
Department of Arthroscopy and Shoulder Surgery, Vale Hospital, Madurai, Tamil Nadu, India.
Department of Orthopaedics, Apollo Hospitals, Madurai, Tamil Nadu, India.
J Orthop Case Rep. 2025 Aug;15(8):340-344. doi: 10.13107/jocr.2025.v15.i08.5988.
A rounded shoulder with anterior tilting of the scapula is the common reason for shoulder impingement syndrome. The mainstay of treatment will be shoulder rehabilitation. While the anterior tilting of the scapula is a part of posture, the critical shoulder angle (CSA) is another anatomical factor that may influence the outcome of patients with shoulder impingement syndrome.
The study aims to identify the role of CSA defining the outcome in patients with CSA > 40° and those <40° angles undergoing the Madurai shoulder pain cure program (MSPCP), a standardized rehabilitation program.
The study was conducted as a prospective analysis with 40 participants suffering from shoulder impingement syndrome. CSA was measured on each patient, and they were divided into two groups: Group A-CSA < 40, and Group B-CSA > 40, after which they were subjected to the standardized MSPCP. The MSPCP is a rehabilitation regimen done for 3 months. This is done in phases: Phase 1 from 0 to 2 weeks, phase 2 from 2 to 6 weeks, and phase 3 from 6 to 12 weeks. The rehab regime includes scapular stabilization exercises, capsular stretching exercises, and rotator cuff isometric exercises to address pain and dysfunction associated with impingement syndrome and rotator cuff tendinitis. The participants were assessed using the Oxford Shoulder Score before the start of rehabilitation, at 2 weeks, 6 weeks, 3 months intervals, or until the symptoms were relieved. The outcomes were tabulated.
Group A participants with < 40° of CSA demonstrated better functional improvements with the mean Oxford Shoulder Score of 39/48 following the MSPCP rehabilitation program compared to Group B participants with CSA more than 40° of a mean Oxford Shoulder Score of 32/48. The statistically significant difference indicates that patients with CSA < 40° had better outcomes.
CSA is a key factor in determining the success of conservative treatment for patients suffering from shoulder impingement syndrome. Patients with CSA < 40° showed significant improvement, and patients with CSA more than 40° showed slow improvement after rehabilitation with the MSPCP program and perhaps needed a longer time to recover.
肩胛骨前倾导致的圆肩是肩峰撞击综合征的常见原因。治疗的主要方法是肩部康复。虽然肩胛骨前倾是姿势的一部分，但关键肩角（CSA）是另一个可能影响肩峰撞击综合征患者治疗效果的解剖学因素。
本研究旨在确定在接受马杜赖肩痛治疗方案（MSPCP，一种标准化康复方案）的CSA>40°和<40°的患者中，CSA对治疗结果的影响。
本研究为前瞻性分析，纳入40例肩峰撞击综合征患者。测量每位患者的CSA，并将他们分为两组：A组-CSA<40°，B组-CSA>40°，然后对他们进行标准化的MSPCP治疗。MSPCP是一个为期3个月的康复方案。分阶段进行：第1阶段为0至2周，第2阶段为2至6周，第3阶段为6至12周。康复方案包括肩胛骨稳定练习、关节囊拉伸练习和肩袖等长练习，以解决与撞击综合征和肩袖肌腱炎相关的疼痛和功能障碍。在康复开始前、2周、6周、3个月时或症状缓解前，使用牛津肩部评分对参与者进行评估。将结果制成表格。
与CSA>40°的B组参与者相比，CSA<40°的A组参与者在接受MSPCP康复方案后，牛津肩部评分平均为39/48，功能改善更好。具有统计学意义的数据差异表明，CSA<40°的患者治疗效果更好。
CSA是决定肩峰撞击综合征患者保守治疗成功与否的关键因素。CSA<40°的患者有显著改善，而CSA>40°的患者在接受MSPCP方案康复后改善缓慢，可能需要更长时间恢复。
