Investigation of the relationship between soft tissue flexibility and acromiohumeral distance in subacromial pain syndrome

Yıl 2021, , 270 - 278, 31.12.2021

Leyla Eraslan , Ozan Yar , Bilge Ergen , Gazi Huri , İrem Düzgün

https://doi.org/10.15437/jetr.803570

Öz

Purpose The aim of this study was to investigate the shoulder tightness, and was to investigate the relationship between the shoulder tightness and the acromiohumeral distance (AHD) in patients with subacromial pain syndrome.
Methods: Twenty-two patients with subacromial pain syndrome (12 females, 10 males; mean age: 31.2±8.6 yrs.; BMI: 22.8±2.8 kg/m2) were included in this study. The shoulder range of movement was measured by standard goniometer, scapular dyskinesis by “yes/no” method, posterior capsule tightness by “Horizontal Adduction Test”, and pectoralis minor tightness by “Pectoralis Minor Length Test”. AHD was measured in resting position by a real-time ultrasonography. Statistical analysis was used for comparing the shoulder tightness between the symptomatic and asymptomatic sides using “a paired sample t-test”. Pectoralis minor tightness, posterior capsule tightness and AHD was analyzed using Pearson Correlation Test.
Results: There was a difference between the posterior capsule tightness (p=0.008) and pectoralis minor length (p<0.001) in symptomatic shoulders compared to asymptomatic sides. However, there were no significant relationship between the shoulder tightness and the AHD (p>0.05).
Conclusion: In general, decreased shoulder soft tissue length was found in symptomatic shoulders when compared to asymptomatic sides in patients with subacromial pain syndrome. However, shoulder tightness (both symptomatic and asymptomatic shoulders) was not related to resting AHD measurements. Based on these findings, we think that shoulder tightness does not play an important role in resting AHD measurements, other factors which may cause a subacromial space narrowing should be considered.

Anahtar Kelimeler

Shoulder impingement syndrome, Shoulder joint, Pectoralis muscles, Subacromial space, Ultrasonography.

Subakromiyal ağrı sendromunda yumuşak doku esnekliği ile akromiyohumeral mesafe arasındaki ilişkinin araştırılması

Öz

Amaç: Bu çalışmanın amacı, subakromiyal ağrı sendromlu hastalardaki omuz çevresi yumuşak doku esneklik kaybının araştırılması ve akromiyohumeral mesafe (AHM) arasındaki ilişkinin ortaya koyulması idi.
Yöntem: Bu araştırmaya subakromiyal ağrı sendromu tanısı konulan 22 hasta (12 kadın, 10 erkek, ortalama yaş: 31,2±8,6 yıl, ortalama VKİ: 22,8±2,8 kg/m2) dahil edildi. Hastaların eklem hareket açıklıkları standart gonyometre, skapular diskinezi “var/yok yöntemi”, posterior kapsül esnekliği “Horizontal Adduksiyon Testi” ve pectoralis minor esnekliği “Pectoralis Minor Uzunluk Testi” kullanılarak ölçüldü. AHM ölçümleri hastaların istirahat postürlerinde ultrasonografi kullanılarak yapıldı. İstatistiksel analizde, etkilenen ve sağlam omuz arasındaki yumuşak doku esneklik farkı “bağımlı gruplarda t-testi”, yumuşak doku esneklikleri ile AHM arasındaki ilişki Pearson Korelasyon Katsayısı kullanılarak analiz edildi.
Bulgular: Hastaların sağlam omuzları ile kıyaslandığında etkilenen omuzlarında posterior kapsül esnekliği (p=0,008) ve pectoralis minor esnekliği (p<0,001) arasında fark vardı. Ancak hastaların omuz çevresi yumuşak doku esneklikleri ile AHM arasında bir ilişki gözlenmedi (p>0,05).
Sonuç: Genel olarak bakıldığında subakromiyal ağrı sendromlu hastaların etkilenen omuzlarının yumuşak doku esnekliklerinin sağlam tarafa göre azaldığı bulundu. Ancak hem etkilenen hem sağlam taraf pectoralis minor ve posterior kapsül esnekliklerinin istirahat AHM ölçümleri ile ilişkili olmadığı sonucuna varıldı. Bu sonuçlara göre omuz çevresi yumuşak doku esneklik kaybı istirahat AHM değişimleri üzerinde önemli bir rolü olmadığı, subakromiyal sıkışmaya neden olabilecek diğer faktörlerin göz önünde bulundurulması gerektiği düşüncesindeyiz.

Anahtar Kelimeler

Omuz sıkışma sendromu, Omuz eklemi, Subakromiyal aralık, Pektoral kas, Ultrasonografi.

Kaynakça

• 1.Mackenzie T, Herrington L, Horsley I, et al. Acromio-Humeral distance in athletes’ shoulders. Ann Sports Med Res. 2015;2:1042.
• 2.Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Bri J Sports Med. 2010;44:319-327.
• 3.Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech 2003;18:369-379.
• 4.Saupe N, Pfirrmann CW, Schmid MR, et al. Association between rotator cuff abnormalities and reduced acromiohumeral distance. AJR Am J Roentgenol. 2006;187:376-382.
• 5.Mayerhoefer ME, Breitenseher MJ, Wurnig C, et al. Shoulder impingement: relationship of clinical symptoms and imaging criteria. Clin J Sport Med. 2009;19:83-89.
• 6.Struyf F, Nijs J, De Graeve J, et al. Scapular positioning in overhead athletes with and without shoulder pain: a case–control study. Scand J Med Sci Sports. 2011;21:809-818.
• 7.Graichen H, Hinterwimmer S, von Eisenhart-Rothe R, et al. Effect of abducting and adducting muscle acitivity on glenohumeral translation, scapular kinematics and subacromial space width in vivo. J Biomech. 2005;38:755-760.
• 8.Graichen H, Bonel H, Stammberger T, et al. Three-dimensional analysis of the width of the subacromial space in healthy subjects and patients with impingement syndrome. AJR Am J Roentgenol. 1999;172:1081-1086.
• 9.Hébert LJ, Moffet H, McFadyen BJ, et al. Scapular behavior in shoulder impingement syndrome. Arch Phys Med Rehabil. 2002;83:60-69.
• 10.Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80:276-291.
• 11.Seitz AL, McClure PW, Finucane S, et al. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech. 2011;26:1-12.
• 12.Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005;35:227-238.
• 13.Lee J-H, Cynn H-S, Yi C-H, et al. Predictor variables for forward scapular posture including posterior shoulder tightness. J Bodyw Mov Ther. 2015;19:253-260.
• 14.Harryman D, Sidles J, Clark JM, et al. Translation of the humeral head on the glenoid with passive glenohumeral motion. J Bone Joint Surg Am. 1990;72:1334-1343.
• 15.Maenhout A, Van Eessel V, Van Dyck L, et al. Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program. Am J Sports Med. 2012;40:2105-2112.
• 16.Lawrence RL, Braman JP, Ludewig PM. Shoulder kinematics impact subacromial proximities: a review of the literature. Braz J Phys Ther. 2020;24:219-230.
• 17.Kalra N, Seitz AL, Boardman ND, et al. Effect of posture on acromiohumeral distance with arm elevation in subjects with and without rotator cuff disease using ultrasonography. J Orthop Sports Phys Ther. 2010;40:633-640.
• 18.Riddle DL, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: shoulder measurements. Phys Ther. 1987;67:668-673.
• 19.McClure P, Tate AR, Kareha S, et al. A clinical method for identifying scapular dyskinesis, part 1: reliability. J Athletic Train. 2009;44:160-164.
• 20.Uhl TL, Kibler WB, Gecewich B, et al. Evaluation of clinical assessment methods for scapular dyskinesis. Arthroscopy. 2009;25:1240-1248.
• 21.Laudner KG, Stanek JM, Meister K. Assessing posterior shoulder contracture: the reliability and validity of measuring glenohumeral joint horizontal adduction. J Athletic Train. 2006;41:375-380.
• 22.Sahrmann S. Diagnosis and treatment of movement impairment syndromes. Elsevier Health Sciences; 2001.
• 23.Lewis JS, Valentine RE. The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with and without shoulder symptoms. BMC Musculoskelet Disord. 2007;9:64.
• 24.Kendall F, McCreary E, Provance P. Muscles: testing and function, Ed 4, Baltimore, 1993.
• 25.McCreesh KM, Crotty JM, Lewis JS. Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review. Br J Sports Med. 2015;49:298-305.
• 26.Pijls BG, Kok F, Penning LI, et al. Reliability study of the sonographic measurement of the acromiohumeral distance in symptomatic patients. J Clin Ultrasound. 2010;38:128-134.
• 27.Cholewinski JJ, Kusz DJ, Wojciechowski P, et al. Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2008;16:408-414.
• 28.Navarro-Ledesma S, Fernandez-Sanchez M, Luque-Suarez A. Does the pectoralis minor length influence acromiohumeral distance, shoulder pain-function, and range of movement? Phys Ther Sport. 2018;34:43-48.
• 29.Mackenzie TA, Herrington L, Funk L, et al. Relationship between extrinsic factors and the acromio-humeral distance. Man Ther. 2016;23:1-8.
• 30.Michener LA, Yesilyaprak SSS, Seitz AL, et al. Supraspinatus tendon and subacromial space parameters measured on ultrasonographic imaging in subacromial impingement syndrome. Knee Surg Sports Traumatol Arthrosc. 2015;23:363-369.
• 31.Desmeules F, Minville L, Riederer B, et al. Acromio-humeral distance variation measured by ultrasonography and its association with the outcome of rehabilitation for shoulder impingement syndrome. Clin J Sport Med. 2004;14:197-205.
• 32.Harput G, Guney-Deniz H, Duzgun I, et. al. Active Scapular Retraction and Acromiohumeral Distance at Various Degrees of Shoulder Abduction. J. Athl Train. 2018;53:584-589.
• 33.Van der Helm FC. Analysis of the kinematic and dynamic behavior of the shoulder mechanism. Clin Biomech. 1994;27:527-550.
• 34.Muraki T, Yamamoto N, Zhao KD, et al. Effects of posterior capsule tightness on subacromial contact behavior during shoulder motions. J Shoulder Elbow Surg. 2012;21:1160-1167.
• 35.Cools AM, Johansson FR, Cambier DC, et al. Descriptive profile of scapulothoracic position, strength and flexibility variables in adolescent elite tennis players. Bri J Sports Med. 2010;44:678-684.
• 36.Navarro-Ledesma S, Luque-Suarez A. Comparison of acromiohumeral distance in symptomatic and asymptomatic patient shoulders and those of healthy controls. Clin Biomech. 2018;53:101-106.