Evaluation of acromion morphology and subacromial distance in patients with shoulder pain

Abstract

Background/Aim: Acromion morphology is not always considered when examining pathologies that may cause shoulder pain in patients who are undergoing physical therapy. However, acromion morphology and the changes caused by these morphological variations in the subacromial distance may cause serious shoulder problems during physical therapy. In this study, the effects of acromion morphology and subacromial distance measurements on shoulder pain were investigated, and the effects of various factors on acromion types were examined. Methods: Our study was a cross-sectional design, and in total, 240 patients had shoulder magnetic resonance images (MRIs) were included in the study. The study included patients with shoulder pain persisting for at least eight weeks and excluded patients with a history of fractures, peripheral nerve damage, osteogenesis imperfecta, and severe osteoporosis. Acromial morphology and subacromial distance were examined on MRIs. Acromial morphology was examined in four subgroups according to the classification by Vanarthos and Monu (1995). Furthermore, the patients were divided into three age groups (18–30, 31–45, and 46–60), and acromion types were examined based on these age groups. In addition, patients’ demographic data were collected, and patients were questioned about painful extremities, dominant extremity, and pain status based on the visual analogue scale (VAS). Results: Subacromial space was measured by determining acromion types using MRIs, and mean subacromial distance was 7.91 mm. Acromion types had significant differences in terms of subacromial distance values (P < 0.001). Pairwise comparisons revealed that the subacromial distance values of Type 3 patients were lower than that of Types 1, 2, and 4 patients (P < 0.001, P = 0.001, and P < 0.001, respectively). Conclusion: The study results revealed that injury of the rotator cuff muscles may occur more frequently in Type 3 acromion than in other acromion types because of the low subacromial distance value. Acromion types, especially the subacromial distance, must be considered in patients with shoulder pain.

Keywords

• Acromion shape
• Shoulder pain
• Rotator cuff pathologies
• Subacromial distance
• Acromion types

Kaynakça

1. 1. Halder MA, Itoi E, An KN. Anatomy And Biomechanics Of The Shoulder. Orthop North Am. 2000;31(2):159-76. doi: 10.1016/S0030-5898(05)70138-3.
2. 2. Burkhart SS. Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears. A suspension bridge model. Clin Orthop Relat Res. 1992;(284):144-52. Indexed in Pubmed: 1395284.
3. 3. França FDO, Godinho AC, Ribeiro EJS, Falster L, Búrigo LEG, Nunes RB. Evaluation of the acromiohumeral distance by means of magnetic resonance imaging umerus. Rev Bras Ortop. 2016;51:169-74. doi: 10.1016/j.rboe.2016.01.008.
4. 4. Hurov J. Anatomy and mechanics of the shoulder: review of current concepts. J Hand Ther. 2009;22(4):328-42. doi: 10.1016/j.jht.2009.05.002.
5. 5. Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. Clin Orthop Relat Res. 1993;(291):20-8. PMID: 8504601.
6. 6. Saupe N, Pfirrmann CW, Schmid MR, Jost B, Werner CM, Zanetti M. Association between rotator cuff abnormalities and reduced acromiohumeral distance. Am J Roentgenol. 2006;187(2):376-82. doi: 10.2214/AJR.05.0435, PMID: 16861541.
7. 7. Zeman CA, Arcand MA, Cantrell JS, Skedros JG, Burkhead Jr WZ. The rotator cuff-deficient arthritic shoulder: diagnosis and surgical management. J Am Acad Orthop Surg. 1998;6(6):337-48. doi: 10.5435/00124635-199811000-00002, PMID: 9826417.
8. 8. Jost B, Pfirrmann CW, Gerber C. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000;82(3):304-14. doi: 10.2106/00004623-200003000-00002, PMID: 10724223.

9. 9. Norwood La Barrack R, Jacobson KE. Clinical presentation of complete tears of the rotator cuff. J Bone Joint Surg Am. 1989;71(4):499-505. PMID: 2703509.
10. 10. Petersson CJ, Redlund- Johnell I. The subacromial space in normal shoulder radiographs. Acta Orthop Scand. 1984;55(1):57-8. doi: 10.3109/17453678408992312, PMID: 6702430.
11. 11. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, Verhaar JAN. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81. doi: 10.1080/03009740310004667, PMID: 15163107.
12. 12. Roe Y, Soberg HL, Bautz-Holter E, Ostensjo S. A systematic review of measures of shoulder pain and functioning using the International classification of functioning, disability and health (ICF). Bmc Musculoskel Dis. 2013;14(1):73. doi: 10.1186/1471-2474-14-73, PMID: 23445557.
13. 13. Sözen HS. Compari̇son of shoulder ultrasonography wi̇th the spesi̇fi̇c physi̇cal exami̇nati̇on of the shoulder, i̇n pati̇ents wi̇th shoulder pai̇n [dissertation]. Gazi University; 2015.
14. 14. Vecchio P, Kavanagh R, Hazleman BL, King RH. Shoulder pain in a community-based rheumatology clinic. Br J Rheumatol. 1995;34(5):440-2. doi: 10.1093/rheumatology/34.5.440, PMID: 7788173.
15. 15. Cotton RE, Rideout DF. Tears of the humeral rotator cuff. A radiological and pathological necropsy survey. J Bone Joint Surg. 1964 46B:314-28. PMID: 14167640.
16. 16. Golding FC. The shoulder- the forgotten joint. Br J Radiol. 1962;35:149-58. doi: 10.1259/0007-1285-35-411-149.
17. 17. Linaker CH, Walker-Bone K. Shoulder disorders and occupation. Best Pract Res Clin Rheumatol. 2015;29(3):405-23. PMID: 26612238.
18. 18. Yao L, Lee HY, Gentili A, Shapiro, MM. Lateral Down-Sloping of the acromion: a useful MR sign? Clin Radiol. 1966; 5(12):869-72. doi: 10.1016/s0009-9260(96)80085-7, PMID: 8972653.
19. 19. Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.
20. 20. Vanarthos WJ, Monu JU. Type 4 acromion: a new classification. Contemp Orthop. 1995;30:227-9. PMID: 10150316.
21. 21. Duymuș M, Asal N, Bozkurt A, Orman G, Yeșilkaya Y, Yılmaz Ö. Semptomatik Hastalarda Akromion Tiplerinin Dağılımı ve Subakromiyal Mesafeler; MRG Bulguları. Kafkas J Med Sci. 2012;2(2):60–5.
22. 22. Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D. Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop. 2013;84(2):178–83. doi: 10.3109/17453674.2013.773413.
23. 23. Botanlıoğlu H, Gülabi D, Kaya İ, Kural C. The Relationship of Acromion Morphology with Age in Impingement Syndrome. Med Bull Haseki. 2007;45:25-41.
24. 24. Koşar İ, Sabancıoğulları V, Erdil H, Çimen M, Aycan K. Acromion Types and Morphometric Evaluation. C. Ü. Medical Faculty Der. 2006;28(1):16–20.
25. 25. Ekin A, Tatari H, Berk H, Mağden O, Havitçioğlu H. Evaluation of the anatomical and radiological features of the acromion in shoulder impingement syndrome. Arthroplasty Arthrosc Surg. 1993;4(7):27-32.
26. 26. Coşkun N, Karaali K, Çevikol C, Demirel BM, Sindel M. Anatomical basics and variations of the scapula in Turkish adults. Saudi Med J. 2006;27(9):1320-5. PMID: 16951766.
27. 27. Yazici M, Kopuz C, Gulman B. Morphologic variants of acromion in neonatal cadavers. J Pediatr Orthop. 1995;15(5)644-7. doi: 10.1097/01241398-199509000-00019, PMID: 7593579.
28. 28. Natsis K, Tsikaras P, Totlis T, Gigis I, Skandalakis P, Appell HJ, Koebke J. Correlation between the four types of acromion and the existence of enthesophytes: a study on 423 dried scapulas and review of the literature. Clin Anat. 2007;2(3):267-72. doi: 10.1002/ca.20320. PMID: 16683236.
29. 29. Gagey N, Ravaud E, Lassau JP. Anatomy of the acromial arch: correlation of anatomy and magnetic resonance imaging. Surg Radiol Anat. 1993;15(1):63-70. doi: 10.1007/BF01629865.
30. 30. Edelson JG, Taitz C. Anatomy of the coraco-acromial arch. Relation to degeneration of the acromion. J Bone Joint Surg Br. 1992;74(4):589-94. doi: 10.1302/0301-620X.74B4.1624522.