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William Temes, Amy Temes Clifton, Valerie Hilton, Leslie Girard, Neisha Strait and Andrew Karduna

Context: The supraspinatus is the most commonly affected muscle with rotator-cuff pathology and necessary for stability of the humeral head in the glenoid fossa. Rehabilitative ultrasound imaging (RUSI) of skeletal muscles provides a safe and clinically accessible measure of intact human muscle function at rest or during contracted states. The ability to perform accurate assessment of supraspinatus function has not been studied and may be of value in assessment and treatment. Objectives: To determine the validity and reliability of measures obtained using RUSI for assessing supraspinatus muscle at rest and contracted conditions. Design: Reliability and validity Setting: Outpatient physical therapy clinic. Subjects: 15 asymptomatic subjects age 30-49 y. Main Outcome Measures: The supraspinatus muscle was measured at rest and contracted with a 0.9-kg weight with the arm positioned in 45° of abduction in the plane of the scapula. Repeated ultrasound images of the supraspinatus were collected by 3 physical therapists on 2 separate days. Main Outcome Measures: Reliability was assessed with the intraclass correlation coefficient (ICC) and standard error of measurement (SEM). Validity was tested by comparing mean difference between active and passive states for all 3 rates on both days. Results: All ICC values were found to be at .9 or above. In addition, for all days and raters, the active condition was significantly thicker than the passive condition (P < .001). Conclusions: Thickness measures of the supraspinatus using RUSI, during passive and active conditions, demonstrate high interrater and intrarater reliability and can easily distinguish between active and passive states. These findings suggest that RUSI may provide an appropriate quantitative measure for changes in the thickness of supraspinatus that are important for determining improvement or deterioration in muscle function.

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Jason S. Scibek and Christopher R. Carcia

Background:

The efficacy of a variety of noninvasive, conservative management techniques for calcific tendinopathy has been investigated and established for improving pain and function and/or facilitating a decrease in the size or presence of calcium deposits. Surprisingly, few have reported on the use of traditional therapeutic exercise and rehabilitation alone in the management of this condition, given the often spontaneous resorptive nature of calcium deposits. The purpose of this case is to present the results of a conservative approach, including therapeutic exercise, for the management of calcific tendinopathy of the supraspinatus, with an emphasis on patient outcomes.

Case Description:

The patient was a self-referred 41-y-old man with complaints of acute right-shoulder pain and difficulty sleeping. Imaging studies revealed liquefied calcium deposits in the right supraspinatus. The patient reported constant pain at rest (9/10) and tenderness in the area of the greater tuberosity. He exhibited a decrease in all shoulder motions and had reduced strength. The simple shoulder test (SST) revealed limited function (0/12). Conservative management included superficial modalities and medication for pain and a regimen of scapulothoracic and glenohumeral range-of-motion (ROM) and strengthening exercises.

Outcomes:

At discharge, pain levels decreased to 0/10 and SST scores increased to 12/12. ROM was full in all planes, and resisted motion was strong and pain free. The patient was able to engage in endurance activities and continue practicing as a health care provider.

Discussion:

The outcomes with respect to pain, function, and patient satisfaction provide evidence to support the use of conservative therapeutic interventions when managing patients with acute cases of calcific tendinopathy. Successful management of calcific tendinopathy requires attention to outcomes and an understanding of the pathophysiology, prognostic factors, and physical interventions based on the current stage of the calcium deposits and the patient’s status in the healing continuum.

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Birinder Singh B. Cheema, Marissa Lassere, Ronald Shnier and Maria A. Fiatarone Singh

The purpose of this article is to document a rotator cuff tear sustained by an elderly woman performing progressive resistance training (PRT) in a recent randomized controlled clinical trial. The patient was a sedentary 73-y-old Caucasian woman. Investigation revealed an acute, full-thickness tear of the right supraspinatus secondary to performing a shoulder press exercise. Further investigation via MRI revealed degenerative disease of the acromioclavicular joint including lateral downsloping of the acromion and an anteroinferior acromial spur, which would presdispose to impingement. Conservative management was implemented in this case for over 6 months with minimal success. The patient remained functionally limited in virtually all activities of daily living. Given the medical history, health status, physical condition, and age of our patient, it is probable that degenerative changes predisposed the patient to the injury. To our knowledge this is the first published report of an older adult sustaining a rotator cuff tear during PRT.

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Josep C. Benitez-Martinez, Jose Casaña-Granell, Yasmin Ezzatvar de Llago, Carlos Villaron-Casales, Gemma V. Espi-Lopez and Fernando Jimenez-Diaz

Context:

The supraspinatus muscle has an important role in the stabilization of the glenohumeral joint. Identifying abnormalities concerning its size and the subacromial space in the presence of pain may be relevant to provide more specific treatments focused on the etiology of pain.

Objective:

To determinate whether painful shoulder causes changes in the supraspinatus cross-sectional area (CSA) and the acromio-humeral distance (AHD) between overhead athletes.

Design:

Cross-sectional study.

Setting:

University campus and local sports clubs’ Physical Therapist room.

Participants:

81 male overhead athletes were divided into 2 groups according to the presence of shoulder pain and clinical symptoms.

Main Outcome Measures:

Ultrasonography measurements of the supraspinatus CSA and the AHD in 2 groups of overhead athletes with and without pain.

Results:

In the pain group, the CSA was significantly smaller compared with the no pain group. No differences between groups were found in the AHD measurement.

Conclusions:

Shoulder pain in overhead athletes was associated with a reduction in their supraspinatus muscle CSA, but not in the AHD. These findings suggest that muscle atrophy exists in the presence of pain. However, in active overhead athletes, the AHD is not clearly reduced in overhead athletes with shoulder pain. Further studies are needed to understand this condition.

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Sarah Ritchie

Column-editor : Jeff G. Konin

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Matthew J. Somma and Travis L. Orth

Edited by Joe J. Piccininni

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Sebastian Klich, Bogdan Pietraszewski, Matteo Zago, Manuela Galli, Nicola Lovecchio and Adam Kawczyński

, which, in turn, results in nonfunctional kinematics. 6 – 8 Thus, it is necessary to evaluate both morphological and viscoelastic properties of shoulder girdle muscles during fatigue exercise. Overhead sports are also exposed to impingement, caused by both supraspinatus tendon thickness (SST) and

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Anthony C. Santago II, Meghan E. Vidt, Xiaotong Li, Christopher J. Tuohy, Gary G. Poehling, Michael T. Freehill and Katherine R. Saul

when performed by young adults, uninjured older adults, and older adults with a degenerative supraspinatus tear; (2) determine which functional task required the most strength; and (3) identify whether the percentage of available shoulder strength used to complete tasks is altered by age or rotator

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Marcelo Peduzzi de Castro, Daniel Cury Ribeiro, Felipe de Camargo Forte, Joelly Mahnic de Toledo, Roberto Costa Krug and Jefferson Fagundes Loss

The aim of this study was to compare shoulder muscle force and moment production during external rotation performed in the transverse and sagittal planes. An optimization model was used for estimating shoulder muscle force production of infraspinatus, teres minor, supraspinatus, anterior deltoid, middle deltoid and posterior deltoid muscles. The model uses as input data the external rotation moment, muscle moment arm magnitude, muscle physiologic cross-sectional area and muscle specific tension. The external rotation moment data were gathered from eight subjects in transverse and six subjects in sagittal plane using an isokinetic dynamometer. In the sagittal plane, all studied muscles presented larger estimated force in comparison with the transverse plane. The infraspinatus, teres minor, supraspinatus and posterior deltoid muscles presented larger moment in sagittal when compared with transverse plane. When prescribing shoulder rehabilitation exercises, therapists should bear in mind the described changes in muscle force production.

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Michael F. Joseph, Kathryn Taft, Maria Moskwa and Craig R. Denegar

Study Design:

Systematic literature review.

Objective:

To assess the efficacy of deep friction massage (DFM) in the treatment of tendinopathy.

Context:

Anecdotal evidence supports the efficacy of DFM for the treatment of tendinopathy. An advanced understanding of the etiopathogenesis of tendinopathy and the resultant paradigm shift away from an active inflammatory model has taken place since the popularization of the DFM technique by Cyriax for the treatment of “tendinitis.” However, increasing mechanical load to the tendinopathic tissue, as well as reducing molecular cross-linking during the healing process via transverse massage, offers a plausible explanation for observed responses in light of the contemporary understanding of tendinopathy.

Evidence Acquisition:

The authors surveyed research articles in all languages by searching PubMed, Scopus, Pedro, CINAHL, PsycINFO, and the Cochrane Library using the terms deep friction massage, deep tissue massage, deep transverse massage, Cyriax, soft tissue mobilization, soft tissue mobilisation, cross friction massage, and transverse friction massage. They included 4 randomized comparison trials, 3 at the extensor carpi radialis brevis (ECRB) and 1 supraspinatus outlet tendinopathy; 2 nonrandomized comparison trials, both receiving DFM at the ECRB; and 3 prospective noncomparison trials—supraspinatus, ECRB, and Achilles tendons. Articles meeting inclusion criteria were assessed based on PEDro and Centre for Evidence-Based Medicine rating scales.

Results:

Nine studies met the inclusion criteria.

Evidence Synthesis:

The heterogeneity of dependent measures did not allow for meta-analysis.

Conclusion:

The varied locations, study designs, etiopathogenesis, and outcome tools used to examine the efficacy of DFM make a unified conclusion tenuous. There is some evidence of benefit at the elbow in combination with a Mills manipulation, as well as for supraspinatus tendinopathy in the presence of outlet impingement and along with joint mobilization. The examination of DFM as a single modality of treatment in comparison with other methods and control has not been undertaken, so its isolated efficacy has not been established. Excellent anecdotal evidence remains along with a rationale for its use that fits the current understanding of tendinopathy.