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The Influences of Subscapularis Lesion on Ultrasonography and Kinematics in Patients With Shoulder Impingement

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ClinicalTrials.gov Identifier: NCT05371457
Recruitment Status : Completed
First Posted : May 12, 2022
Last Update Posted : July 18, 2022
Sponsor:
Information provided by (Responsible Party):
National Taiwan University Hospital

Brief Summary:
Subacromial and subcoracoid impingement have been categorized as external impingement, one type of shoulder impingement syndrome (SIS). Differentiation between subacromial impingement and subcoracoid impingement are important in determining the treatment target. The thickness of the coracohumeral ligament (CHL) may affect coracohumeral distance (CHD), which has been suggested as a possible factor in developing subcoracoid impingement with subscapularis (SSC) lesion. Evidence that indicates the existence of abnormal SSC, CHL thickness and CHD in people with SIS is limited. The purposes of the study were (1) to evaluate the correlations between CHL thickness and CHD by using ultrasonography in people with SIS with and without SSC lesion, (2) to examine the difference in SSC/CHL thickness and CHD between people with SIS with and without SSC lesion.

Condition or disease
Shoulder Impingement Syndrome

Show Show detailed description

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Study Type : Observational
Actual Enrollment : 40 participants
Observational Model: Case-Only
Time Perspective: Cross-Sectional
Official Title: The Influences of Subscapularis Lesion on Ultrasonography and Scapular Kinematics in Patients With Shoulder Impingement Syndrome
Actual Study Start Date : May 14, 2022
Actual Primary Completion Date : June 15, 2022
Actual Study Completion Date : July 15, 2022



Primary Outcome Measures :
  1. Thickness of Coracohumeral Ligament (CHL) [ Time Frame: Baseline ]
    The T3300 ultrasound system (BenQ, Taipei, Taiwan) is a portable ultrasonography machine to collect thickness of CHL as well as CHD. B-mode US depicts the CHL as a linear hyperechoic band surrounded by hyperechoic fat. Differentiation of the CHL from surrounding tissues can be achieved by tilting the probe to show anisotropy and by dynamic examination IR and ER. The CHL will be loosened (concave) in IR and tightened (straight) in ER. During the maximal ER, the thickness of the CHL at a 2-mm distance from the coracoid process will be measured.

  2. Coracohumeral Distance (CHD) [ Time Frame: Baseline ]
    CHD was measured with the probe positioned on the lateral border of the coracoid process to obtain images of the coracoid process and humeral head in 4 different shoulder rotation positions: (1) shoulder neutral rotation (CHD-NR), (2) external rotation (CHD-ER) and (3) shoulder internal rotation with maximal forward flexion and full adduction (CHD-IRFA, with the arm adducted across the chest reaching for the opposite shoulder) and (4) shoulder internal rotation (CHD-IR). Participants were asked to sit with their arms by their sides and to perform the 4 different positions respectively. The measurements were repeated for 3 trials with repositioning of the arm to a neutral position for intervals of 10 seconds. The distance measured was that between the coracoid process and the lesser tuberosity of the humerus. The distance will be measured in the shortest distance between the interval of coracoid process and the lesser tuberosity of the humerus.

  3. Long Head of Biceps Tendon (LHBT) Stability [ Time Frame: Baseline ]
    dynamic stability assessment and presence of "chondral print" will be measured for LHBT stability. The probe will be placed at the level of bicipital groove and slightly move upward for short axis image (dynamic stability and "chondral print") and orientated perpendicularly between the bicipital groove for long axis image ("chondral print"). The participant's forearm is placed with the supinated elbow flexed 90° and 10° of IR. Then, the LHBT transposition will be recorded while asking the participant to externally and internally rotation of GH joint for dynamic stability assessment. For "chondral print" evaluation, investigate the presence of irregularity of bicipital groove under short and long axis view.

  4. Humerus elevation [ Time Frame: Baseline ]
    The Polhemus 3Space FASTRAK system (Polhemus Inc., Colchester, VT, USA) is an electromagnetic motion analysis system with Motion Monitor software which is used to collect three-dimensional scapular kinematics. The sensors will be attached to bony landmarks (sternum, the scapular acromial process, and the distal humerus between the lateral and medial epicondyles). The recording will be started with the participants in a sitting position, and two hands at the sides. Then, the participants will be asked to perform 5 trials of full ROM scapular plane elevation, and simultaneously we measuring the kinematic data. The humerus elevation, scapular upward/downward rotation, anterior/posterior tipping and internal/external rotation, elevation/depression will be calculated by the software. The kinematic data will be recorded during 30°, 60°, 90° and 120° in raising and lowering phase of humeral elevation in the scapular plane.

  5. Scapular upward/downward rotation [ Time Frame: Baseline ]
    See outcome 4

  6. Scapular anterior/posterior tipping [ Time Frame: Baseline ]
    See outcome 4

  7. Scapular internal/external rotation [ Time Frame: Baseline ]
    See outcome 4

  8. Scapular elevation/depression [ Time Frame: Baseline ]
    See outcome 4

  9. Scapular muscles activities [ Time Frame: Baseline ]
    Electromyography surface silver chloride circular electrodes with an interelectrode distance of 20 mm, and a Grass AC/DC amplifier with a gain of 1,000, a common mode rejection ratio of 86 dB at 60 Hz, and a bandwidth (-3 dB) of 10 - 1,000 Hz were used. The sEMG data will be collected at 2,000 Hz/channel using a 16-bit analog to digital converter. Each electrode will be controlled with an impedance less than 10 k. The procedures of the recording of the sEMG activity are the same as the kinematic data. A RMS algorithm will be used to produces sEMG envelopes with a sampling rate of 50. Results will be normalized to the maximal activity during MVIC trials. Upper trapezius(UT), long head of biceps(LHB), lower trapezius(LT) and serratus anterior(SA) muscle activation in 0-30°, 30°-60°, 60°-90°, 90°-120° and >120° in raising and lowering phase will be recorded. The mean sEMG amplitude of each phase will be reported as a percentage of MVIC to assess the activity of each muscle.



Information from the National Library of Medicine

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Ages Eligible for Study:   20 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Forty subjects whose age from 20 to 60 years old were recruited from National Taiwan University Hospital and through general local internet media. The inclusion criteria of subjects will be at least three positive of five tests, including Neer's test, Hawkin's test, Empty can test, tenderness in tendon of rotator cuff and resisted external test. In addition, participants with a history of shoulder dislocation, fracture or surgery, history of direct contact injury to the neck or upper extremities within the past month, glenohumeral joint instability (positive apprehension test, sulcus sign), neurologic disorder (upper motor neuron diseases, cervical radiculopathy), passive ER ROM less than 30 degrees and pain (visual analogue scale, VAS less than 5) during the experimental tasks will be excluded.
Criteria

Inclusion criteria:

  1. Age from 20 to 60 years old
  2. Unilateral shoulder symptoms

2. At least three positive of five tests, including Neer's test, Hawkin's test, Empty can test, tenderness in tendon of rotator cuff and resisted external test.

Exclusion criteria:

  1. Shoulder dislocation
  2. Fracture
  3. Surgery
  4. History of direct contact injury to the neck or upper extremities within the past month
  5. Glenohumeral joint instability (positive apprehension test, sulcus sign)
  6. Neurologic disorder (upper motor neuron diseases, cervical radiculopathy)
  7. Passive ER ROM less than 30 degrees
  8. Pain (visual analogue scale, VAS more than 5)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05371457


Locations
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Taiwan
National Taiwan University Hospital
Taipei, Taiwan, 100
Sponsors and Collaborators
National Taiwan University Hospital
Investigators
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Principal Investigator: Jiu- Jenq Lin, PHD School and Graduate Institute of Physical Therapy College of Medicine, National Taiwan University
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Responsible Party: National Taiwan University Hospital
ClinicalTrials.gov Identifier: NCT05371457    
Other Study ID Numbers: 202011045RIND
First Posted: May 12, 2022    Key Record Dates
Last Update Posted: July 18, 2022
Last Verified: December 2021
Keywords provided by National Taiwan University Hospital:
shoulder impingement syndrome
subcoracoid impingement
coracohumeral ligament distance
subscapularis
Additional relevant MeSH terms:
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Shoulder Impingement Syndrome
Syndrome
Rotator Cuff Injuries
Disease
Pathologic Processes
Rupture
Wounds and Injuries
Shoulder Injuries
Tendon Injuries
Joint Diseases
Musculoskeletal Diseases