To analyze the changes of range of motion and manifestation frequency of impingement sign according to ages in shoulder impingement syndrome after excluding complete rotator tears by MRI, the authors reviewed 74 patients whose impingement injection tests to the subacromial space were positive in the Dankook university hospital. We used paired student t-test for comparison with the contralateral shoulder. l. Average forward elevation, abduction, external rotation and internal rotation of the shoulders were not significantly different in stage I and II, but significantly different statistically in stage II over 40 years old. 2. Average external rotation at 90degrees abductions of the shoulders was not significantly different statistically in stage I, II and stage II over 40 years old. 3. Frequencies of the painful arc were 83% in stage I, 71% in stage II and 58 % in stage II over 40 years old. Physical examinations of painful arc in 1 case of stage II, 7 cases of stage II over 40 years old were impossible because of limitation of motion. 4. Frequencies of lateral impingement sign were 100% in stage I, 86% in stage II, 100% in stage II over 40 years old. Frequencies of Neer's impingement sign were 75% in stage I, 67% in stage II, 88% in stage II over 40 years old. Frequencies of Hawkins impingement sign were 67% in stage I, 62% in stage II and 82% in stage over 40 years old. Except external rotation at 90degrees abduction, range of motion of the shoulder may be decreased in impingement syndrome over 40 years old. Because of difference of frequencies, more than two impingement signs should be tested for the diagnosis of shoulder impingement syndrome.
Adult ; Diagnosis ; Humans ; Magnetic Resonance Imaging ; Physical Examination ; Range of Motion, Articular ; Shoulder Impingement Syndrome* ; Shoulder Joint ; Shoulder*

The aim of this study was to assess the diagnostic ability of magnetic resonance imaging (MRI) in subacromial impingement syndrome (SIS), using a physiological standard of reference. MRI of the rotator cuff (RC) and subacromial injection test (SIT), a reference standard for SIS diagnosis, were performed in 125 painful shoulders. MRI diagnostic accuracies were determined using a 2 x 2 table and the percentage values of SIS diagnosis in patients with the three Zlatkin MRI stages were determined. Shoulder function was evaluated using the Constant Scale, and results were compared for stages. The sensitivity, specificity, accuracy, positive and negative predictive values of MRI for SIS diagnosis were 98.85%, 36.84%, 80%, 78.18% and 93.33% respectively. Of the 32 patients with Zlatkin stage 1 changes in MRI, 20 (62%) had SIT approved SIS diagnosis, while 47 (79%) of the 59 patients with Zlatkin 2 and all of the 19 (100%) patients with Zlatkin 3 changes were diagnosed with SIS by SIT. Mean Constant scores were 78.04 +/- 18.3, 65.0 +/- 19.9 and 54.52 +/- 20.7 in patients with Zlatkin stages 1, 2 and 3, respectively (p < 0.05). The MRI of RC did not prove to be an excellent tool for SIT based SIS diagnosis, with its low specificity. However, the technique can give important clues, as its sensitivity and negative predictive values are high.
Adolescence ; Adult ; Aged ; Female ; Human ; Magnetic Resonance Imaging ; Male ; Middle Age ; Shoulder Impingement Syndrome/*diagnosis

The pathophysiology of impingement syndrome and labral tear was variable and not clear. In general populations, lesions occur mainly in acute cases. But in athletes, lesions are caused by repetitive exposure to excessive force, resulting in different patterns. For diagnosis, thorough physical examinations and radiologic findings should be combined. In athletes, conservative treatment including posterior capsular stretching and periscapular muscle strengthening is recommended as the first choice of treatment considering chronic progression and adaptive change. When choosing surgical treatment because of failure of conservative treatment, careful attention should be paid to the choice of repair or debridement of the rotator cuff partial tear, and the choice of the labral repair or biceps tenodesis.
Athletes* ; Debridement ; Diagnosis* ; Humans ; Physical Examination ; Rotator Cuff ; Shoulder Impingement Syndrome ; Tears* ; Tenodesis

Shoulder pain is a common problem in outpatient medical practice. Shoulder pain usually causes disability in activities of daily living, and therefore its proper diagnosis and management are essential. The prevalence of shoulder pain in Korea has been gradually increasing, and the differential diagnosis of shoulder pain has become more important. In Korea, the most common causes of shoulder pain are rotator cuff disease, including impingement syndrome (31%), adhesive capsulitis (35%), and calcific tendinitis (4%). This article presents the pathophysiology, clinical characteristics, typical physical examination findings and provocation tests, and radiologic findings of common shoulder diseases, including rotator cuff disease, adhesive capsulitis, and calcific tendinitis, to provide a guide to differential diagnosis. Common shoulder diseases can be easily diagnosed with careful history taking and precise physical examination; moreover, ultrasonography is a useful diagnostic tool for rotator cuff disease and can also assist with the differential diagnosis of shoulder diseases in the outpatient clinic.
Activities of Daily Living ; Ambulatory Care Facilities ; Bursitis ; Diagnosis ; Diagnosis, Differential* ; Humans ; Joint Capsule ; Korea ; Outpatients ; Physical Examination ; Prevalence ; Rotator Cuff ; Shoulder ; Shoulder Impingement Syndrome ; Shoulder Pain* ; Tendinopathy ; Ultrasonography

Shoulder pain is a common problem in outpatient medical practice. Shoulder pain usually causes disability in activities of daily living, and therefore its proper diagnosis and management are essential. The prevalence of shoulder pain in Korea has been gradually increasing, and the differential diagnosis of shoulder pain has become more important. In Korea, the most common causes of shoulder pain are rotator cuff disease, including impingement syndrome (31%), adhesive capsulitis (35%), and calcific tendinitis (4%). This article presents the pathophysiology, clinical characteristics, typical physical examination findings and provocation tests, and radiologic findings of common shoulder diseases, including rotator cuff disease, adhesive capsulitis, and calcific tendinitis, to provide a guide to differential diagnosis. Common shoulder diseases can be easily diagnosed with careful history taking and precise physical examination; moreover, ultrasonography is a useful diagnostic tool for rotator cuff disease and can also assist with the differential diagnosis of shoulder diseases in the outpatient clinic.
Activities of Daily Living ; Ambulatory Care Facilities ; Bursitis ; Diagnosis ; Diagnosis, Differential* ; Humans ; Joint Capsule ; Korea ; Outpatients ; Physical Examination ; Prevalence ; Rotator Cuff ; Shoulder ; Shoulder Impingement Syndrome ; Shoulder Pain* ; Tendinopathy ; Ultrasonography

OBJECTIVETo evaluate the reliability and diagnosis accuracy of 5 special tests used for the diagnosis of subacromial impingement syndrome (SAIS).

METHODSA prospective blinded cohort study was taken,in which 105 patients with shoulder pain were reviewed. All the patients took 5 special syndrome tests including Neer syndrome, Hawkins-Kennedy syndrome, painful arc empty can test and external rotation resistance test, also underwent arthroscopic surgical examination. The Nikolaus's criterion was regarded as a golden standard for SAIS. Data accuracy analysis was calculated through a receiver operating characteristic (ROC) curve, sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR). The binary Logistic regression analysis was used to find out the best test combination for ruling in or out SAIS. The interrater reliability was assessed by the Kappa coefficient and percent agreement.

RESULTSThe ROC analysis indicated a significant area under the curve (AUC) (AUC=0.62 to 0.73, P<0.05) for all tests except the Hawkins-Kennedy. Tests with a +LR greater or equal to 2.0 were the painful arc,empty can,external rotation resistance, Tests with a-LR less than 0.5 were Neer,painful are ,external rotation resistance. The regression analysis found the painful arc, empty can and external rotation resistance made the best combination for diagnosis SAIS,while the painful are and external rotation resistance made the best combination for ruling out SAIS. The difference of ROC analysis was significant with a cut-off of 3 positive tests out of 5 tests. All tests had moderate to good agreement (Kappa=0.42 to 0.71).

CONCLUSIONThe single test of painful arc, empty can and external rotation resistance, as well as 3 or more positive tests of the 5 tests can help confirm the diagnosis of SAIS, while the single test of Neer, painful arc and external rotation resistance are help rule out the diagnisis of SAIS. The tests of painful arc, empty can and ex ternal rotation resistance are the best combination for the diagnosis of SAIS (when 2 or more are positive), while the tests of painful arc and external rotation resistance are the best combination for ruling out SAIS (when both are negative)

Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Physical Examination ; methods ; Prospective Studies ; Reproducibility of Results ; Shoulder Impingement Syndrome ; diagnosis

The purpose of this review was to demonstrate magnetic resonance (MR) arthrography findings of anatomy, variants, and pathologic conditions of the superior glenohumeral ligament (SGHL). This review also demonstrates the applicability of a new MR arthrography sequence in the anterosuperior portion of the glenohumeral joint. The SGHL is a very important anatomical structure in the rotator interval that is responsible for stabilizing the long head of the biceps tendon. Therefore, a torn SGHL can result in pain and instability. Observation of the SGHL is difficult when using conventional MR imaging, because the ligament may be poorly visualized. Shoulder MR arthrography is the most accurately established imaging technique for identifying pathologies of the SGHL and associated structures. The use of three dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences produces thinner image slices and enables a higher in-plane resolution than conventional MR arthrography sequences. Therefore, shoulder MR arthrography using 3D VIBE sequences may contribute to evaluating of the smaller intraarticular structures such as the SGHL.
Adult ; *Breath Holding ; Female ; Humans ; Imaging, Three-Dimensional/*methods ; Ligaments, Articular/*anatomy & histology/pathology ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Shoulder Impingement Syndrome/*diagnosis ; *Shoulder Joint/injuries ; Tendon Injuries/diagnosis