To evaluate effects of subacromial bursa injection with steroid according to dosage and to investigate whether hyaluronidase can reduce steroid dosage.
Thirty patients with periarticular shoulder disorder were assigned to receive subacromial bursa injection once a week for two consecutive weeks. Ten patients (group A) underwent subacromial bursa injection with triamcinolone 20 mg; another group of ten patients (group B) with hyaluronidase 1,500 IU and triamcinolone 20 mg; and the other ten patients (group C) with triamcinolone 40 mg. We examined the active range of motion (AROM) of the shoulder joint, visual analogue scale (VAS), and shoulder disability questionnaire (SDQ) at study entry and every week until 1 week after the 2nd injection.
All groups showed statistically significant improvements in VAS after 1st and 2nd injections. When comparing the degree of improvement in VAS, there were statistically significant differences between groups C and A or B, but not between groups A and B. SDQ was statistically significantly improved only in groups B and C, as compared to pre-injection. There were statistically significant differences in improvement of SDQ after the 2nd injection between groups C and A or B. Statistically significant improvements in AROM were shown in abduction (groups B and C) and in flexion (group C only).
Repeated high-dose (40 mg) steroid injection was more effective in terms of pain relief and functional improvements of shoulder joint than medium-dose (20 mg) steroid injection in periarticular disorder. Hyaluronidase seems to have little additive effect on subacromial bursa injection for reducing the dosage of steroid.
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Ischiofemoral impingement syndrome is known as one of the causes of hip pain due to impingement of ischium and femur, and usually correlated with trauma or operation. We report a rare case of ischiofemoral impingement syndrome that has no history of trauma or surgery. A 48-year-old female patient was referred for 2 months history of the left hip pain, radiating to lower extremity with a hip snapping sensation. She had no history of trauma or surgery at or around the hip joint and femur. The magnetic resonance imaging (MRI) of the lumbar spine showed no abnormality, except diffuse bulging disc without cord compression at the lumbosacral area. Electrophysiologic study was normal, and there were no neurologic abnormalities compatible with the lumbosacral radiculopathy or spinal stenosis. Hip MRI revealed quadratus femoris muscle edema with concurrent narrowing of the ischiofemoral space. The distance of ischiofemoral space and quadratus femoris space were narrow. It was compatible with ischiofemoral impingement syndrome. After treatment with nonsteroidal anti-inflammatory drugs, physical therapy, and exercise program, the patient's pain was relieved and the snapping was improved. To our knowledge, this is the first reported case of a nontraumatic, noniatrogenic ischiofemoral impingement syndrome, and also the first case to be treated by a nonsurgical method in the Republic of Korea.
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To investigate the relationship between the shoulder gradient and acromiohumeral interval of both shoulders in patients with unilateral shoulder impingement syndrome.
Using the angulometer, we measured the shoulder gradient in patients with unilateral shoulder impingement syndrome in a standing position. Using the radiography, we measured the acromiohumeral interval and the angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapula.
In patients with unilateral shoulder impingement syndrome, the frequency of shoulder impingement syndrome was 76.2% (16 of 21) on the side of the relatively lower shoulder. The mean acromiohumeral interval on the side of the lower shoulder was 10.03±1.28 mm, compared with 10.46±1.50 mm for the higher shoulder. The angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapular of the side of the lower shoulder was -0.31±3.73 degrees, compared with 3.85±4.42 degrees for the higher shoulder.
The frequency of shoulder impingement syndrome was significantly higher on the side of the relatively lower shoulder, and there is no significant difference in the acromiohumeral interval between the side of the lower shoulder and that of the higher shoulder. In patients with unilateral shoulder impingement syndrome, the scapular on the side of lower shoulder was more rotated downward than on the side of the higher shoulder.
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Objective: The purpose of this study was to evaluate the ultrasonographic (US) findings in the shoulder impingement syndrome and to correlate them with the Hawkins and Kennedy's clinical stages.
Method: 41 patients with suspected shoulder impingement syndrome were evaluated. All patients were divided into 3 clinical groups according to Hawkins and Kennedy and US examination was done in each group.
Results: US findings were as follows. In stage I, there were 3 normal findings, 5 tendinitis of the rotator cuff (RC), 2 partial thickness tear of RC, and 0 full thickness tear of RC. In stage II, 6 normal findings, 13 tendinitis of RC, 3 partial thickness tear of RC and 2 full thickness tear of RC. In stage III, 0 normal findings, 1 tendinitids of RC, 1 partial thickness tear of RC, and 5 full thickness tear of RC.
The most common findings in the tendinits of RC were tendon thickness, focal hypoechogenicity and calcification. In partial thickness tear of RC, focal hypoechogenicity and impingement in abduction were most common findings. In full thickness tear of RC, the irregular humeral head surface and the biceps tendon effusion were most common findings
Conclusion: The ultrasonography is a valuable means of evaluating the shoulder impingement syndrome and its findings have good correlation with clinical stages
Objective: The purpose of this study was to find out the usefulness of ultrasonographic evaluation in shoulder impingement syndrome.
Method: The patients with positive impingement sign (49 patients) at shoulder joint were evaluated. The Ultrasonograms of shoulder were performed at first visit and 4 weeks later. The patients who showed abnormal findings were treated with subacromial steroid injection. In order to check the efficacy of injection, we also used questionnair which consist of active range of motion, shoulder pain score, and visual analogue scale.
Results: 16 among 49 patients (32.7%) had abnormal ultrasonograms as follows; only fluid collection in subacromial bursa was shown in 3 patients (6.1%), only fluid collection in biceps long head tendon sheath in 4 (8.2%), partial thickness tear of supraspinatus tendon (SSP) in 6 (12.2%), and full thickness tear of SSP in 3 (6.1%). Follow-up ultrasonograms were performed after subacromial steroid injection on 4 patients and 3 among the 4 patients showed marked improvement ultrasonographically. 23 among 49 patients were recruited and showed marked improvement in each questionnaire.
Conclusion: Ultrasonography gave good information in management of impingement syndrome furthermore it could be used as a primary imaging technique evaluating rotator cuff disease.
Objective: To study the acromial type, acromial angle, acromial tilt and subacromial distances which known as extrinsic factors of subacromial impingement syndrome in groups of subacromial impingement syndrome and normal control.
Method: The radiography of shoulder named shoulder series composed of AP view, arch view and impingement view was performed in thirty patients with subacromial impingement syndrome and ninety persons with normal adult and we measured the acromial type, acromial angle, acromial tilt, subacromial distances and subacromial spur.
Results: Mean subacromial distances of impingement group were 11.3⁑2.4 mm in AP view, 11.1⁑2.5 mm in arch view and those of normal control group were 11.1⁑2.2 mm in AP view, 10.4⁑1.9 mm in arch view. Incidences of acromial type I,II,III in impingement group were 15 (50%), 10 (33.3%), 5 (16.7%) respectively and those in normal control group were 20 (22.2%), 46 (51.1%), 24 (26.7%) respectively. Incidence of subacromial spur was 19 (63.3%) in impingement group and 52 (57.8%) in normal control group.
Mean subacromial spur size was 10.0⁑5.4 mm in impingement group and 12.4⁑4.5 mm in normal control group. Mean acromial angle was 27.1⁑8.3 degree in impingement group and 29.1⁑8.7 degree in normal control group. Mean acromial tilt was 28.0⁑6.39 degree in impingement group and 31.8⁑3.4 degree in normal control group.
Conclusion: No significant statistical difference between subacromial impingement syndrome group and normal control group in acromial type, acromial angle, acromial tilt and subacromial distance known as extinsic factors of subacromial impingement syndrome
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