A new pathophysiology of atraumatic rotator cuff tears: adduction restriction of the glenohumeral joint
Background: The pathophysiology of atraumatic rotator cuff tears (ATTs) has not been fully understood. Adduction restriction of the glenohumeral joint can cause pain and disability in patients with ATTs. We aimed to use our adduction test (pushing the humerus toward the side in the coronal plane wit...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-06-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638320300244 |
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| author | Yuichiro Yano, MD, PhD Junichiro Hamada, MD, PhD Yoshihiro Hagiwara, MD, PhD Hiroshi Karasuno, RPT, PhD Kazuya Tamai, MD, PhD Kazuaki Suzuki, MD |
| author_facet | Yuichiro Yano, MD, PhD Junichiro Hamada, MD, PhD Yoshihiro Hagiwara, MD, PhD Hiroshi Karasuno, RPT, PhD Kazuya Tamai, MD, PhD Kazuaki Suzuki, MD |
| author_sort | Yuichiro Yano, MD, PhD |
| collection | DOAJ |
| description | Background: The pathophysiology of atraumatic rotator cuff tears (ATTs) has not been fully understood. Adduction restriction of the glenohumeral joint can cause pain and disability in patients with ATTs. We aimed to use our adduction test (pushing the humerus toward the side in the coronal plane with scapular fixation) to fluoroscopically measure the glenohumeral adduction angle (GAA) and to assess the effectiveness of adduction manipulation. Materials and methods: Fifty-five patients with ATTs were included in the study. The GAAs of the patients vs. healthy subjects without ATTs were measured fluoroscopically and compared. During the test, patients showed restriction and expressed pain. The visual analog scale (VAS) score, passive range of motion (ROM), and the American Shoulder and Elbow Surgeons score at the initial visit were compared with those after adduction manipulation. Results: Of the patients, 41 (75%) had positive adduction test results. A higher percentage of positive adduction test results was observed in smaller tears. The average GAA was –21.4° on the affected side, which was smaller than that on the unaffected side, at –2.8° (P < .001), and that in healthy subjects, at 4.8° (P < .001). After manipulation, the GAA was –0.8° (P < .001) and the VAS score, the American Shoulder and Elbow Surgeons score, and all ROM values significantly improved up to the level on the unaffected side. Conclusion: Adduction restriction of the glenohumeral joint was identified in 75% of all the patients with ATTs. Adduction manipulation significantly reduces the VAS score and restores the ROM. Adduction restriction is considered a crucial pathophysiology of ATTs. |
| first_indexed | 2024-12-17T07:49:44Z |
| format | Article |
| id | doaj.art-3594a7568fab4ebe8ecbca5ceccd9a6d |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-12-17T07:49:44Z |
| publishDate | 2020-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-3594a7568fab4ebe8ecbca5ceccd9a6d2022-12-21T21:57:53ZengElsevierJSES International2666-63832020-06-0142333340A new pathophysiology of atraumatic rotator cuff tears: adduction restriction of the glenohumeral jointYuichiro Yano, MD, PhD0Junichiro Hamada, MD, PhD1Yoshihiro Hagiwara, MD, PhD2Hiroshi Karasuno, RPT, PhD3Kazuya Tamai, MD, PhD4Kazuaki Suzuki, MD5Department of Orthopaedic Surgery, Tochigi Medical Center, Tochigi, JapanDepartment of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, Fukushima, Japan; Corresponding author: Junichiro Hamada, MD, PhD, Department of Orthopaedic Surgery, Kuwano Kyoritsu Hospital, 2-9-18 Shima, Koriyama, Fukushima, 963-8034, Japan.Department of Orthopaedic Surgery, Tohoku University, Miyagi, JapanDepartment of Physical Therapy, Josai International University, Chiba, JapanDepartment of Orthopaedic Surgery, Tohto Bunkyo Hospital, Tokyo, JapanDepartment of Orthopaedic Surgery, East Japan Railway Sendai Hospital, Miyagi, JapanBackground: The pathophysiology of atraumatic rotator cuff tears (ATTs) has not been fully understood. Adduction restriction of the glenohumeral joint can cause pain and disability in patients with ATTs. We aimed to use our adduction test (pushing the humerus toward the side in the coronal plane with scapular fixation) to fluoroscopically measure the glenohumeral adduction angle (GAA) and to assess the effectiveness of adduction manipulation. Materials and methods: Fifty-five patients with ATTs were included in the study. The GAAs of the patients vs. healthy subjects without ATTs were measured fluoroscopically and compared. During the test, patients showed restriction and expressed pain. The visual analog scale (VAS) score, passive range of motion (ROM), and the American Shoulder and Elbow Surgeons score at the initial visit were compared with those after adduction manipulation. Results: Of the patients, 41 (75%) had positive adduction test results. A higher percentage of positive adduction test results was observed in smaller tears. The average GAA was –21.4° on the affected side, which was smaller than that on the unaffected side, at –2.8° (P < .001), and that in healthy subjects, at 4.8° (P < .001). After manipulation, the GAA was –0.8° (P < .001) and the VAS score, the American Shoulder and Elbow Surgeons score, and all ROM values significantly improved up to the level on the unaffected side. Conclusion: Adduction restriction of the glenohumeral joint was identified in 75% of all the patients with ATTs. Adduction manipulation significantly reduces the VAS score and restores the ROM. Adduction restriction is considered a crucial pathophysiology of ATTs.http://www.sciencedirect.com/science/article/pii/S2666638320300244Atraumatic rotator cuff tearsglenohumeral jointadduction restrictionadduction testadduction manipulationcoracohumeral ligament |
| spellingShingle | Yuichiro Yano, MD, PhD Junichiro Hamada, MD, PhD Yoshihiro Hagiwara, MD, PhD Hiroshi Karasuno, RPT, PhD Kazuya Tamai, MD, PhD Kazuaki Suzuki, MD A new pathophysiology of atraumatic rotator cuff tears: adduction restriction of the glenohumeral joint JSES International Atraumatic rotator cuff tears glenohumeral joint adduction restriction adduction test adduction manipulation coracohumeral ligament |
| title | A new pathophysiology of atraumatic rotator cuff tears: adduction restriction of the glenohumeral joint |
| title_full | A new pathophysiology of atraumatic rotator cuff tears: adduction restriction of the glenohumeral joint |
| title_fullStr | A new pathophysiology of atraumatic rotator cuff tears: adduction restriction of the glenohumeral joint |
| title_full_unstemmed | A new pathophysiology of atraumatic rotator cuff tears: adduction restriction of the glenohumeral joint |
| title_short | A new pathophysiology of atraumatic rotator cuff tears: adduction restriction of the glenohumeral joint |
| title_sort | new pathophysiology of atraumatic rotator cuff tears adduction restriction of the glenohumeral joint |
| topic | Atraumatic rotator cuff tears glenohumeral joint adduction restriction adduction test adduction manipulation coracohumeral ligament |
| url | http://www.sciencedirect.com/science/article/pii/S2666638320300244 |
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