Sunday, April 16, 2017

CPR for Shoulder Pain but Responds Well After C/S or T/S Manipulation

Boyles et al.38 demonstrated that thoracic manipulation resulted in a statistically significant decrease in self-reported pain and disability in patients with shoulder impingement syndrome at 48 hours follow-up. Finally, Mintken et al.39 were able to develop a CPR for patients with a primary complaint of shoulder pain who demonstrated rapid improvement in pain and disability following cervical and thoracic spine manipulation. The prospective single-arm trial found if three out of five prognostic variables were present

1. Pain-free Shoulder flexion <127°
2. Shoulder internal rotation <53° at 90° of abduction
3. Negative Neer test
4. No medication use for their shoulder pain
5. Symptoms <90 days),

The chance of experiencing rapid improvement following manipulation improved from 61 to 89% (positive likelihood ratio = 5.3).39

Acromial Types 各種形狀的 Acromion


Reference 本文出處:  https://radiopaedia.org/articles/acromial-types

The shape of the acromion had been initially divided into three types (which was known as the Bigliani classification) 3, to which a fourth has been added 2. They are useful as a standardised way of describing the acromion, as well as predicting to a degree the incidence of impingement.
Acromion其實一開始有分三種型式,後來才加上了第四種。如此的分類在臨床上的使用,使其是能夠將之標準化後,變得在看 Impingement syndromes 能夠更有效地去推測。


分類
Classification

This classification was initially proposed by Bigliani et al in 1986 on outlet view radiographs, and later modified by Kitay et al 7 and Vanarthos et al in 1995, which remains the most widely accepted classification at time of writing (July 2016).
Acromion morphology (types) are based on sagittal oblique MRI:

如此的分類方法一開始是由 Bigliani 於1986年所提出的。之後也曾經在1995年被Kitay et al 7 and Vanarthos 等學者重新修訂過,也是最廣泛被使用且接受的。Acromion 的形體學是要在MRI 的sagittal oblique 的角度之下才看得出來。



http://musculoskeletalkey.com/wp-content/uploads/2016/06/F000055f005-008-9781455709779.jpg

  1. flat inferiorly (12%) 6
  2. curved (56%)
    • parallel to the humeral head with a concave undersurface 
    • considered most common type 3
  3. hooked (29%)
    • the most anterior portion of the acromion has a hooked shape
    • associated with increased incidence of shoulder impingement
  4. convex (upturned) (3%)
    • most recent classification of acromion process shape
    • the undersurface of the acromion is convex near the distal end 4
    • no convincing correlation between a type 4 acromion and impingement syndrome exists 4, 5