Tim Leschinger1,2, Christopher Wallraff3, Dirk Müller4, Matthias Hackenbroch5, Henning Bovenschulte6, Jan Siewe3. 1. Center for Orthopedic and Trauma Surgery, University Medical Center, Joseph-Stelzmann-Str. 24, 50937, Cologne, Germany. tim.leschinger@uk-koeln.de. 2. Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany. tim.leschinger@uk-koeln.de. 3. Center for Orthopedic and Trauma Surgery, University Medical Center, Joseph-Stelzmann-Str. 24, 50937, Cologne, Germany. 4. Department of Radiology, University Hospital of Cologne, Cologne, Germany. 5. Center of Radiology Euskirchen, Euskirchen, Germany. 6. PAN Clinic Cologne, Cologne, Germany.
Abstract
BACKGROUND: Understanding the mechanisms of shoulder impingement created by clinical tests is crucial to accurately evaluate the condition. The objective of this study was to relate mechanisms of subacromial and coracoid impingement occurring in positions of the shoulder during clinical examination, in quantitative and qualitative terms. METHODS: A 1.0T open magnetic resonance imaging system was used in 18 female and 19 male subjects, to determine the distances between the humeral head and the acromion or coracoid, and contact with the rotator cuff (RC). Measurements were taken with the shoulder in neutral, "Hawkins", "Neer", and 90° abduction/15° internal rotation (horizontal impingement test) positions. Additionally, impingement was classified based on the grade of RC contact with the acromion or coracoid. RESULTS: In the Hawkins position, distance between the supraspinatus and the coracoid was closest (14.5 ± 4.5 mm), while the coracohumeral distance (CHD) narrowed (p < 0.001). In the horizontal impingement test position, the minimum distance between the subscapularis and coracoid was found, whereas the CHD increased (27.4 ± 5.7 mm). In the Neer and Hawkins positions, the space between the greater tuberosity and acromion was significantly narrowed, which was also the case in the horizontal impingement test position compared to neutral position (p < 0.001). CONCLUSION: Shoulder movements of forward flexion and internal rotation (Hawkins test) and abduction and internal rotation (horizontal impingement test) can lead to different coracoid impingement mechanisms during clinical examination. The Hawkins, Neer, and horizontal impingement tests lead to comparable narrowed acromiohumeral distances and subacromial contact of the RC. LEVEL OF EVIDENCE: Therapeutic level III.
BACKGROUND: Understanding the mechanisms of shoulder impingement created by clinical tests is crucial to accurately evaluate the condition. The objective of this study was to relate mechanisms of subacromial and coracoid impingement occurring in positions of the shoulder during clinical examination, in quantitative and qualitative terms. METHODS: A 1.0T open magnetic resonance imaging system was used in 18 female and 19 male subjects, to determine the distances between the humeral head and the acromion or coracoid, and contact with the rotator cuff (RC). Measurements were taken with the shoulder in neutral, "Hawkins", "Neer", and 90° abduction/15° internal rotation (horizontal impingement test) positions. Additionally, impingement was classified based on the grade of RC contact with the acromion or coracoid. RESULTS: In the Hawkins position, distance between the supraspinatus and the coracoid was closest (14.5 ± 4.5 mm), while the coracohumeral distance (CHD) narrowed (p < 0.001). In the horizontal impingement test position, the minimum distance between the subscapularis and coracoid was found, whereas the CHD increased (27.4 ± 5.7 mm). In the Neer and Hawkins positions, the space between the greater tuberosity and acromion was significantly narrowed, which was also the case in the horizontal impingement test position compared to neutral position (p < 0.001). CONCLUSION: Shoulder movements of forward flexion and internal rotation (Hawkins test) and abduction and internal rotation (horizontal impingement test) can lead to different coracoid impingement mechanisms during clinical examination. The Hawkins, Neer, and horizontal impingement tests lead to comparable narrowed acromiohumeral distances and subacromial contact of the RC. LEVEL OF EVIDENCE: Therapeutic level III.
Authors: George P Pappas; Silvia S Blemker; Christopher F Beaulieu; Timothy R McAdams; Sean T Whalen; Garry E Gold Journal: J Shoulder Elbow Surg Date: 2006 Jan-Feb Impact factor: 3.019
Authors: Nobuyuki Yamamoto; Takayuki Muraki; John W Sperling; Scott P Steinmann; Eiji Itoi; Robert H Cofield; Kai-Nan An Journal: J Shoulder Elbow Surg Date: 2009-05-07 Impact factor: 3.019
Authors: Tim Leschinger; Christopher Wallraff; Dirk Müller; Matthias Hackenbroch; Henning Bovenschulte; Jan Siewe Journal: Biomed Res Int Date: 2017-08-20 Impact factor: 3.411
Authors: Mehmet Cetinkaya; Muhammet Baybars Ataoglu; Mustafa Ozer; Tacettin Ayanoglu; Ali Yusuf Oner; Ulunay Kanatli Journal: Acta Orthop Traumatol Turc Date: 2018-02-13 Impact factor: 1.511