Rotator Cuff Tears in Hemiplegic Shoulder - Full Text View

Purpose

The purpose of the study is to evaluate the prevalence of rotator cuff tears in the shoulders of hemiplegic patients of different severity.

Condition
Hemiplegia

Study Type:	Observational
Study Design:	Observational Model: Case-Only Time Perspective: Cross-Sectional
Official Title:	Observational Study to Evaluate the Prevalence of Rotator Cuff Tears in Hemiplegic Shoulders

Further study details as provided by Seoul National University Hospital:

Primary Outcome Measures:

Rotator Cuff Tear of the Hemiplegic Shoulder, Confirmed by Ultrasonography [ Time Frame: within one month after enrollment ] [ Designated as safety issue: No ]
All patients underwent ultrasonography (USG) for the both, affected and unaffected, shoulders. USG routinely examined biceps, subscapularis, supraspinatus, and infraspinatus tendons as for the partial or complete tears, calcifications, bony irregularity and bursal swellings.

Secondary Outcome Measures:

Rotator Cuff Tear of the Unaffected Shoulder, Confirmed by Ultrasonography [ Time Frame: within one month after enrollment ] [ Designated as safety issue: No ]
All patients were performed ultrasonography (USG) for the both, affected and unaffected, shoulders. USG routinely examined biceps, subscapularis, supraspinatus, and infraspinatus tendons as for the partial or complete tears, calcifications, bony irregularity and bursal swellings.
Subluxation of the Glenohumeral Joint, Confirmed by Physical Examination [ Time Frame: within one month after enrollment ] [ Designated as safety issue: No ]
The glenohumeral joint subluxation was examined by palpating the subacromial regions of the both sides and comparing the affected side with the unaffected side while patients are seated and relaxed. If the palpated space between the acromion and the humeral head was wider on the affected side by one half finger breath or more, it was judged to be subluxation.
Muscle Strength, Measured by Physical Examination, Per Medical Research Council Muscle Strength Grading System [ Time Frame: within one month after enrollment ] [ Designated as safety issue: No ]
Muscle strength was measured for forward flexion and abduction of the shoulder per Medical Research Council (MRC) scale in each participants. Their mean +/- SD were calculated in each group.

MRC scale:

Grade 5: Normal and can move against full resistance. Grade 4: Reduced but can move against resistance. Grade 3: Can move only against gravity Grade 2: Can move without gravity Grade 1: Only a trace of movement Grade 0: No movement.

Enrollment:	51
Study Start Date:	January 2008
Study Completion Date:	August 2010
Primary Completion Date:	April 2010 (Final data collection date for primary outcome measure)

Groups/Cohorts
hemiplegia patients with hemiplegia, without other musculoskeletal disorders of the shoulder

Detailed Description:

Rotator cuff tears are often suspected to contribute hemiplegic shoulder pain. However, it is controversial whether their incidence increases in hemiplegia. Based on the postulate that muscle weakness in hemiplegia predisposes rotator cuff injury due to biomechanical failure, this study aims to investigate whether the rotator cuff tears are associated with the muscle strength of the shoulder by observing hemiplegic shoulders of varying degree of paresis.

Eligibility

Ages Eligible for Study:	20 Years to 90 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No
Sampling Method:	Probability Sample

Study Population

university hospital, department of rehabilitation medicine admitted patients due to hemiplegia

Criteria

Inclusion Criteria:

hemiplegia; unilateral weakness of sudden onset
secondary to strokes or other brain lesions
compatible with brain lesions confirmed by imaging studies

Exclusion Criteria:

bilateral weakness
any history of intensive trauma of the shoulder, reported
preexisting musculoskeletal disorder of the shoulder

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00998868

Locations

Korea, Republic of
Seoul National University Hospital
Seoul, Korea, Republic of

Sponsors and Collaborators

Seoul National University Hospital

Investigators

Principal Investigator:

Tai Ryoon Han, MD, PhD

Seoul National University College of Medicine

More Information

Publications:

Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJ. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl. 2006 Mar;88(2):116-21. Review.

Sano H, Ishii H, Trudel G, Uhthoff HK. Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: a comparative study with human cadaveric shoulders. J Shoulder Elbow Surg. 1999 Nov-Dec;8(6):574-9.

Yu D. Shoulder pain in hemiplegia. Phys Med Rehabil Clin N Am. 2004 Aug;15(3):vi-vii, 683-97.

Bender L, McKenna K. Hemiplegic shoulder pain: defining the problem and its management. Disabil Rehabil. 2001 Nov 10;23(16):698-705. Review.

Gilmore PE, Spaulding SJ, Vandervoort AA. Hemiplegic shoulder pain: implications for occupational therapy treatment. Can J Occup Ther. 2004 Feb;71(1):36-46. Review.

Van Ouwenaller C, Laplace PM, Chantraine A. Painful shoulder in hemiplegia. Arch Phys Med Rehabil. 1986 Jan;67(1):23-6.

Joynt RL. The source of shoulder pain in hemiplegia. Arch Phys Med Rehabil. 1992 May;73(5):409-13.

Hakuno A, Sashika H, Ohkawa T, Itoh R. Arthrographic findings in hemiplegic shoulders. Arch Phys Med Rehabil. 1984 Nov;65(11):706-11.

Rizk TE, Christopher RP, Pinals RS, Salazar JE, Higgins C. Arthrographic studies in painful hemiplegic shoulders. Arch Phys Med Rehabil. 1984 May;65(5):254-6.

Lo SF, Chen SY, Lin HC, Jim YF, Meng NH, Kao MJ. Arthrographic and clinical findings in patients with hemiplegic shoulder pain. Arch Phys Med Rehabil. 2003 Dec;84(12):1786-91.

Najenson T, Yacubovich E, Pikielni SS. Rotator cuff injury in shoulder joints of hemiplegic patients. Scand J Rehabil Med. 1971;3(3):131-7. No abstract available.

Nepomuceno CS, Miller JM 3rd. Shoulder arthrography in hemiplegic patients. Arch Phys Med Rehabil. 1974 Feb;55(2):49-51. No abstract available.

Wolff AB, Sethi P, Sutton KM, Covey AS, Magit DP, Medvecky M. Partial-thickness rotator cuff tears. J Am Acad Orthop Surg. 2006 Dec;14(13):715-25.

Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. 1972. J Bone Joint Surg Am. 2005 Jun;87(6):1399.

MacGillivray JD, Fealy S, Potter HG, O'Brien SJ. Multiplanar analysis of acromion morphology. Am J Sports Med. 1998 Nov-Dec;26(6):836-40.

Wang JC, Horner G, Brown ED, Shapiro MS. The relationship between acromial morphology and conservative treatment of patients with impingement syndrome. Orthopedics. 2000 Jun;23(6):557-9.

Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983 Mar;(173):70-7. No abstract available.

Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006 Aug;88(8):1699-704.

Jobe CM. Superior glenoid impingement. Orthop Clin North Am. 1997 Apr;28(2):137-43.

Blevins FT. Rotator cuff pathology in athletes. Sports Med. 1997 Sep;24(3):205-20. Review.

Soslowsky LJ, Thomopoulos S, Tun S, Flanagan CL, Keefer CC, Mastaw J, Carpenter JE. Neer Award 1999. Overuse activity injures the supraspinatus tendon in an animal model: a histologic and biomechanical study. J Shoulder Elbow Surg. 2000 Mar-Apr;9(2):79-84.

Perry SM, McIlhenny SE, Hoffman MC, Soslowsky LJ. Inflammatory and angiogenic mRNA levels are altered in a supraspinatus tendon overuse animal model. J Shoulder Elbow Surg. 2005 Jan-Feb;14(1 Suppl S):79S-83S.

Lohr JF, Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res. 1990 May;(254):35-8.

Rothman RH, Parke WW. The vascular anatomy of the rotator cuff. Clin Orthop Relat Res. 1965 Jul-Aug;41:176-86. No abstract available.

Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970 Aug;52(3):540-53. No abstract available.

Yuan J, Murrell GA, Wei AQ, Wang MX. Apoptosis in rotator cuff tendonopathy. J Orthop Res. 2002 Nov;20(6):1372-9.

Yuan J, Murrell GA, Trickett A, Wang MX. Involvement of cytochrome c release and caspase-3 activation in the oxidative stress-induced apoptosis in human tendon fibroblasts. Biochim Biophys Acta. 2003 Jun 17;1641(1):35-41.

Yuan J, Murrell GA, Trickett A, Landtmeters M, Knoops B, Wang MX. Overexpression of antioxidant enzyme peroxiredoxin 5 protects human tendon cells against apoptosis and loss of cellular function during oxidative stress. Biochim Biophys Acta. 2004 Jul 23;1693(1):37-45.

Bonita R, Beaglehole R. Recovery of motor function after stroke. Stroke. 1988 Dec;19(12):1497-500.

Soslowsky LJ, Malicky DM, Blasier RB. Active and passive factors in inferior glenohumeral stabilization: a biomechanical model. J Shoulder Elbow Surg. 1997 Jul-Aug;6(4):371-9.

Ovesen J, Nielsen S. Experimental distal subluxation in the glenohumeral joint. Arch Orthop Trauma Surg. 1985;104(2):78-81.

Halder AM, Halder CG, Zhao KD, O'Driscoll SW, Morrey BF, An KN. Dynamic inferior stabilizers of the shoulder joint. Clin Biomech (Bristol, Avon). 2001 Feb;16(2):138-43.

Niessen M, Janssen T, Meskers C, Koppe P, Konijnenbelt M, Veeger D. Kinematics of the contralateral and ipsilateral shoulder: a possible relationship with post-stroke shoulder pain. J Rehabil Med. 2008 Jun;40(6):482-6.

Diederichsen LP, Nørregaard J, Dyhre-Poulsen P, Winther A, Tufekovic G, Bandholm T, Rasmussen LR, Krogsgaard M. The activity pattern of shoulder muscles in subjects with and without subacromial impingement. J Electromyogr Kinesiol. 2009 Oct;19(5):789-99. Epub 2008 Dec 4.

Gold GE, Pappas GP, Blemker SS, Whalen ST, Campbell G, McAdams TA, Beaulieu CF. Abduction and external rotation in shoulder impingement: an open MR study on healthy volunteers initial experience. Radiology. 2007 Sep;244(3):815-22. Epub 2007 Aug 9.

Pong YP, Wang LY, Wang L, Leong CP, Huang YC, Chen YK. Sonography of the shoulder in hemiplegic patients undergoing rehabilitation after a recent stroke. J Clin Ultrasound. 2009 May;37(4):199-205.

Kim HA, Kim SH, Seo YI. Ultrasonographic findings of painful shoulders and correlation between physical examination and ultrasonographic rotator cuff tear. Mod Rheumatol. 2007;17(3):213-9. Epub 2007 Jun 20.

Responsible Party:	Sun Gun Chung, Professor, Seoul National University Hospital
ClinicalTrials.gov Identifier:	NCT00998868 History of Changes
Other Study ID Numbers:	SNUH-RM-TRHan-RCTHS-01
Study First Received:	October 20, 2009
Results First Received:	August 15, 2010
Last Updated:	September 23, 2011
Health Authority:	Korea: Food and Drug Administration Korea: Ministry for Health, Welfare and Family Affairs

Keywords provided by Seoul National University Hospital:

Rotator Cuff
Tendinopathy
ultrasonography

Additional relevant MeSH terms:

Hemiplegia
Paralysis
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms

ClinicalTrials.gov processed this record on May 16, 2013