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Saturday, March 18, 2000

Glenoid-rotator coff contact may cause pain, tearing

Contact of the rotator cuff to the posterior-superior glenoid (internal impingement) has been suggested to be a cause of pain and cuff tearing in athletes, say authors of a study in poster exhibit 326. They observe that rotator cuff makes contact to the glenoid in other positions has not been previously described and that the purpose of their study was to evaluate the prevalence of cuff contact with the arm in a throwing position (ab-ER) and with the arm in flexion (Neer sign).

They found that internal impingement (ab-ER) and contact of the cuff during flexion (Neer sign) are physiological and may not indicate pathological processes. However, they say this does not rule out that contact of the cuff with the glenoid rim is a source of pain with both of these maneuvers. The location of contact in the Neer sign suggests that pain in this position is not due to contact of the cuff to the acromion, but to the glenoid. They suggest that this phenomenon be called "internal contact" and not "internal impingement" unless other criteria are met.

To conduct their study, 80 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated with preoperative histories, physical exams and radiographs prior to undergoing arthroscopy in a lateral position. During arthroscopy the arm was passively elevated in forward flexion and contact of the cuff with the antero-superior glenoid was measured in degrees of arm elevation using a goniometer. Likewise, the arm was placed in ab-ER and the presence or absence of cuff contact was noted and the arm position measured.

The patients included 45 men and 35 women with an average age of 39 years.

Twenty-five percent of the patients were involved in overhead recreational sports. Eighty-six percent of all patients demonstrated internal impingement at an average of 99 degrees abduction and 93 degrees external rotation. On preoperative examination 75 percent of the patients had a positive Neer sign. At arthroscopy, the cuff of 79 percent of patients made contact antero-superiorly (Neer sign) at an average of 124 degrees (+/- 14.5).

Patients with a positive Neer sign preop did not make contact at a statistically different degree than those with a negative test. There was no significant association between contact in flexion or ab-ER by diagnosis, activity level, preoperative range of motion, presence of labral pathology or rotator cuff tear tearing.

Co-authors of the study, all of Johns Hopkins, are Edward G. McFarland, MD, director, division, sports medicine and shoulder surgery, Johns Hopkins Medical Institutions; Carlos Neira, research fellow, sports medicine and shoulder surgery, Johns Hopkins Medical Institutions; and Cheng-Yen Hsu, MD.

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2000 Academy News March 18 Index C

Last modified 24/February/2000 by IS