Abstract
Previous studies demonstrate that scapulohumeral mechanics improve after subacromial injection. However, it is unclear how injection affects muscle firing. Forty-one subjects with two-tendon rotator cuff tears and 23 volunteer subjects with normal rotator cuffs documented by ultrasonography were examined. Electromyographic activity from 12 muscles was collected during ten functional tasks. Nine symptomatic subjects with rotator cuff tears underwent subacromial injection of anesthetic and underwent repeat electromyographic examination. Subjects with rotator cuff tears demonstrate global electromyographic differences when compared to normal controls. Asymptomatic subjects with rotator cuff tears had significantly increased anterior deltoid firing when compared to symptomatic counterparts during forward shoulder elevation. After subacromial injection, symptomatic subjects demonstrate increased anterior deltoid firing. Previous in vitro and in vivo studies have suggested that pain leads to deltoid inhibition and that subacromial injection leads to improved deltoid firing and, subsequently, improved shoulder function. This study provides direct evidence that subacromial injection improves deltoid firing in symptomatic subjects with rotator cuff tears. These findings reinforce the concept that deltoid inhibition resulting from pain is an important component of the motor disability associated with rotator cuff tears.
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Acknowledgments
The authors gratefully acknowledge the assistance of Mark W. Lenhoff and Brian S. Pansy for data analysis; Ronald S. Adler MD for musculoskeletal imaging and interpretation; David W. Altchek MD, Russell F. Warren MD, Edward V. Craig MD, and Thomas L. Wickiewicz MD for their suggestions for study improvement and patient contributions; Daniel E. Weiland MD and Samuel P. Robinson MD for early project development and patient recruitment; and previous sports fellows Eric L. Chehab MD, Aimee S. Klapach MD, William M. Isbell MD, Daniel P. Tomlinson MD, and Nikhil N. Verma MD for their involvement in patient recruitment.
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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained.
This study was performed at Leon Root, M.D. Motion Analysis Laboratory, Hospital for Special Surgery, 510 East 73rd Street, New York, NY 10021, USA.
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Cordasco, F.A., Chen, N.C., Backus, S.I. et al. Subacromial Injection Improves Deltoid Firing in Subjects with Large Rotator Cuff Tears. HSS Jrnl 6, 30–36 (2010). https://doi.org/10.1007/s11420-009-9127-6
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DOI: https://doi.org/10.1007/s11420-009-9127-6