Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 2, pp 363–369 | Cite as

Supraspinatus tendon and subacromial space parameters measured on ultrasonographic imaging in subacromial impingement syndrome

  • Lori A. MichenerEmail author
  • Sevgi S. Subasi Yesilyaprak
  • Amee L. Seitz
  • Mark K. Timmons
  • Matthew K. Walsworth



To characterize the supraspinatus tendon thickness, subacromial space, and the relationship between tendon thickness and subacromial space to further elucidate the mechanisms of subacromial impingement syndrome.


In a single-blind cross-sectional study, subjects were recruited with subacromial impingement syndrome (n = 20) and asymptomatic controls (n = 20) matched for age, gender, and hand dominance. Ultrasound images were collected using a 4–12-MHz linear transducer in B-mode of the supraspinatus tendon in the transverse (short axis) and the anterior aspect of the subacromial space outlet. Using image callipers, measurements of tendon thickness were taken at 3 points along the tendon and averaged for a single thickness measure. The subacromial space outlet was measured via the acromiohumeral distance (AHD) defined by the inferior acromion and superior humeral head. The occupation ratio was calculated as the tendon thickness as a percentage of AHD.


The subacromial impingement syndrome group had a significantly thicker tendon (mean difference = 0.6 mm, p = 0.048) and a greater tendon occupation ratio (mean difference = 7.5 %, p = 0.014) compared to matched controls. There were no AHD group differences.


The supraspinatus tendon was thicker and occupied a greater percentage of AHD, supporting an intrinsic mechanism. An extrinsic mechanism of tendon compression is theoretically supported, but future imaging studies need to confirm direct compression with elevation. Treatment to reduce tendon thickness may reduce symptoms, and surgical intervention to increase subacromial space may be considered if tendon compression can be verified.


Rotator cuff disease Impingement syndrome Shoulder Tendon Subacromial space 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Azzoni R, Cabitza P (2004) Sonographic versus radiographic measurement of the subacromial space width. Chir Organ Mov 89:143–150Google Scholar
  2. 2.
    Azzoni R, Cabitza P, Parrini M (2004) Sonographic evaluation of subacromial space. Ultrasonics 42:683–687PubMedCrossRefGoogle Scholar
  3. 3.
    Bretzke CA, Crass JR, Craig EV, Feinberg SB (1985) Ultrasonography of the rotator cuff. Normal and pathologic anatomy. Invest Radiol 20:311–315PubMedCrossRefGoogle Scholar
  4. 4.
    Cholewinski JJ, Kusz DJ, Wojciechowski P et al (2008) Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder. Knee Surg Sports Traumatol Arthrosc 16:408–414PubMedCrossRefGoogle Scholar
  5. 5.
    Desmeules F, Minville L, Riederer B et al (2004) Acromio-humeral distance variation measured by ultrasonography and its association with the outcome of rehabilitation for shoulder impingement syndrome. Clin J Sport Med 14:197–205PubMedCrossRefGoogle Scholar
  6. 6.
    Flatow EL, Soslowsky LJ, Ticker JB et al (1994) Excursion of the rotator cuff under the acromion. Patterns of subacromial contact. Am J Sports Med 22:779–788PubMedCrossRefGoogle Scholar
  7. 7.
    Giphart JE, van der Meijden OA, Millett PJ (2012) The effects of arm elevation on the 3-dimensional acromiohumeral distance: a biplane fluoroscopy study with normative data. J Should Elbow Surg 21:1593–1600CrossRefGoogle Scholar
  8. 8.
    Girometti R, De Candia A, Sbuelz M et al (2006) Supraspinatus tendon US morphology in basketball players: correlation with main pathologic models of secondary impingement syndrome in young overhead athletes. Preliminary report. Radiol Med (Torino) 111:42–52CrossRefGoogle Scholar
  9. 9.
    Joensen J, Couppe C, Bjordal JM (2009) Increased palpation tenderness and muscle strength deficit in the prediction of tendon hypertrophy in symptomatic unilateral shoulder tendinopathy: an ultrasonographic study. Physiotherapy 95:83–93PubMedCrossRefGoogle Scholar
  10. 10.
    Juul-Kristensen B, Bojsen-Moller F, Holst E, Ekdahl C (2000) Comparison of muscle sizes and moment arms of two rotator cuff muscles measured by ultrasonography and magnetic resonance imaging. Eur J Ultrasound 11:161–173PubMedCrossRefGoogle Scholar
  11. 11.
    Kalra N, Seitz AL, Boardman ND III, Michener LA (2010) Effect of posture on acromiohumeral distance with arm elevation in subjects with and without rotator cuff disease using ultrasonography. J Orthop Sports Phys Ther 40:633–640PubMedCrossRefGoogle Scholar
  12. 12.
    Leggin BG, Michener LA, Shaffer MA et al (2006) The Penn shoulder score: reliability and validity. J Orthop Sports Phys Ther 36:138–151PubMedCrossRefGoogle Scholar
  13. 13.
    Leong HT, Tsui S, Ying M et al (2012) Ultrasound measurements on acromiohumeral distance and supraspinatus tendon thickness: test-retest reliability and correlations with shoulder rotational strengths. J Sci Med Sport 15:284–291PubMedCrossRefGoogle Scholar
  14. 14.
    Malanga GA, Chu SK, Ramirez Del TJ et al (2012) Sonographic evaluation of supraspinatus cross-sectional area in collegiate baseball players. PM R 4:488–492PubMedCrossRefGoogle Scholar
  15. 15.
    Michener LA, McClure PW, Karduna AR (2003) Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon) 18:369–379CrossRefGoogle Scholar
  16. 16.
    Michener LA, Walsworth MK, Doukas WC, Murphy KP (2009) Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil 90:1898–1903PubMedCrossRefGoogle Scholar
  17. 17.
    Neer CS (1983) Impingement lesions. Clin Orthop Relat Res 3(173):70–77 Google Scholar
  18. 18.
    Pijls BG, Kok FP, Penning LI et al (2010) Reliability study of the sonographic measurement of the acromiohumeral distance in symptomatic patients. J Clin Ultrasound 38:128–134PubMedGoogle Scholar
  19. 19.
    Seitz AL, McClure PW, Finucane S et al (2012) The scapular assistance test results in changes in scapular position and subacromial space but not rotator cuff strength in subacromial impingement. J Orthop Sports Phys Ther 42:400–412PubMedCrossRefGoogle Scholar
  20. 20.
    Seitz AL, Michener LA (2011) Ultrasonographic measures of subacromial space in patients with rotator cuff disease: a systematic review. J Clin Ultrasound 39:146–154PubMedCrossRefGoogle Scholar
  21. 21.
    Thompson MD, Landin D, Page PA (2011) Dynamic acromiohumeral interval changes in baseball players during scaption exercises. J Shoulder Elbow Surg 20:251–258PubMedCrossRefGoogle Scholar
  22. 22.
    Wallny T, Wagner UA, Prange S et al (1999) Evaluation of chronic tears of the rotator cuff by ultrasound. A new index. J Bone Joint Surg Br 81:675–678PubMedCrossRefGoogle Scholar
  23. 23.
    Wang HK, Lin JJ, Pan SL, Wang TG (2005) Sonographic evaluations in elite college baseball athletes. Scand J Med Sci Sports 15:29–35PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Lori A. Michener
    • 1
    Email author
  • Sevgi S. Subasi Yesilyaprak
    • 2
  • Amee L. Seitz
    • 3
  • Mark K. Timmons
    • 1
  • Matthew K. Walsworth
    • 4
  1. 1.COOR Laboratory, Department of Physical TherapyVirginia Commonwealth UniversityRichmondUSA
  2. 2.School of Physical Therapy and RehabilitationDokuz Eylül UniversityIzmirTurkey
  3. 3.Physical Therapy Department, Bouve College of Health ScienceNortheastern UniversityBostonUSA
  4. 4.Department of RadiologyUniversity of California Los AngelesLos AngelesUSA

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