Limitation of the External Glenohumeral Joint Rotation is Associated with Subacromial Impingement Syndrome, Especially Pain

Background: Subacromial impingement syndrome is a common disorder associated with functional impairment and disability of the shoulder. Internal/external glenohumeral rotation is important for shoulder function. However, because it is difficult to measure the glenohumeral joint rotation angle physically, the relationship between this angle and the clinical symptoms of subacromial impingement syndrome is still largely unknown. Using advanced cine-magnetic resonance imaging techniques, we designed a study to improve our understanding of the nature of this relationship.

Methods: We evaluated 100 shoulders with subacromial impingement syndrome. Patients underwent cine-magnetic resonance imaging during axial rotation with the arm adducted. During imaging, patients rotated their shoulder from maximum internal rotation to maximum external rotation over 10 seconds and then to maximum internal rotation over 10 seconds. The rotation angles were then evaluated using a series of axial images. The Constant-Murley (Constant) and UCLA scores for each patient were determined, and the correlation between the scores and rotational angles was assessed. Patients were divided into 3 groups according to the Constant pain score, and the rotational angles of each group were compared. Rotational angles were also compared between shoulders with and without night pain.

Results: The external rotation angle showed a significant but low correlation with the Constant and UCLA scores (ρ = 0.24 and 0.24, respectively), whereas the internal rotation angle did not. In comparing the pain groups of Constant score and UCLA score, the external rotation angle significantly decreased as pain increased ( < .01), demonstrating a negative correlation (ρ = -0.47, -0.41, respectively). Additionally, the shoulders of patients with night pain showed significantly more restriction of external rotation angles than the shoulders of those without night pain ( = .01).

Conclusions: Limitation of the glenohumeral joint's external rotation is correlated with pain, for which we explore possible explanations. The results suggest that night pain can be effectively reduced using therapeutic interventions that target external rotational dysfunction.