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Subacromiale klachten [evidence statement]

A.1 Pathofysiologie

Zie ook noot 1 - Aangenomen wordt dat acute of langdurige overbelasting van ‘weke delen’ in de subacromiale regio aanleiding geeft tot lokale weefselbeschadiging en aseptische ontsteking met zwelling en pijn. Histologisch onderzoek laat zien dat er meestal sprake is van een tendinose (verstoring van de continuïteit van het peesweefsel) en geen tendinitis, zoals vaak gedacht (Kahn et al., 2002).

Een tendinose kan ook symptoomloos verlopen en het is dan ook beter om te spreken van een tendinopathie als generieke term voor pijnlijke pezen (Maffulli, 1998). Neer (1972) beschreef 3 stadia van impingement, waarbij de klachten evolueren van reversibele peespathologie op jonge leeftijd tot irreversibele rotatorcuffrupturen op oudere leeftijd (noot 1). Volgens de huidige inzichten kunnen tendinopathieën van pezen en/of de bursa op den duur leiden tot rotatorcuffrupturen (Stevenson & Trojian, 2002).

Noot 1 Stadia impingement

Noot 1

Neer (1972) heeft 3 stadia van impingement beschreven:

  • In stadium I is sprake van een aseptische ontsteking: dit stadium komt vooral bij patiënten jonger dan 25 jaar.
  • In stadium II is er sprake van fibrosering en irreversibele veranderingen in de pees: dit stadium komt vooral voor bij patiënten van 25-40 jaar.
  • Stadium III komt in het algemeen voor bij patiënten ouder dan 40 jaar. In dit stadium wordt een peesscheur frequent gezien, bij vaak langer bestaande fibrose en tendinopathie van de pees. 
    • Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. Br J Sports Med. 2007;41(4):200-10.
    • Aktas I, Akgun K, Cakmak B. Therapeutic effect of pulsed electromagnetic field in conservative treatment of subacromial impingement syndrome. Clin Rheumatol. 2007;26(8):1234-9.
    • Bahr R, Fossan B, Loken S, Engebretsen L. Surgical treatment compared with eccentric training for patellar tendinopathy (Jumper`s Knee). A randomized, controlled trial. J Bone Joint Surg Am. 2006;88(8):1689-98.
    • Beurskens AJ, Vet HC de, Koke AJ. Responsiveness of functional status in low back pain: a comparison of different instruments. Pain. 1996;65(1):71-6.
    • Bingol U, Altan L, Yurtkuran M. Low-power laser treatment for shoulder pain. Photomed Laser Surg. 2005;23(5):459-64.
    • Borstad JD, Ludewig PM. Comparison of three stretches for the pectoralis minor muscle. J Shoulder Elbow Surg. 2006;15(3):324-30.
    • Brox JI, Staff PH, Ljunggren AE, Brevik JI. Arthroscopic surgery compared with supervised exercises in patients with rotator cuff disease (stage II impingement syndrome). BMJ. 1993;307(6909):899-903.
    • Cacchio A, Paoloni M, Barile A, Don R, Paulis F de, Calvisi V, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther. 2006;86(5):672-82.
    • Cools AM, Cambier D, Witvrouw EE. Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Br J Sports Med. 2008;42(8):628-35.
    • Cools AM, Walraven M. Oefentherapie bij schouderaandoeningen. Antwerpen: Standaard Uitgeverij; 2006.
    • Desmeules F, Cote CH, Fremont P. Therapeutic exercise and orthopedic manual therapy for impingement syndrome: a systematic review. Clin J Sport Med. 2003;13(3):176-82.
    • Dickens VA, Williams JL, Bahmra MS. Role of physiotherapy in the treat-ment of subacromial impingement syndrome: a prospective study. Physiotherapy. 2005;91:159-64.
    • Ebenbichler GR, Erdogmus CB, Resch KL, Funovics MA, Kainberger F, Barisani G, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med. 1999;340(20):1533-8.
    • Ejnisman B, Andreoli CV, Soares BG, Fallopa F, Peccin MS, Abdalla RJ, et al. Interventions for tears of the rotator cuff in adults. Cochrane Database Syst Rev. 2004(1):CD002758.
    • Gerdesmeyer L, Wagenpfeil S, Haake M, Maier M, Loew M, Wortler K, et al. Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290(19):2573-80.
    • Giombini A, Di Cesare A, Safran MR, Ciatti R, Maffulli N. Short-term effectiveness of hyperthermia for supraspinatus tendinopathy in athletes: a short-term randomized controlled study. Am J Sports Med. 2006;34(8):1247-53.
    • Gosens T, Hofstee DJ. Calcifying tendinitis of the shoulder: advances in imaging and management. Curr Rheumatol Rep. 2009;11(2):129-34.
    • Graichen H, Hinterwimmer S, Eisenhart-Rothe R von, Vogl T, Englmeier KH, Eckstein F. Effect of abducting and adducting muscle activity on glenohumeral translation, scapular kinematics and subacromial space width in vivo. J Biomech. 2005;38(4):755-60.
    • Grant HJ, Arthur A, Pichora DR. Evaluation of interventions for rotator cuff pathology: a systematic review. J Hand Ther. 2004;17(2):274-99.
    • Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003(2):CD004258.
    • Haahr JP, Ostergaard S, Dalsgaard J, Norup K, Frost P, Lausen S, et al. Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis. 2005;64(5):760-4.
    • Harniman E, Carette S, Kennedy C, Beaton D. Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther. 2004;17(2):132-51.
    • Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, 3rd, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests (Discussion 92). Br J Sports Med. 2008;42(2):80-92.
    • Hinterwimmer S, Eisenhart-Rothe R von, Siebert M, Putz R, Eckstein F, Vogl T, et al. Influence of adducting and abducting muscle forces on the subacromial space width. Med Sci Sports Exerc. 2003;35(12):2055-9.
    • Hughes PC, Taylor NF, Green RA. Most clinical tests cannot accurately diagnose rotator cuff pathology: a systematic review. Aust J Physiother. 2008;54(3):159-70.
    • Huskisson EC. Pain measurement and assessment. New York: Raven Press; 1983.
    • Jonsson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study. Br J Sports Med. 2005;39(11):847-50.
    • Jonsson P, Wahlstrom P, Ohberg L, Alfredson H. Eccentric training in chronic painful impingement syndrome of the shoulder: results of a pilot study. Knee Surg Sports Traumatol Arthrosc. 2006;14(1):76-81.
    • Khan KM, CookJL, Kannus P, Maffulli N, Bonar SF. Time to abandon the ‘tendinitis’ myth. BMJ. 2002;324(7338):626-7.
    • Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med. 2008;36(9):1789-98.
    • Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J. Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg. 2002;11(6):550-6.
    • Kingma JJ, Knikker R de, Wittink HM, Takken T. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med. 2007;41(6):e3.
    • Krasny C, Enenkel M, Aigner N, Wlk M, Landsiedl F. Ultrasound-guided needling combined with shock-wave therapy for the treatment of calcifying tendonitis of the shoulder. J Bone Joint Surg Br. 2005;87(4):501-7.
    • Kuhn JE, Nashville TN. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009;18(1):138-60.
    • Leduc BE, Caya J, Tremblay S, Bureau NJ, Dumont M. Treatment of calcifying tendinitis of the shoulder by acetic acid iontophoresis: a double-blind randomized controlled trial. Arch Phys Med Rehabil. 2003;84(10):1523-7.
    • Lombardi I Jr, Magri AG, Fleury AM, Da Silva AC, Natour J. Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum. 2008;59(5):615-22.
    • Ludewig PM, Borstad JD. Effects of a home exercise programme on shoulder pain and functional status in construction workers. Occup Environ Med. 2003;60(11):841-9.
    • Luime JJ, Verhagen AP, Miedema HS, Kuiper JI, Burdorf A, Verhaar JA, et al. Does this patient have an instability of the shoulder or a labrum lesion? JAMA. 2004;292(16):1989-99.
    • Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14(8):840-3.
    • McClure P, Balaicuis J, Heiland D, Broersma ME, Thorndike CK, Wood A. A randomized controlled comparison of stretching procedures for posterior shoulder tightness. J Orthop Sports Phys Ther. 2007;37(3):108-14.
    • Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther. 2004;17(2):152-64.
    • Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Med Rehabil. 2008;89(6):1162-8.
    • Neer CS. 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54(1):41-50.
    • Osteras H, Aamodt A. Regarding. ‘Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol’. J Shoulder Elbow Surg. 2009;18(4):e33; author reply e33-4.
    • Ottenheijm RP, Jansen MJ, Staal JB, Bruel A van den, Weijers RE, Bie RA de, et al. Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2010;91(10):1616-25.
    • Pan PJ, Chou CL, Chiou HJ, Ma HL, Lee HC, Chan RC. Extracorporeal shock wave therapy for chronic calcific tendinitis of the shoulders: a functional and sonographic study. Arch Phys Med Rehabil. 2003;84(7):988-93.
    • Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102(1-2):167-78.
    • Pleiner J, Crevenna R, Langenberger H, Keilani M, Nuhr M, Kainberger F, et al. Extracorporeal shockwave treatment is effective in calcific tendonitis of the shoulder. A randomized controlled trial. Wien Klin Wochenschr. 2004;116(15-16):536-41.
    • Rompe JD, Zoellner J, Nafe B. Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder. Clin Orthop Relat Res. 2001(387):72-82.
    • Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum. 2009;61(5):623-32.
    • Sabeti M, Dorotka R, Goll A, Gruber M, Schatz KD. A comparison of two different treatments with navigated extracorporeal shock-wave therapy for calcifying tendinitis - a randomized controlled trial. Wien Klin Wochenschr. 2007;119(3-4):124-8.
    • Senbursa G, Baltaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):915-21.
    • Silva L, Andreu JL, Munoz P, Pastrana M, Millan I, Sanz J, et al. Accuracy of physical examination in subacromial impingement syndrome. Rheumatology (Oxford). 2008;47(5):679-83.
    • Stevenson JH, Trojian T. Evaluation of shoulder pain. J Fam Pract. 2002;51(7):605-11.
    • van der Wees PJ, Hendriks HJM, Heldoorn M, Custers JWH, Bie RA de. Methode voor ontwikkeling, implementatie en bijstelling van KNGF-richtlijnen. Amersfoort/Maastricht: KNGF/CEBP; 2007.
    • Walther M, Werner A, Stahlschmidt T, Woelfel R, Gohlke F. The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: results of a prospective, randomized study. J Shoulder Elbow Surg. 2004;13(4):417-23.
    • Werner A, Walther M, Ilg A, Stahlschmidt T, Gohlke F. Self-training versus conventional physiotherapy in subacromial impingement syndrome. Dui. Z Orthop Ihre Grenzgeb. 2002;140(4):375-80.
    • Winters JC, Windt DAWM van der, Spinnewijn WEM, Jongh AC de, Heijden GJMG van der, Buis PAJ, et al. NHG-Standaard Schouderklachten. Huisarts Wet. 2008;51(11):555-65.
    • Wittenberg RH, Rubenthaler F, Wolk T, Ludwig J, Willburger RE, Steffen R. Surgical or conservative treatment for chronic rotator cuff calcifying tendinitis-a matched-pair analysis of 100 patients. Arch Orthop Trauma Surg. 2001;121(1-2):56-9.
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