Tehran University Medical Journal

Background: Rotator cuff injuries are the most common causes of shoulder pain and supraspinatus muscle is usually involved. Clinical tests are available and inexpensive tools for assessment of shoulder dysfunctions. The empty can (EC) and full can (FC) tests are considered as shoulder gold standard tests. Recently, hug up (HU) test has been developed to assess the supraspinatus. So far, no ultrasonographic study has compared supraspinatus muscle thickness in these testing positions. The present study aimed to compare the supraspinatus muscle thickness in the hug up testing position with the full can and empty can testing positions in young and healthy women.
Methods: Forty healthy women (mean age 21.62±2.4 years) participated in this cross-sectional-comparative study from April to June 2018 in the Biomechanic Laboratory of Rehabilitation School, Shahid Beheshti University of Medical Sciences in Tehran, Iran. The supraspinatus muscle thickness was scanned during rest and contracted states with a 0.5 Kg weight cuff. For contracted states, (A) EC testing position: the arm was at 90º abduction in the scaption plane with the thumb-down, (B) FC testing position: the arm was maintained at 90º abduction in the scaption plane with the thumb-up, (C) HU testing position: the palm of hand was placed on the opposite shoulder with the elbow flexed.
Results: The Bonferroni test showed significant differences (P<0.001) between the muscle thickness in the rest and the testing positions. The muscle thickness in the empty can testing position was significantly less than the full can testing position (P=0.001), no significant difference was found between the muscle thickness in the hug up testing position compared to the full can and empty can testing positions.
Conclusion: All of the empty can, full can and hug up testing positions demonstrated increased mean muscle thickness when compared to the rest position and the greatest muscle thickness was in the full can testing position. It seems that supraspinatus muscle thickness in hug up testing position is similar with empty can and full can testing positions.

Background: The objective of this study was the transcultural adaptation of the Rotator cuff quality of life (RC-QOL) questionnaire and the determination of the reliability and validity of the questionnaire in the Persian-speaking population with rotator cuff disease.
Methods: This study was conducted in Isfahan from April 2022 to February 2023. The participants consisted of 56 people with rotator cuff pathology. The process of adapting and translating the questionnaire was done with the methodology presented previously by Beaton et al. Content validity was first tested by a group of orthopedic and physical medicine and rehabilitation specialists and then through a pilot study consisting of 15 Persian-speaking patients with rotator cuff disease. Test-retest reliability was established with an intraclass correlation coefficient. Internal consistency was calculated using Cronbach's alpha. The measurement's error estimation was calculated with the standard error of the measurement. Reproducibility evaluation was measured with a 3-day interval between the completion of the test-retest questionnaire.

Results: The age range of the participants was 34 to 68 years (55% men and 45% women). The mean (standard deviation) of the total score of the RC-QOL questionnaire was 44.33(10.81) and ranged from 17.35 to 70.88. Cronbach's alpha was 0.971, which showed high internal consistency. The intraclass correlation coefficient was 0.99, indicating high test-retest reliability. The mean values (standard deviations) of the DASH and SPADI questionnaires were equal to 77.66(13.69) and 66.66(18.25), respectively. The results of the study showed excellent and significant convergent validity of the RC-QOL questionnaire with both the DASH and SPADI questionnaires. The correlation value with the DASH and SPADI questionnaires was equal to 0.907 and 0.941, respectively. Conclusion: The Persian version of the RC-QOL questionnaire is a valid and reliable tool to evaluate the quality of life in patients diagnosed with rotator cuff injuries.

Background: The most common cause of Shoulder pain is inflammation in the subacromial bursa. Intra-bursal corticosteroid injections are one of the most common methods in cases of bursitis. Recently, botulinum toxin A injection has also been used as a safe treatment in these patients. This injection does not have many of corticosteroid disadvantages. The most important disadvantages of this method are its cost. This study was performed to compare corticosteroids with botulinum toxin A in the treatment of subacromial bursitis by single injection.
Methods: This study is a prospective randomized clinical trial performed on patients with rotator cuff tendinopathy who were referred to the physical medicine and rehabilitation clinic of Iran University of Medical Sciences from November 2020 to October 2021. 54 patients with signs and symptoms of rotator cuff tendinopathy, were randomly assigned to one of the two groups of botulinum toxin A or corticosteroid injection. Routine treatment included exercise training for all patients. Patient's symptoms were assessed using VAS, Constant Score and SPADI criteria before treatment, two weeks and two months after injection.
Results: In the VAS study, both groups showed an improvement over baseline (P=0.000), which was significantly greater in the corticosteroid group. VAS between the first and second follow-up showed a decrease in the botulinum toxin A group and an increase in the corticosteroid group. In the Constant Score and SPADI study, both groups showed an improvement over baseline.
Conclusion: This study showed that a single-session injection of botulinum toxin A is less effective than corticosteroid in controlling symptoms of these patients. However, the therapeutic effect of botulinum toxin A, remains 2 months and unlike corticosteroid, has more reliability and durability.