Acromio-humeral distance variation measured by ultrasonography and its association with the outcome of rehabilitation for shoulder impingement syndrome

Clin J Sport Med. 2004 Jul;14(4):197-205. doi: 10.1097/00042752-200407000-00002.


Objective: First, to validate an ultrasonographic measure of the acromio-humeral distance (AHD); second, to compare the AHD variation during active abduction in patients with shoulder impingement syndrome (SIS) and healthy subjects; and third, to evaluate the relationship between functional status and AHD variations before and after rehabilitation in SIS subjects.

Design: This study has 3 components: (1) a reliability study, (2) a case-control study, and (3) a preliminary pretreatment/posttreatment clinical trial.

Setting: Primary care hospital setting.

Participants: Seven SIS patients and 13 healthy subjects.

Interventions: For the clinical trial, the SIS subjects participated in 12 sessions of a rehabilitation program over 4 weeks.

Main outcome measures: First, intraclass correlation coefficient for interobserver reliability; second, AHD measured at 0 degrees, 45 degrees, and 60 degrees of active abduction; and third, Western Ontario Rotator Cuff Index.

Results: Intraclass correlation coefficient for interobserver reliability ranged from 0.86 to 0.92 for the 3 shoulder positions. A significant reduction of the AHD was found within groups between rest and active abduction (P < 0.05). Comparison of AHD between groups was not statistically different (P = 0.06; beta < 0.80). In pre-post rehabilitation analysis, improvement of the Western Ontario Rotator Cuff Index score was positively correlated to the reduction of the AHD narrowing as the arm was abducted (r = 0.86; P = 0.01).

Conclusions: The ultrasound measure of AHD is reliable and sensitive. Although a distinct pattern of AHD variation in SIS patients could not be confirmed, a strong positive relationship was found between the reduction of AHD narrowing and functional improvement following rehabilitation. Ultrasound measurement of AHD might help identify SIS patients who will benefit from rehabilitation.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Acromion / anatomy & histology*
  • Acromion / diagnostic imaging*
  • Adult
  • Case-Control Studies
  • Humans
  • Humerus / anatomy & histology*
  • Humerus / diagnostic imaging*
  • Outcome Assessment, Health Care
  • Range of Motion, Articular / physiology
  • Reproducibility of Results
  • Rest / physiology
  • Shoulder Impingement Syndrome / diagnostic imaging*
  • Shoulder Impingement Syndrome / physiopathology
  • Shoulder Impingement Syndrome / rehabilitation*
  • Ultrasonography