The Role of Pectoralis Minor Tightness in the Development of Rotator Cuff Tears

Официальное название

The Role of Pectoralis Minor Muscle Tightness in the Development of Rotator Cuff Tears: A Propensity Score Matched Case-Control Study

Обзор

This study investigates whether tightness of a small chest muscle called the pectoralis minor is associated with the development of partial rotator cuff tears in the shoulder. Using a propensity score matched case-control design, the study compares patients with rotator cuff tears (case group, n=45) to patients with intact rotator cuffs (control group, n=45). Adults aged 18-55 who are evaluated by MRI and/or shoulder arthroscopy at Gazi University Hospital may be invited. The case group includes patients found to have partial rotator cuff tears during arthroscopy. The control group includes patients whose rotator cuff was documented as intact by MRI. Groups are matched 1:1 on age, sex, BMI, and dominant side. Before surgery, two trained clinician measures shoulder posture and pectoralis minor length using simple external tools (a digital caliper and ruler-like square). For arthroscopy patients, the surgeon records general arthroscopic findings. No extra procedures are added for research. We expect to include 90 participants total. The primary hypothesis is that pectoralis minor tightness is more prevalent in patients with rotator cuff tears compared to controls. A secondary hypothesis is that tears in patients with pectoralis minor tightness more often partial-thickness bursal side rotator cuff tear. Results may help clinicians understand shoulder mechanics and improve prevention or rehabilitation strategies.

Подробное описание

Rationale and Objectives Pectoralis minor (PM) tightness alters scapular position (anterior tilt, internal rotation) and may increase subacromial compression. This propensity score matched case-control study evaluates whether PM tightness is associated with the development of partial rotator cuff tears (RCTs).

Design and Setting Single-center, propensity score matched case-control study at a tertiary academic hospital (orthopaedic shoulder service, Gazi University Hospital). Care is not altered by participation. All surgical and imaging procedures are standard of care; research procedures are limited to noninvasive postural/PM length measurements and structured data collection.

Participants Inclusion criteria consisted of patients aged 18-55 years who were scheduled to undergo surgical treatment for a partial-thickness rotator cuff tear (case group) and individuals aged 18-55 years with no evidence of rotator cuff or other shoulder pathology on magnetic resonance imaging (control group). Patients were excluded if they had a history of trauma, thoracic outlet syndrome, systemic inflammatory disease, prior surgery on the affected shoulder, and declined participation in the examination. After application of the eligibility criteria, patients with partial-thickness rotator cuff tears will be matched in a 1:1 ratio with patients without rotator cuff or other shoulder pathology. Matching was performed based on age, sex, body mass index (BMI), and dominant extremity involvement. Covariate balance was assessed using absolute standardized differences, with a predefined threshold of 0.1.

Study Procedures

Preoperative assessments (same-day or pre-op clinic):

* Pectoralis minor length (mm): Pectoralis minor length was measured using a digital caliper, with the coracoid process and the fourth rib adjacent to the sternum serving as palpable anatomical landmarks; three trials recorded; mean used for analysis. * Medial scapular border-thoracic distance (mm) using rulers. * Forward shoulder posture using a 300 mm square. * Imaging abstraction: Standard shoulder radiographs and MRI summarized. * Anatomical and radiological measurements were assessed by two independent authors blinded to patient's group status.

Intraoperative assessment (for arthroscopy patients):

Surgeons document tear characteristics using a standardized form based on video visualization.

Sample Size and Power A priori power analysis was performed using effect sizes derived from PMI measurements in previous studies (Cohen's d = 0.91-1.83).Using the smallest effect size as a conservative estimate, a minimum sample size of 20 patients per group was required to achieve 80% power at a two-sided α level of 0.05.

Statistical Analysis Plan

* Software: IBM SPSS Statistics-26, R (MatchIt package) * Normality: Shapiro-Wilk test * Comparisons: Paired t-test / Wilcoxon / McNemar for matched pairs * Primary outcome: Presence of rotator cuff tear (case vs control) as a function of PM tightness * Secondary outcome: The tear is a partial bursal surface tear as a function of PM tightness in the case group * Significance level: two-sided alpha=0.05

Первичные конечные точки

• Pectoralis minor muscle length difference between case and control groups [Срок оценки: Preoperative assessment, Day 0]

Вторичные конечные точки (6)

• Case group [Срок оценки: Intraoperative, Day 0 (index arthroscopy)]
• Forward shoulder posture [Срок оценки: Preoperative assessment, Day 0]
• Medial Scapular Border Thoracic Distance [Срок оценки: Preoperative assessment, Day 0]
• Thoracic Kyphosis and Proximal Kyphosis(Cobb angle) [Срок оценки: Preoperative imaging review, Day 0]
• Scapular index (Coracoid-Sternum/Acromian lateral tip - thoracic spine) [Срок оценки: Preoperative assessment, Day 0]
• Acromial Morphology [Срок оценки: Preoperative imaging review, Day 0]

Критерии участия

Inclusion criteria consisted of patients aged 18-55 years who were scheduled to undergo surgical treatment for a partial-thickness rotator cuff tear (case group) and individuals aged 18-55 years with no evidence of rotator cuff or other shoulder pathology on magnetic resonance imaging (control group). Patients were excluded if they had a history of trauma, thoracic outlet syndrome, systemic inflammatory disease, prior surgery on the affected shoulder, and declined participation in the examination.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Модель наблюдения

Случай-контроль

Центры проведения

Turkey (Türkiye) · 1 центр

• Gazi University Hospital — Ankara

Публикации

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• Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006 Aug;88(8):1699-704. doi: 10.2106/JBJS.E.00835. PMID 16882890
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• Peterson DE, Blankenship KR, Robb JB, Walker MJ, Bryan JM, Stetts DM, Mincey LM, Simmons GE. Investigation of the validity and reliability of four objective techniques for measuring forward shoulder posture. J Orthop Sports Phys Ther. 1997 Jan;25(1):34-42. doi: 10.2519/jospt.1997.25.1.34. PMID 8979174
• Du WY, Huang TS, Hsu KC, Lin JJ. Measurement of scapular medial border and inferior angle prominence using a novel scapulometer: A reliability and validity study. Musculoskelet Sci Pract. 2017 Dec;32:120-126. doi: 10.1016/j.msksp.2017.08.004. Epub 2017 Aug 15. PMID 28827031

Идентификаторы

NCT: NCT07228936 · E-77082166-302.08.01-1273486

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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