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Shoulder Impingement SyndromePMinor-RotatorNCT07228936

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

An observational study of Shoulder Impingement Syndrome and Rotator Cuff Injuries, run by Gazi University at 1 site in Turkey (Türkiye).

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

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… Read more about this study

Who is it for?
Ages 18 to 55 yearsHealthy volunteers can take part
How many people
90 participants
Where
1 siteTurkey (Türkiye)
Study dates
18 Jun 2025to 3 Aug 2026
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 55 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Study population: 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.

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.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Turkey (Türkiye)1 site, 1 recruiting
  • Gazi University Hospital

    Ankara, Cankaya, 06500

    Cagatay Delice, +90 546 581 9056, cgty_166@hotmail.com

    Recruiting

Other trials in Turkey (Türkiye)

About this study

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

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.

Read more

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.

Read the detailed description

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
Keywords
rotator cuff, Rotator Cuff Injuries, Posture, Scapula, Pectoralis Muscles, Arthroscopy, Shoulder Joint, Pectoralis Minor
Medical subject headings
Shoulder Impingement Syndrome, Rotator Cuff Injuries

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT07228936
Study groupRoleWhat they receive
Rotator Cuff Tear (Case)Patients who underwent shoulder arthroscopy and were found to have partial rotator cuff tears during surgery. Pectoralis minor length, medial scapular distance, and forward shoulder posture were measured preoperatively. Propensity score matched 1:1 with the control group on age, sex, BMI, and dominant side.
Intact Rotator Cuff (Control)İndividuals aged 18-55 years with no evidence of rotator cuff or other shoulder pathology on magnetic resonance imaging. Propensity score matched 1:1 with the case group on age, sex, BMI, and dominant side.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Pectoralis minor muscle length difference between case and control groups

    Comparison of pectoralis minor (PM) muscle length (mm) and pectoralis minor index between patients with partial rotator cuff tears (case group) and patients with intact rotator cuffs (control group). PM length is measured as the linear distance from coracoid tip to rib attachment using a digital caliper. The pectoralis minor index was calculated by dividing the pectoralis minor length by the patient's height and multiplying the result by 100.

    Measured: Preoperative assessment, Day 0

Secondary outcomes (6)
  1. Case group

    Arthroscopic classification of the partial rotator cuff tear appears to begin, recorded with a standardized intraoperative checklist in the case group only. Analysis evaluates whether PM-tight patients more frequently exhibit partial bursal side tear compared to non-tight patients within the RCT group.

    Measured: Intraoperative, Day 0 (index arthroscopy)

  2. Forward shoulder posture

    Anterior displacement of the acromion relative to the thorax measured with a square ruler (standardized upright position). Three trials; mean used.

    Measured: Preoperative assessment, Day 0

  3. Medial Scapular Border Thoracic Distance

    Medial scapular distance was measured as the shortest distance between the medial scapular border and the posterior chest wall using a ruler positioned perpendicular to the midpoint of the medial scapular border; three trials, mean used.

    Measured: Preoperative assessment, Day 0

  4. Thoracic Kyphosis and Proximal Kyphosis(Cobb angle)

    Lateral thoracic radiograph measured using the Cobb method: superior endplate line of T5 and inferior endplate line of T12 (use closest visible end vertebrae if either is obscured). Lines perpendicular to each endplate are drawn; the included angle is recorded as the thoracic kyphosis Cobb angle. Proximal thoracic kyphosis is also measured between T2 and T5.

    Measured: Preoperative imaging review, Day 0

  5. Scapular index (Coracoid-Sternum/Acromian lateral tip - thoracic spine)

    The scapular index was determined using a digital caliper by measuring the distance between the midpoint of the sternal notch and the medial aspect of the coracoid process, as well as the horizontal distance between the posterolateral angle of the acromion and the thoracic spine, and was calculated as (sternal notch-coracoid distance / acromion-thoracic spine distance) × 100.

    Measured: Preoperative assessment, Day 0

  6. Acromial Morphology

    Acromial morphology was assessed on supraspinatus outlet radiographs according to the Bigliani classification and categorized as type I (flat), type II (curved), or type III (hooked).

    Measured: Preoperative imaging review, Day 0

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Nov 2025
  2. Study start18 Jun 2025
  3. Primary completion3 Aug 2026 (estimated)
  4. Study completion3 Aug 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Case-control
Time perspective
Prospective
Enrolment
90 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07228936
Sponsor's protocol ID
E-77082166-302.08.01-1273486
Acronym
PMinor-Rotator
Status last verified
Aug 2026
First submitted
13 Nov 2025
Last updated
4 Aug 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg. 2003 Mar-Apr;11(2):142-51. doi: 10.5435/00124635-200303000-00008.

    PubMed 12670140
  • 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.

    PubMed 16882890
  • Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014 Apr;48(8):692-7. doi: 10.1136/bjsports-2013-092148. Epub 2013 May 18.

    PubMed 23687006
  • Borstad JD, Ludewig PM. The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther. 2005 Apr;35(4):227-38. doi: 10.2519/jospt.2005.35.4.227.

    PubMed 15901124
  • Oyama S, Myers JB, Wassinger CA, Daniel Ricci R, Lephart SM. Asymmetric resting scapular posture in healthy overhead athletes. J Athl Train. 2008 Oct-Dec;43(6):565-70. doi: 10.4085/1062-6050-43.6.565.

    PubMed 19030133
  • Ludewig PM, Reynolds JF. The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther. 2009 Feb;39(2):90-104. doi: 10.2519/jospt.2009.2808.

    PubMed 19194022
  • 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.

    PubMed 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.

    PubMed 28827031
  • Borstad JD. Measurement of pectoralis minor muscle length: validation and clinical application. J Orthop Sports Phys Ther. 2008 Apr;38(4):169-74. doi: 10.2519/jospt.2008.2723. Epub 2007 Nov 21.

    PubMed 18434665

Questions about this trial

What is this clinical trial studying?

An observational study of Shoulder Impingement Syndrome and Rotator Cuff Injuries, run by Gazi University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 4 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Cagatay Delice (+90 546 5819056, cgty_166@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Pectoralis minor muscle length difference between case and control groups (time frame: Preoperative assessment, Day 0). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07228936, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Aug 2026.

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