The management of shoulder impingement and related disorders: A systematic review on diagnostic accuracy of physical tests and manual therapy efficacy.

BACKGROUND: Diagnostic accuracy of physical tests and effectiveness of musculoskeletal rehabilitation of shoulder disorders are still debated. OBJECTIVES: To investigate diagnostic accuracy of physical tests, efficacy of physiotherapy and coherence between target of assessment and intervention for shoulder impingement and related disorders like bursitis, rotator cuff and long head biceps tendinopathy and labral lesions. METHODS: A systematic search of four databases was conducted, including RCTs and cross-sectional studies. Cochrane Risk of Bias and QUADAS-2 were adopted for critical appraisal and a narrative synthesis was undertaken. RESULTS: 6 RCTs and 2 cross-sectional studies were appraised. Studies presented low to moderate risk of bias. There is a lack of evidence to support the mechanical construct guiding the choice of physical tests for diagnosis of impingement. Manual techniques appear to yield better results than placebo and ultrasounds, but not better than exercise therapy alone. Discrepancy between the goal of assessment strategies and the relative proposed treatments were present together with high heterogeneity in terms of selection of patients, type of endpoints and follow-ups. CONCLUSIONS: Musculoskeletal physiotherapy seems to be an effective treatment for patients with shoulder pain although it is still based on weak diagnostic clinical instruments. The adoption of more functional and prognostic assessment strategies is advisable to improve coherence between evaluation and treatment.

Does the outcome of diagnostic ultrasound influence the treatment modalities and recovery in patients with shoulder pain in physiotherapy practice? Results from a prospective cohort study.

STUDY DESIGN: Prospective cohort study including patients with shoulder pain in primary care physiotherapy. BACKGROUND: There is an increased tendency to use diagnostic ultrasound to aid the diagnostic strategy and target treatment. It is a relatively cheap and accessible imaging technique but the implications for practice and patients are unknown. OBJECTIVES: To study the influence of diagnostic ultrasound (DUS) on diagnostic work-up, treatment modalities and recovery. METHODS: Participants (n = 389) with a new episode of shoulder pain were assessed at baseline and followed for 6, 12 and 26 weeks. Diagnostic work-up, including the use of DUS, and treatment strategies were reported by the therapists at 3, 6 and 12 weeks. RESULTS: Most patients (41%) were diagnosed with subacromial impingement/pain syndrome after physical examination or DUS. DUS was used in 31% of the participants. Tendinopathy was the most found abnormality in this sub-population. Patients who underwent DUS were more frequently treated using exercise therapy. Patients that not had DUS were more likely to receive massage therapy, trigger point therapy or mobilisation techniques. Logistic regression analyses did not show a significant association between DUS and recovery after 26 weeks (0.88, 95%CI:0.50-1.57). Correcting for the therapist as a confounder using a multilevel binary logistic regression did not show a significant cluster effect. CONCLUSION: Diagnostic US as a work-up component does not seem to influence diagnosis or recovery but does influence the choice of treatment modality. Conclusions are limited to observational data. High quality randomized trials should study the effect of DUS on recovery.

Effect of manual physiotherapy in homogeneous individuals with subacromial shoulder impingement: A randomized controlled trial.

OBJECTIVE: To compare the effect of specific interventions aimed at (1) the upper thoracic spine (passive mobilization) and (2) the posterior shoulder (massage, passive mobilization, and stretching) to (3) an active control intervention in a homogeneous group with extrinsic subacromial shoulder impingement (SSI). STUDY DESIGN: Single-centre, prospective, double-blinded, randomized controlled trial. METHOD: Eligible individuals with clearly defined extrinsic SSI were randomized to each group. Treatment duration was 12 consecutive weeks consisting of nine treatments over 6 weeks, followed by 6 weeks when one home exercise was performed daily. Outcomes included (1) active thoracic flexion/extension range of motion, (2) passive glenohumeral internal rotation and posterior shoulder range, (3) pain rating, and (4) shoulder pain and function disability index. Data were analysed at baseline, 6 and 12 weeks. Shoulder pain and function disability index scores were investigated via email 6 months after commencement of treatment. RESULTS: Twenty participants completed treatment in each group. No differences were identified between groups at baseline. Upper thoracic and posterior shoulder interventions, with a targeted home exercise, both significantly decreased pain and increased function scores and increased posterior shoulder range compared with active control at 12 weeks, and 6 months following cessation of the trial. CONCLUSION: Manual therapy treatment that addresses these extrinsic factors, of thoracic spine or posterior shoulder tightness, decreases the signs and symptoms of SSI. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR; 12615001303538).

Does taping in addition to physiotherapy improve the outcomes in subacromial impingement syndrome? A systematic review.

BACKGROUND: Taping is used with or without other interventions for many purposes, especially to manage pain and improve functional activity in patients with shoulder pain. OBJECTIVES: The aim of this review was to determine whether any taping technique in addition to physiotherapy care is more effective than physiotherapy care alone in patients with shoulder impingement syndrome. METHODS: A systematic search of Cochrane Database of Systematic Review, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, AMED, EMBASE (OVID), The Kinesio Kinesio® Taping Method, Kinesio® Tex Tape UK and International websites ( www.kinesiotaping.co.uk ; www.kinesiotaping.com ) was conducted to June 2015. The outcome measures were pain, disability, range of motion and muscle strength. As data were not suitable for meta-analysis, narrative synthesis were applied. RESULTS: Three randomized controlled trials and one controlled trial (135 patients) were included. The results were conflicting and weak on the effectiveness of taping as an adjunct therapy for improvement of pain, disability, range of motion and muscle strength. CONCLUSION: Clinical taping in addition to physiotherapy interventions (e.g. exercise, electrotherapy, and manual therapy) might be an optional modality for managing patients with shoulder impingement syndrome, especially for the initial stage of the treatment; however, we need further robust, placebo controlled and consistent studies to prove whether it is more effective than physiotherapy interventions without taping.

Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic- and therapeutic management.

BACKGROUND: Shoulder pain is one of the three main musculoskeletal complaints and more than 50% of the patients have symptoms longer than 6 months. Until now, limited data exist about the content of physiotherapy for patients with shoulder pain in primary care. OBJECTIVE: Describe current physiotherapeutic diagnostic- and therapeutic management, including the use of diagnostic ultrasound, in patients with shoulder pain in primary care. DESIGN AND SETTING: A prospective cohort study in primary care physiotherapy with a 12 week follow-up. METHODS: Descriptive data from physiotherapists was collected, such as: the diagnostic hypotheses after patient history and physical examination, the use of specific tests and diagnostic ultrasound, the interventions used and possible changes in treatment plan. RESULTS: Subacromial impingement syndrome was the most common hypothesis after patient history (48%) as well as physical examination (39%). Diagnostic ultrasound was used in 31% and of these patients the clinical diagnosis changed in 29%. Various interventions were used in all clinical diagnoses. After 12 weeks 41% of patients still received physiotherapy treatment. CONCLUSIONS: Patients with shoulder pain in physiotherapy practice frequently show signs of subacromial impingement syndrome. The interventions used by the physiotherapists were generally in line with the guideline for subacromial impingement syndrome however a small proportion of physiotherapists used massage and tape/bracing techniques. A large proportion of patients were still receiving treatment after 12 weeks when no improvement was observed. If treatment for patients with subacromial impingement shows no benefit patients should be referred back to the general practitioner or orthopedic surgeon. Conclusions from this study might be slightly biased because of the selection of physiotherapists.

Effects of Low-Load Exercise on Postneedling-Induced Pain After Dry Needling of Active Trigger Point in Individuals With Subacromial Pain Syndrome.

BACKGROUND: The application of dry needling usually is associated with postneedling-induced pain. A postneedling intervention to reduce this adverse event is needed. OBJECTIVE: To determine the effectiveness of low-load exercise on reducing postneedling-induced pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome. DESIGN: A 72-hour follow-up, single-blind randomized controlled trial. SETTING: Urban hospitals. PARTICIPANTS: Individuals with subacromial pain syndrome (n = 90, 52% female, mean age: 35 ± 13 years) with active TrPs in the infraspinatus muscle. INTERVENTIONS: All individuals received dry needling into the infraspinatus active TrP. Then, they were divided randomly into an experimental group, which received a single bout of low-load exercise of shoulder muscles; a placebo group, which received inactive ultrasound for 10 minutes; and a control group, which did not receive any intervention. OUTCOME MEASURES: Numerical Pain Rating Scale (0-10 point) was administered postneedling, immediately postintervention (2 minutes), and 24, 48, and 72 hours after needling. Shoulder pain (Numerical Pain Rating Scale, 0-10) and disability (Disabilities of the Arm, Shoulder and Hand; Shoulder Pain and Disability Index) were assessed before and 72 hour after needling. RESULTS: The 5 × 3 analysis of covariance showed that the exercise group demonstrated a larger decrease in postneedling-induced pain immediately after (P = .001), 24 hours (P = .001), and 48 hours after (P = .006) than placebo or control groups. No differences were found at 72 hours (P = .03). Similar improvements in shoulder pain (P < .001) and related disability (Disabilities of the Arm, Shoulder and Hand: P < .001; Shoulder Pain and Disability Index: P < .001) were observed 72 hours after needling, irrespective of the treatment group. CONCLUSIONS: Low-load exercise was effective for reducing postneedling-induced pain on active TrPs in the infraspinatus muscle 24 and 48 hours after needling. The application of a postneedling intervention did not influence short-term pain and disability changes. LEVEL OF EVIDENCE: I.

[Impingement syndromes of the shoulder]. / Impingement-Syndrome der Schulter.

In addition to tears of the rotator cuff, isolated impingement syndrome of the shoulder is the most common diagnosis in shoulder disorders. This is of high relevance in orthopedic sports medicine. In fact, impingement of the shoulder is not the diagnosis but rather a symptom of a functional or even a structural pathology. Detailed knowledge about the different types of impingement and the underlying causes is essential to provide adequate treatment. Primarily, impingement of the shoulder should be treated nonoperatively. However, if there is no clinical improve despite adequate conservative treatment, there is usually a structural pathology which cannot be adequately compensated for and surgical treatment may be necessary. In the case of severe structural pathologies, such as a full-thickness tear of the rotator cuff, a subsequent surgical treatment may be indicated.

Laser Acupuncture Treatment Improves Pain and Functional Status in Patients with Subacromial Impingement Syndrome: A Randomized, Double-Blind, Sham-Controlled Study.

Objective: The present study aims to determine the effect of laser acupuncture in patients with subacromial impingement syndrome (SAIS). Design: Randomized, double-blind, sham-controlled study. Setting: Physical medicine and rehabilitation outpatient clinic. Subjects: A total 73 patients with SAIS were randomly assigned into a treatment group (n = 36) and a control group (n = 37). Methods: The treatment group received laser acupuncture, and the control group received sham laser acupuncture. Eleven acupuncture points (GB 21, LI 4, LI 11, LI 14, LI 15, LI 16, SI 9, SI 10, SI 11, TE 14, and TE 15) were irradiated using a gallium-aluminium-arsenide continuous wave diode-laser, with a wavelength of 850 nm and a power output of 100 mV. The laser acupuncture treatment at each acupuncture point was administered at 4 joules/cm 2 (total dose = 40 joules). All patients were also treated with a hot pack. The patients were assessed at baseline and after 15 sessions of laser treatment. Pain severity and doctor's and patient's global assessments were measured via visual analog scale (VAS). Range of motion (ROM) and functional status were measured using a digital inclinometer and the Shoulder Pain Disability Index, respectively. Results: Statistically significant improvements were observed in all parameters in the treatment group. All parameters of pain and functional status in the treatment group were significantly better than those in the control group at week 3. Conclusions: To the best of our knowledge, this is the first study that investigates the effect of laser acupuncture in SAIS. The positive results of the present study should lead to further laser acupuncture studies with combinations of different acupuncture points, at different wavelengths, and with long-term follow-up periods.

Effects of a movement training oriented rehabilitation program on symptoms, functional limitations and acromiohumeral distance in individuals with subacromial pain syndrome.

BACKGROUND: Multiple factors have been associated with the presence of a subacromial pain syndrome (SPS), including deficits in performance of scapular and glenohumeral muscles. Such deficits can lead to inadequate kinematics and decreased acromiohumeral distance (AHD). Exercises that aim at correcting these deficits, such as movement training, were suggested to improve symptoms and functional limitations. To date, few studies have assessed outcomes following an intervention focused on movement training. OBJECTIVES: Evaluate the effects of a rehabilitation program based on movement training on symptoms, functional limitations and AHD in individuals with SPS. DESIGN: Prospective single group pre-post design. METHODS: Twenty-five participants with SPS (SPS group) participated in a 6-week program. Twenty asymptomatic volunteers were recruited for normative AHD values (control group). Outcomes of both groups were evaluated at baseline and 6 weeks, i.e. immediately following intervention for the SPS group. Changes in symptoms and functional limitations for SPS group were assessed using the Western Ontario Rotator Cuff (WORC) index and Disability of the Arm Shoulder and Hand (DASH) questionnaire. Changes in AHD for both groups were assessed using ultrasonographic measures. RESULTS: Following the rehabilitation program, the scores on WORC and DASH were significantly improved (p < 0.001). AHD increased significantly in the SPS group (p = 0.019), especially in a subgroup with initial deficits (p < 0.001). CONCLUSION: The rehabilitation program yielded improvements in symptoms and functional limitations in participants with SPS. Moreover, it led to an increase of the AHD--thus potentially decreasing subacromial compression, particularly in participants with an initially smaller AHD. The trial was registered at ClinicalTrials.gov: identifier--NCT02395770.

[Quality of post-operative pain therapy after subacromial decompression of the shoulder with resection of the lateral clavicula by arthroscopy]. / Qualität der postoperativen Schmerztherapie nach arthroskopischer subakromialer Schulterdekompression mit Resektion der lateralen Klavikula.

BACKGROUND: Shoulder impingement is one of the most common orthopaedic arthropathies. A minimally invasive surgery is indicated in cases of persistent symptoms or non-responders to conservative pain therapy. Normally, strong postoperative pain of the shoulder requires an effective pain therapy. PATIENTS/MATERIAL AND METHODS: 100 patients suffering from shoulder impingement with involvement of the acromioclavicular joint (55 male, 45 female, mean age 56, age range 37-78 years) were operated in 2007 and 2008 in the department of orthopaedics of the LVR-hospital. We aimed to evaluate the value of a subacromial pain catheter with ropivacaine (n = 33) compared to a conservative pain therapy ("Würzburger Schmerztropf"/tramadol, novaminsulfon and metroclopramid and "Hettinger Infusion"/tramadol, novaminsulfon, dimenhydrinate as needed) alone (n = 34) or with an additional intraoperative administration of a single dose of ropivacaine (n = 33) after arthroscopic subacromial decompression of the shoulder with resection of the lateral clavicula. Additionally, patients of all three groups received a baseline analgesia with cryotherapy and diclofenac. RESULTS: Patients who received pain therapy by subacromial catheter reported less pain in the first 48 hours after surgery compared to ropivacaine intraoperatively and a standard pain therapy. Although all three methods achieved a significant pain reduction in the postoperative period, patients with subacromial catheter claimed the highest satisfaction with the therapy. Moreover, we could show that the subacromial pain catheter is a very efficient method with a high acceptance by the patients which is easy to perform and free of complications when considering the respective hygienic measures.

Intervención grupal del síndrome subacromial en atención primaria / A group intervention for shoulder impingement syndrome in primary care

Introducción. El aumento de consultas por dolor de hombro en los servicios de rehabilitación impone buscar alternativas eficientes para mejorar su manejo. Objetivos. Evaluar la efectividad de un programa de rehabilitación grupal para mejorar la funcionalidad y el dolor en pacientes afectos de síndrome subacromial y ver qué variables se asocian a un mejor resultado funcional final. Métodos. Estudio longitudinal prospectivo de intervención antes/después. Muestra: 211 pacientes. La intervención consistió en 10 sesiones de electroterapia analgésica individual, 5 sesiones de cinesiterapia grupal y una sesión informativa: «escuela de hombro». El seguimiento fue de un año. Medimos la funcionalidad con el test de Constant y el dolor con la escala visual analógica. Pruebas estadísticas: chi cuadrado, T-test, ANOVA y regresión lineal múltiple (p < 0,05). Resultados. La funcionalidad mejoró significativamente en los 4 períodos estudiados respecto al valor inicial y se estabilizó a los 6 meses. El perfil de paciente que obtuvo mayor funcionalidad fue: mujer, mayor de 60 años, sin dolor en reposo inicial y laboralmente no activa. La mejora del dolor observada a largo plazo no fue significativa. El consumo de analgésicos se redujo significativamente a los 3 meses. La adherencia al tratamiento domiciliario de ejercicios fue del 81% a los 3 y 6 meses y del 70,6% al año. Conclusiones. La aplicación de un programa de rehabilitación grupal en pacientes afectos de síndrome subacromial se ha mostrado efectivo para mejorar la funcionalidad a largo plazo. Sin embargo, el dolor no ha mostrado mejoría significativa a lo largo del estudio (AU)

Introduction. Due to the increase in consultations for shoulder pain in rehabilitation services, there is a need for efficient alternatives to improve the management of this disorder. Objectives. To evaluate the effectiveness of a supervised group exercise program to improve functionality and pain in patients with shoulder impingement syndrome and to identify the variables that are associated with a better functional outcome. Methods. A prospective longitudinal, pre and post intervention study was carried out in a sample of 211 patients. The treatment consisted of 10 individual sessions of analgesic electrotherapy, 5 sessions of group exercise therapy and an educational session: «shoulder school». One year follow-up was performed. Shoulder function and pain were assessed using Constant's test and the visual analogue scale. The statistical analysis was carried out with the chi-square test, T-test, ANOVA and multiple linear regression (P < .05). Results. Functionality improved significantly in all periods studied compared with baseline and stabilized at 6 months. The profile of patients who achieved greater functionality was female, older than 60 years, with no initial rest pain and occupationally inactive. Long-term pain improvement was not significant. Analgesic use was significantly reduced at 3 months. Adherence to home exercise treatment was 81% at 3 and 6 months and 70.6% at one year. Conclusions. The application of a group rehabilitation program in patients with shoulder impingement syndrome was effective in improving long-term functionality. However, there was no significant pain improvement during the study (AU)

[Practice guideline 'Diagnosis and treatment of the subacromial pain syndrome']. / Richtlijn 'Diagnostiek en behandeling van het subacromiaal pijnsyndroom'.

In shoulder pain there is often no direct relationship between the symptoms and the anatomical substrate; for this reason, the term 'subacromial pain syndrome' (SAPS) is better than 'impingement'. The diagnosis of SAPS can only be made using a combination of tests. Imaging diagnostics, preferably ultrasound, can be carried out if conservative treatment does not give the required result. Acute pain is treated by giving advice and if necessary analgesics; a subacromial injection of glucocorticoids is indicated if symptoms recur or are persistent. Exercise therapy should be specific, of low intensity and high frequency, including eccentric training, scapula stabilization and trigger point massage. Rehabilitation in a specialized unit may be considered if pain maintaining behaviour is playing a role. There is no convincing evidence that surgical treatment is more effective than conservative management and there is no indication for the surgical treatment of asymptomatic rotator cuff tears.

The addition of cervical unilateral posterior-anterior mobilisation in the treatment of patients with shoulder impingement syndrome: a randomised clinical trial.

Shoulder impingement syndrome (SIS) is a complex, multi-factorial problem that is treated with a variety of different conservative options. One conservative option that has shown effectiveness is manual therapy to the thoracic spine. Another option, manual therapy to the cervical spine, has been studied only once with good results, evaluating short-term outcomes, in a small sample size. The purpose of this study was to investigate the benefit of neck manual therapy for patients with SIS. The study was a randomised, single blinded, clinical trial where both groups received pragmatic, evidence-based treatment to the shoulder and one group received neck manual therapy. Subjects with neck pain were excluded from the study. Comparative pain, disability, rate of recovery and patient acceptable symptom state (PASS) measures were analyzed on the 68 subjects seen over an average of 56.1 days (standard deviation (SD)=55.4). Eighty-six percent of the sample reported an acceptable change on the PASS at discharge. There were no between-groups differences in those who did or did not receive neck manual therapy; however, both groups demonstrated significant within-groups improvements. On average both groups improved 59.7% (SD=25.1) for pain and 53.5% (SD=40.2) for the Quick Disabilities of the Shoulder and Hand Questionnaire (QuickDASH) from baseline. This study found no value when neck manual therapy was added to the treatment of SIS. Reasons may include the lack of therapeutic dosage provided for the manual therapy approach or the lack of benefit to treating the neck in subjects with SIS who do not have concomitant neck problems.

Shoulder muscle function in frozen shoulder syndrome patients following manipulation under anesthesia: a 6-month follow-up study.

INTRODUCTION: The present study evaluates changes in shoulder muscle function in patients with frozen shoulder syndrome (FSS) following manipulation under general anesthesia (MUA). PATIENTS AND METHODS: Fifteen FSS patients with mean (±SD) age of 53.6±9.7 years were included in this study. Isometric endurance of the shoulder muscles was characterized by time and net impulse (NI), which were assessed with the patient holding a weight in the hand until exhaustion. Fatigability of the deltoid and trapezius muscles during isometric endurance test was assessed by electromyogram power spectrum median frequency (MF) slope per minute. Patients were also screened for daytime pain. Data were collected before MUA, and at 1 and 6 months postoperatively. RESULTS: Six months postoperatively, the MF slope for the trapezius and deltoid muscles of the involved and uninvolved shoulders did not differ (P>0.05), whereas NI remained lower and endurance time was longer (P<0.05). Shoulder pain was reduced as compared to preoperative levels (on visual analog scale) 1 and 6 months postoperatively (P<0.05). DISCUSSION: In patients with FSS, the fastest improvements in shoulder muscle NI, fatigability and pain take place in the first month after MUA; 6 months after MUA, however, NI and endurance time remained impaired for the involved shoulder. Physiotherapy should pay more attention to muscle function recovery. LEVEL OF EVIDENCE: Level III, prospective follow-up study.

EMG biofeedback effectiveness to alter muscle activity pattern and scapular kinematics in subjects with and without shoulder impingement.

BACKGROUND: Muscle imbalance between serratus anterior (SA), upper trapezius (UA), middle trapezius (MT), and lower trapezius (LT) muscles has been observed in subjects with subacromial impingement syndrome (SAIS). OBJECTIVE: (1) To investigate the effect of electromyography (EMG) biofeedback training on muscle balance ratios and scapular kinematics in healthy adults and subjects with SAIS. (2) To investigate whether the effects of EMG biofeedback on muscle balance ratios are different between groups. DESIGN: Twelve healthy adults and 13 subjects with SAIS were recruited in this study. EMG was used to record the activity of scapular muscles. The ratios (UT/SA, UT/MT, and UT/LT) during exercises with/without EMG biofeedback were calculated. Scapular kinematics were recorded before and after exercises with/without EMG biofeedback. RESULTS: For the subjects with SAIS, muscle balance ratios were lower during forward flexion with EMG biofeedback than during exercise only (UT/SA: 70.3-45.2; UT/LT: 124.8-94.6). Additionally, similar results were found during side-lying external rotation (UT/MT: 58.5-36.4). For the scapular upward rotation and tipping in both groups, there were no significant differences with and without EMG biofeedback. CONCLUSION: EMG biofeedback improved the scapular muscular balance during training exercises in both groups. Further clinical trials should investigate the long-term effects of EMG biofeedback.

Mobilization with movement and kinesiotaping compared with a supervised exercise program for painful shoulder: results of a clinical trial.

OBJECTIVE: The purpose of this study was to compare the efficacy of Mobilization with Movement (MWM) and kinesiotaping (KT) techniques with a supervised exercise program in participants with patients with shoulder pain. METHODS: Twenty subjects with shoulder pain were included if subjects were diagnosed by the referring physician with either rotator cuff lesion with impingement syndrome or impingement shoulder syndrome. Participants were randomly assigned to 1 of 2 groups after clinical and radiologic assessment: group 1 was treated with MWM and KT techniques, whereas group 2 was treated with a supervised exercise program. The main outcome measures were active pain-free shoulder abduction and flexion tested on days 0, 5, and 10. RESULTS: Improvement in active pain-free shoulder range of motion was significantly higher in the group treated with MWM and KT. Repeated-measures analysis of variance indicated significant effects of treatment, time, and treatment×time interaction. CONCLUSION: This study suggests that MWM and KT may be an effective and useful treatment in range of motion augmentation of subjects with rotator cuff lesion and impingement syndrome or impingement shoulder syndrome.

Effectiveness of microwave diathermy on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome: a randomized placebo-controlled clinical study.

The aim of this clinical trial was to evaluate the effectiveness of therapeutic MD on pain, functional capacity, muscle strength, quality of life, and depression in patients with subacromial impingement syndrome (SIS). A total of 40 inpatient subjects with definite SIS were included in this study. These patients were sequentially randomized into 2 groups. Group 1 (n = 20) received therapeutic MD. Group 2 (n = 20) was served as control group and received sham MD. Superficial heat and exercise program were given to both groups. Both of the programs were performed 5 times weekly for 3 weeks. Patients were assessed before treatment (BT), after treatment (AT), and at a 1-month follow-up (F). Outcome measures included visual analogue scale, goniometry, Shoulder Pain and Disability Index, Shoulder Disability Questionnaire, shoulder isokinetic muscle testing, handgrip strength, Short Form 36, and Beck Depression Index. The patients with SIS in each group had significant improvements in pain, shoulder ROM, disability, shoulder muscles and grip strength, quality of life, and depression AT and F when compared with their initial status (P < 0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P > 0.05). A 2,450-MHz MD regimen showed no beneficial effects in patients with SIS, so the superficial heat and exercise program, as it is efficient, may be preferable for the treatment of SIS, alone.

Efectos del vendaje neuromuscular (kinesiotaping) en el síndrome del supraespinoso / Kinesio taping effects of the supraspinatus syndrome

El objetivo principal de este trabajo es conocer la eficacia del vendaje neuromuscular en un deportista de élite con síndrome del supraespinoso respecto a otros tratamientos conservadores en los que no se aplica. Se ha realizado una valoración inicial (pretest) y final (postest) en donde las variables sometidas a estudio fueron el dolor, la amplitud articular del hombro, la fuerza muscular y el índice de esfuerzo percibido. Los tratamientos aplicados con duración de 3 semanas se dividen en dos fases: fase 1, termoterapia de alta frecuencia, ultrasonidos y masoterapia, y fase 2, el tratamiento anterior combinado con la técnica de vendaje neuromuscular. Los resultados indican una reducción del dolor en ambas fases (mayor en la fase 2) y aumento y estabilización en cantidad y/o calidad de la movilidad glenohumeral en la fase 2. El vendaje neuromuscular podría considerarse una técnica complementaria al tratamiento conservador ya que podría reducir el dolor y mejorar la movilidad articular (AU)

The main objective of this work is to determine the effectiveness of kinesio taping in an elite athlete with supraspinatus syndrome compared to other conservative treatments in which this Taping was not used. An initial assessment (pretest) and final assessment (posttest) were carried out in which the variables studied were pain, shoulder range of motion, muscle strength and the Perceived Exertion Index. The treatments were applied for three weeks and were divided into two phases: Phase 1, high frequency thermotherapy, ultrasound and massage therapy and phase 2, previous treatment combined with the kinesio taping technique. The results indicate a reduction in pain in both phases (higher in phase 2) and an increase as well as stabilization in quantity and/or quality of glenohumeral mobility in phase 2. Kinesio taping can be considered a complementary technique to the conservative treatment as it may reduce pain and improve joint mobility (AU)

The effects of unsupervised movement training with visual feedback on upper limb kinematic in persons with shoulder impingement syndrome.

Persons with shoulder impingement syndrome (SIS) present impairments that can be improved following supervised movement training with feedback; however, retention is low. The purpose of this study was to evaluate if kinematic changes observed following supervised training can be maintained using unsupervised training with visual feedback. Thirty-three subjects with SIS participated in two visits, one day apart. Kinematic patterns of the upper limb were evaluated once during the first visit, immediately after supervised training; they were evaluated twice during the second visit, before and immediately after unsupervised training. Kinematic patterns were characterized by total excursion and final position during reaching. Unsupervised training consisted of reaching movements performed in front of a mirror. The day after supervised training, subjects with SIS used significantly larger trunk rotation and finished reaching with the trunk more rotated as compared to immediately after supervised training. Following unsupervised training, kinematics of the trunk was back to the level observed immediately after supervised training. Subjects who presented the largest kinematic deficits also significantly improved their shoulder and clavicular movements. Unsupervised training appears to be a good complement to supervised training in order to normalize the kinematic impairments of persons with SIS as compared to healthy subjects.

Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial.

BACKGROUND: Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations, frequent difficulties in clinical diagnosis and lack of effectiveness in treatment. Based on clinical experience, we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction. The hypothesis of this study is to relate subacromial impingement syndrome (SIS) with myofascial pain syndrome (MPS), since myofascial trigger points (MTrPs) cause pain, functional limitation, lack of coordination and alterations in quality of movement, even prior to a tendinopathy. MTrPs can coexist with any degenerative subacromial condition. If they are not taken into consideration, they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective.The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and/or SIS. METHOD/DESIGN: A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis, positive provocation test responses, the existence of active MTrPs and the results obtained with ultrasonography (US) and Magnetic Renonance Imaging (MRI). A randomized double blinded clinical trial will be carried out in experimental conditions: A Protocolized treatment based on active and passive joint repositioning, stabilization exercises, stretching of the periarticular shoulder muscles and postural reeducation. B. The previously described protocolized treatment, with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment. DISCUSSION: This study aims to provide a new vision of shoulder pain, from the perspective of MPS. This syndrome can, by itself, account for shoulder pain and dysfunction, although it can coexist with real conditions involving the tendons. TRIAL REGISTRATION: ISRCTN Number: 30907460.