Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials.

AIM: To summarise the current evidence regarding the effectiveness of physical therapy on pain, function and range of motion in individuals with subacromial pain syndrome (SAPS). DESIGN: Systematic review. DATA SOURCES: PubMed, Web of Science, CINAHL, Cochrane, Embase, Lilacs, Ibecs and Scielo databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCTs) investigating physical therapy modalities for SAPS on pain, function/disability or range of motion were included. RESULTS: 64 high-quality RCTs were included. Exercise therapy provided high evidence of being as effective as surgery intervention and better than no treatment or placebo treatment to improve pain, function and range of motion in the short, mid and long terms. The combination of mobilisation and exercises provided high evidence to decrease pain and improve function in the short term. There is limited evidence for improvements on the outcomes with the isolated application of manual therapy. High level of evidence was synthesised regarding the lack of beneficial effects of physical resources such as low-level laser, ultrasound and pulsed electromagnetic field (PEMF) on pain, function or range of motion in the treatment of SAPS. There is limited evidence for microwave diathermy and transcutaneous electrical nerve stimulation. There is moderate evidence to no benefits with taping in the short term. Effects of diacutaneous fibrolysis and acupuncture are not well established yet. CONCLUSIONS: Exercise therapy should be the first-line treatment to improve pain, function and range of motion. The addition of mobilisations to exercises may accelerate reduction of pain in the short term. Low-level laser therapy, PEMF and taping should not be recommended.

Pain in workers with shoulder impingement syndrome: an assessment using the DASH and McGill pain questionnaires

OBJECTIVE: This study assessed physical function and pain in male and female workers with shoulder impingement syndrome using the Brazilian Portuguese versions of the Disabilities of the Arm, Shoulder and Hand (DASH) and McGill pain questionnaires. METHODS: Twenty-seven assembly line workers (18 men and 9 women; mean age of 33.26 ± 6.49 years) in the school supply industry were evaluated. The duration of the shoulder impingement pain was 31.74 ± 32.92 months and the amount of time of the workers in this industry was 11.08 ± 6.41 years. The DASH questionnaire was used to evaluate functional status and symptoms of the upper limbs of the workers. Using the McGill Pain Questionnaire, the pain was quantified by the number of words chosen and by the pain rating index (PRI). RESULTS: The women presented higher scores (P< 0.05) than the men for both DASH overall and DASH work scores. The women chose more words (17.00 ± 2.59) than the men (13.33 ± 3.16) and also presented the highest total PRI (P< 0.05). CONCLUSIONS: The results obtained in this group of Brazilian workers with shoulder impingement identify the most commonly used descriptors of shoulder pain. Further, this study shows that females are more likely than males to refer physical disability and pain. Also, the DASH and McGill pain questionnaires are important and helpful tools in the clinical evaluation of shoulder impingement syndrome.

OBJETIVO: Este estudo avaliou função física e dor em trabalhadores com síndrome do impacto através das versões brasileiras dos questionários "Disabilities of the Arm, Shoulder and Hand" (DASH) e McGill de dor. MÉTODO: Vinte e sete trabalhadores (18 homens e 9 mulheres; idade média de 33,26 ± 6,49 anos) de uma linha de produção de uma indústria de material escolar foram avaliados. O tempo de duração de dor no ombro era de 31,74 ± 32,92 meses e o tempo de trabalho na indústria era de 11,08 ± 6,41 anos. O questionário DASH foi utilizado para avaliar o estado funcional e os sintomas dos membros superiores dos trabalhadores. Através do questionário McGill de dor, a dor foi quantificada pelo número de palavras escolhidas e pelo índice de classificação da dor (ICD). RESULTADOS: As mulheres apresentaram maiores escores (P< 0,05) que os homens para ambos os módulos do DASH. As mulheres escolheram mais palavras (17,00 ± 2,59) que os homens (13,33 ± 3,16) e também apresentaram o maior ICD total (P< 0,05). CONCLUSÃO: Os resultados obtidos neste grupo de trabalhadores brasileiros com síndrome do impacto do ombro identificam os mais comuns descritores utilizados para dor no ombro. Além disso, este estudo mostra que as mulheres estão mais propensas a relatarem incapacidade física e dor quando comparadas aos homens. Os questionários DASH e McGill de dor são ferramentas importantes e úteis na avaliação clínica da síndrome do impacto do ombro.