Abstract
The purpose of this clinical trial is to compare the effectiveness of a scapular-focused treatment with a control therapy in patients with shoulder impingement syndrome. Therefore, a randomized clinical trial with a blinded assessor was used in 22 patients with shoulder impingement syndrome. The primary outcome measures included self-reported shoulder disability and pain. Next, patients were evaluated regarding scapular positioning and shoulder muscle strength. The scapular-focused treatment included stretching and scapular motor control training. The control therapy included stretching, muscle friction, and eccentric rotator cuff training. Main outcome measures were the shoulder disability questionnaire, diagnostic tests for shoulder impingement syndrome, clinical tests for scapular positioning, shoulder pain (visual analog scale; VAS), and muscle strength. A large clinically important treatment effect in favor of scapular motor control training was found in self-reported disability (Cohen’s d = 0.93, p = 0.025), and a moderate to large clinically important improvement in pain during the Neer test, Hawkins test, and empty can test (Cohen’s d 0.76, 1.04, and 0.92, respectively). In addition, the experimental group demonstrated a moderate (Cohen’s d = 0.67) improvement in self-experienced pain at rest (VAS), whereas the control group did not change. The effects were maintained at three months follow-up.
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References
Kessel L, Watson M (1977) Painful arc syndrome – clinical classification as a guide to management. J Bone Joint Surg 59:166–172
Lewis J, Green A, Wright C (2005) Subacromial impingement syndrome: the role of posture and muscle imbalance. J Should Elbow Surg 14:385–392
Kulenkampff HA, Reichelt A (1989) Studies on conservative and operative treatment of the supraspinatus syndrome. Akt Rheum 14:70–76
Koehler SM, Thorson DC (1996) Swimmer’s shoulder – targeting treatment. Phys Sportsmed 24:39–50
Wilk KE, Obna P, Simpson CD, Cain EL, Dugas J, Andrews JR (2009) Shoulder injuries in the overhead athlete. J Orthop Sports Phys 39:38–54
Viikari-Juntura E, Shiri R, Solovieva S, Karpinnen J, Leino-Arjas P, Varonen H, Kalso E, Ukkola O (2008) Risk factors of atherosclerosis and shoulder pain – Is there an association? A systemic Review. Eur J Pain 12:412–426
Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C (2004) Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthr Rheumathol 51:642–651
Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS et al (2004) Prevalence and incidence of shoulder pain in the general population: a systematic review. Scand J Rheumatol 33:73–81
Neer CS II (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder. A preliminary report. J Bone Joint Surg Am 54A:41–50
Walch G, Boileau P, Noel E et al (1992) Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Should Elbow Surg 1:238–245
Cools AM, Cambier D, Witvrouw EE (2008) Screening the athlete’s shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Br J Sports Med 42:628–635
Borsa PA, Timmons MK, Sauers EL (2003) Scapular-positioning patterns during humeral elevation in unimpaired shoulders. J Athl Train 38:12–17
Kibler BW, Sciascia A, Dome D (2006) Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med 34:1643–1647
Burkhart S, Morgan C, Kibler W (2003) The disabled shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 19:641–661
McClure P, Tate A, Kareha S, Irwin D, Zlupko E (2009) A clinical method for identifying scapular dyskinesis, Part 1: reliability. J Athl Train 44:160–164
Mottram S (1997) Dynamic stability of the scapula. Man Ther 2:123–131
Blevins F (1997) Rotator cuff pathology in athletes. Sports Med 24:205–220
Kaplan LD, McMahon PJ, Towers J et al (2004) Internal impingement: findings on magnetic resonance imaging and arthroscopic evaluation. Arthroscopy 20:701–704
Atalar H, Yilmaz C, Polat O, Selek H, Uras I, Yanik B (2009) Restricted scapular mobility during arm abduction: implications for impingement syndrome. Acta Orthop Belgica 75:19–24
Cools AM, Witvrouw EE, Declercq GA, Vanderstraeten GG, Cambier DC (2005) Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. Br J Sports Med 38:64–68
Endo K, Yukata K, Yasui N (2004) Influence of age on scapulo-thoracic orientation. Clin Biomech 19:1009–1013
Hébert LJ, Moffet H, McFadyen BJ, Dionne CE (2002) Scapular behaviour shoulder impingement syndrome. Arch Phys Med Rehabil 83:60–69
Host HH (1995) Scapular taping in the treatment of anterior shoulder impingement. Phys Ther 75:803–812
Lewis J, Green A, Reichard Z, Wright C (2002) Scapular position: the validity of skin surface palpation. Man Ther 7:26–30
Ludewig PM, Cook TM (2000) Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 80:276–291
McClure PW, Michener LA, Karduna AR (2006) Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome. Phys Ther 86:1075–1090
Schmitt L, Snyder-Mackler L (1999) Role of scapular stabilizers in etiology and treatment of impingement syndrome. J Orthop Sports Phys Ther 29:31–38
Lukasiewicz AC, McClure P, Michener L, Pratt N, Sennet B (1999) Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther 29:574–586
Morrissey D, Morrissey MC, Driver W, King JB, Woledge RC (2008) Manual landmark identification and tracking during the medial rotation test of the shoulder: an accuracy study using three-dimensional ultrasound and motion analysis measures. Man Ther 13:529–535
Smith M, Sparkes V, Busse M, Enright S (2009) Upper and lower trapezius muscle activity in subjects with subacromial impingement symptoms: Is there imbalance and can taping change it? Phys Ther Sport 10:45–50
Borstad JD, Ludewig PM (2005) The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals. J Orthop Sports Phys Ther 35:227–238
Roy JS, Moffet H, Hébert L, Lirette R (2009) Effect of motor control and strengthening exercises on shoulder function in persons with impingement syndrome: A single-subject study design. Man Ther 14:180–188
Bernhardsson S, Klintberg IH, Wendt GK (2011) Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome. Clin Rehab 25:69–78
Kuhn JE (2009) Exercise in the treatment of rotator cuff impingement: A systematic review and a synthesized evidence-based rehabilitation protocol. J Should Elbow Surg 18:138–160
Green S, Buchbinder R, Glazier R, Forbes A (1998) Systematic review of randomised controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ 316:354–360
Desmeules F, Cote CH, Fremont P (2003) Therapeutic exercise and orthopedic manual therapy for impingement syndrome: a systematic review. Clin J Sport Med 13:176–182
Faber E, Kuiper JI, Burdorf A, Miedema HS, Verhaar JA (2006) Treatment of impingement syndrome: a systematic review of the effects on functional limitations and return to work. J Occup Rehab 16:7–25
Kromer TO, Tautenhahn UG, de Bie RA, Staal JB, Bastiaenen CHG (2009) Effects of Physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature. J Rehab Med 41:870–888
Van der Windt DAWM, van der Heijden GJMJ, de Winter AF et al (1998) The responsiveness of the Shoulder Disability Questionnaire Annals of the Rheumatic Diseases. Ann Rheum Dis 57:82–87
Dorrestijn O, Stevens M, Diercks RL, van der Meer K, Winters JC (2007) A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial. BMC Musculoskelet Disord. doi:10.1186/1471-2474-8-15
Gürsel YK, Ulus GY, Bilgiç A, Dinçer G, van der Heijden GJMG (2004) Adding ultrasound in the management of soft tissue disorders of the shoulder: a randomized placebo-controlled. Trial Phys Ther 84:336–343
van Wilgen CP, Dijkstra PU, van der Laan BFAM, Plukker JTM, Roodenburg JLN (2004) Shoulder complaints after nerve sparing neck dissections. Int J Oral Maxillofac Surg 33:253–257
Van der Heijden GJMG, Leffers P, Bouter LM (2000) Shoulder disability suestionnaire design and responsiveness of a functional status measure. J Clin Epidem 53:29–38
Paul A, Lewis M, Shadforth MF et al (2004) A comparison of four shoulder-specific questionnaires in primary care. Ann Rheum Dis 63:1293–1299
Smidt N, van der Windt DA, Assendelft WJ, Mourits AJ, Devillé WL, De Winter AF, Bouter LM (2002) Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis. Arch Phys Med Rehabil 83:1145–1150
Bijur PE, Latimer CT, Gallagher EJ (2002) Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Academ Emerg Med 10:390–392
Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27:117–126
Mark HSM, Au TTS, Choi YF, Wong TW (2009) The minimum clinically significant difference in visual analogue scale pain score in a local emergency setting. Hong Kong J Emerg Med 16:233–236
Struyf F, Nijs J, De Coninck K, Giunta M, Mottram S, Meeusen R (2009) Clinical assessment of scapular positioning in musicians: an inter-tester reliability study. J Athl Train 44:519–526
Nijs J, Roussel N, Vermuelen K, Souvereyns G (2005) Scapular positioning in patients with shoulder pain: a study examining the reliability and clinical importance of 3 clinical tests. Arch Phys Med Rehab 86:1349–1355
Lewis JS, Valentine RE (2007) The pectoralis minor length test: a study of the intra-rater reliability and diagnostic accuracy in subjects with and without shoulder symptoms. BMC Musc Skel Dis 8:63. doi:10.1186/1471-2474-8-64
Watson L, Balster SM, Finch C et al (2005) Measurement of scapula upward rotation: a reliable clinical procedure. Br J Sports Med 39:599–603
Holtermann A, Roeleveld K, Mork PJ, Grönlund C, Karlsson JS, Andersen LL, Olsen HB, Zebis MK, Sjøgaard G, Søgaard K (2009) Selective activation of neuromuscular compartments within the human trapezius muscle. J Electromyogr Kinesiol 19:896–902
Cools A, Declercq G, Cambier D, Mahieu N, Witvrouw E (2007) Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scand J Med Sci Sports 17:25–33
Jonsson P, Wahlström P, Obergh L, Alfredson H (2006) Eccentric training in chronic painful impingement syndrome of the shoulder: results of a pilot study. Knee Surg Sports Traumatol Arthrosc 14:76–81
Cohen J (1988) Statistical power analysis for the behavioral sciences Series. Editor, Hillsdale, New Jersey, Lawrence Erlbaum Associates
Lombardi I, Magri AG, Fleury AM, Da Silva AC, Natour J (2008) Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum 59:615–622
Juul-Kristensen B, Hilt K, Enoch F, Remvig L, Sjogaard G (2011) Scapular dyskinesis in trapezius myalgia and intraexaminer reproducibility of clinical tests. Physiother Theory Pract 27:492–502
Smith J, Dietrich CT, Kotajarvi BR, Kaufman KR (2006) The effect of scapular protraction on isometric shoulder rotation strength in normal subjects. J Should Elbow Surg 15:339–343
Hayes K, Walton JR, Szomor ZL, Murrell GA (2002) Reliability of 3 methods for assessing shoulder strength. J Should Elbow Surg 11:33–39
Acknowledgments
This study was financially supported by MSD Europe bvba, Nijverheidsstraat 18, Londerzeel, Belgium, and by research grant (G842) supplied by the Department of Health Sciences, Artesis University College Antwerp, Antwerp, Belgium. The material used in this study was provided by MSD Europe bvba.
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Trial registration: Clinical trials ISRCTN20736216
The study protocol was reviewed and approved by the Medical Ethics Committee of the UZ Brussel University Hospital, Brussels Free University (Vrije Universiteit Brussel), approved on 15 October 2008 (ref: BUN B14320084388).
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Struyf, F., Nijs, J., Mollekens, S. et al. Scapular-focused treatment in patients with shoulder impingement syndrome: a randomized clinical trial. Clin Rheumatol 32, 73–85 (2013). https://doi.org/10.1007/s10067-012-2093-2
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DOI: https://doi.org/10.1007/s10067-012-2093-2