None listed
Conditions
Brief summary
Shoulder impingement is a common diagnosis referred for physiotherapy treatment. Patients complain of pain when lifting their arm and difficulty with functions such as washing their hair or when reaching for objects. (Michener, McClure et al. 2003) suggest “it is the most common disorder of the shoulder, accounting for 44-65% of all complaints of shoulder pain during a physician’s office visit.” In addition, approximately one-fifth of all disability payments for musculoskeletal disorders are for shoulder disorders (Michener, Walsworth et al. 2004) These statistics indicate that a large portion of the general community may be affected by a shoulder disorder and that it causes significant discomfort and limitation to their function. Physiotherapists use past clinical experience in addition to a thorough examination to identify physical characteristics causing signs of impingement and which are able to be modified (Sorohan and Mc Creesh 2009). A study has been completed (JCU ethics approval number H3945) which took an homogeneous group, aged 40 to 60 years, presenting with positive shoulder impingement signs and symptoms of gradual onset and without trauma, and compared these physical characteristics to a matched asymptomatic group in age and physical activity level. Significant differences between groups were found in upper back (thoracic) posture, range of upper back (thoracic) movement and tightness in the back of the shoulder. No significant differences were found in shoulder muscle strength or shoulder blade positioning. This prospective, randomized double blinded,control trial will compare the clinical efficacy of two evidence based physiotherapy treatment approaches (one directed at the thoracic spine and one directed at the posterior shoulder) as compared to ultrasound treatment. The results of this project will result in the development of an evidence based program to manage shoulder impingement.
Interventions
Physiotherapy treatment provided for six consecutive weeks. Twice a week for three weeks followed by once a week for three weeks.
Intervention One is mobilisation of thoracic spine in prone position which consists of transverse mobilisations from the direction of painful side to non-painful side and costovertebral mobilisation on the painful side at thoracic levels 1 to 6. Time taken = 20 minutes..A home exercise of lying on rolled towel positioned longitudinally along thoracic spine for 5 mins
Physiotherapy treatment provided for six consecutive weeks. Twice a week for three weeks followed by once a week for three weeks. Intervention One is mobilisation of thoracic spine in prone position which consists of transverse mobilisations from the direction of painful side to non-painful side and costovertebral mobilisation on the painful side at thoracic levels 1 to 6. Time taken = 20 minutes..A home exercise of lying on rolled towel positioned longitudinally along thoracic spine for 5 mins, twice a day - to be continued on a daily basis for the full twelve weeks of the study. Intervention two is release of posterior shoulder tightness using massage to the posterior soft tissues and AP mobilisation of painful glenohumeral joint. Time taken = 20 minutes. A home programme of passive cross adduction stretch in standing, performed twice for the count of 20, two times during the day - to be continued on a daily basis for the full twelve weeks of the study The home programme is monitored via exercise diary provided to the subjects.
Sponsors
Helen Land
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
40 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
Minimum of three positive orthopaedic special tests. Hawkins- Kennedy and/or Neer must be positive along with two of the following: Painful Arc, Speed, Cross Body Adduction, External Rotation Resistance Test and pain on tendon palpation. Catching’ or aching pain without appreciable joint stiffness. Pain localized to the anterior or antero-lateral-superior shoulder. Insidious onset of symptoms with a possible history of gradual progression over time but without history of trauma.
Exclusion criteria
Previously undergone shoulder surgery or suffered a fracture of the shoulder girdle Presence of scoliosis or current cervical or thoracic signs or symptoms, Glenohumeral instability by eliciting a grade 2 or 3 in an anterior, posterior or inferior load and shift test or have had a previous shoulder dislocation. A diagnosed systemic or neurological disease. The identification of osteophytes within the subacromial space; calcification of tendons or large rotator cuff tears on imaging
Outcome results
None listed