Shoulder Pain
Conditions
Keywords
shoulder, pectoralis minor, stretching, scapular kinematics
Brief summary
The purpose of this study is to verify the effects of a stretching protocol for the pectoralis minor muscle on its resting length and on the 3D kinematics of the scapula during arm flexion in asymptomatic subjects and patients with impingement syndrome with shortened pectoralis minor.
Detailed description
Fifty subjects (25 symptomatic and 25 asymptomatic for shoulder pain) will be recruited. All of them will be initially assessed twice with one week between the assessments. On each day, they will complete two questionnaires (DASH and SPADI) to assess pain and shoulder function. The resting length of the pectoralis minor muscle and scapular kinematics data during arm flexion will also be measured using an electromagnetic tracking system. Initially, the resting length of the pectoralis minor will be measured, and then 3 repetitions of arm elevation in the sagittal plane will be completed. The stretching protocol will be performed daily for 6 weeks. The stretching will be performed with the subject standing, with 90° of arm abduction and 90° of elbow flexion and palm on a flat planar surface. The subject then will place the leg opposite to the flat surface in front of the other with slight knee flexion and tilt the trunk forward like a rigid block and rotate it slightly increasing the horizontal abduction at the shoulder. This procedure will be done 4 times for 1 min and 30s interval between repetitions. After the 6 weeks, the subject will have the same variables from the initial assessments reassessed. For the questionnaires and length of pectoralis minor a two-way ANOVA for repeated measures will be used to check the main effects of group and evaluation and whether there is interaction between them. For scapular internal/external rotation, upward/downward rotation, and tilt anterior/posterior a three-way ANOVA for repeated measures will use to analyze the main effects of group (symptomatic and asymptomatic), elevation angle of the arm (30°, 60°, 90° and 120°) and evaluation (1, 2 and 3) and whether there is evaluation x group x angle interaction. A p value less than 0.05 will be considered significant.
Interventions
PROCEDUREStretching-Asymptomatic subjects
The stretching will be performed with the subject standing, with 90° of arm abduction and 90° of elbow flexion and palm on a flat planar surface. The subject then will place the leg opposite to the flat surface in front of the other with slight knee flexion and tilt the trunk forward like a rigid block and rotate it slightly increasing the horizontal abduction at the shoulder. This procedure will be done 4 times for 1 min and 30s interval between repetitions.
PROCEDUREStretching-Subjects with shoulder pain
The stretching will be performed with the subject standing, with 90° of arm abduction and 90° of elbow flexion and palm on a flat planar surface. The subject then will place the leg opposite to the flat surface in front of the other with slight knee flexion and tilt the trunk forward like a rigid block and rotate it slightly increasing the horizontal abduction at the shoulder. This procedure will be done 4 times for 1 min and 30s interval between repetitions.
Sponsors
Universidade Metodista de Piracicaba
Universidade Federal de Sao Carlos
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
Asymptomatic subjects were included if they did not have any positive test for SIS. The subjects with shoulder pain were included if: 1. they had history of shoulder, at least one week; 2. 18 - 45 years; 3. range of motion \> 150° evaluated with digital inclinometer; 4. one or more impingement tests positive - Neer (Neer, 1972), Hawkins (Hawkins and Kennedy, 1980) and Jobe (Jobe and Moynes, 1982) - associated with painful arc during arm elevation, or during external rotation with 90° of arm elevation; 5. Individuals from both groups also had to present with shortened PM muscle length.
Exclusion criteria
Individuals from both groups were excluded if they: 1. BMI (body mass index) \> 28kg/m2; 2. irradiated shoulder pain; 3. scoliosis; 4. history of shoulder pain with beginning traumatic; 5. history of fracture or surgery in upper limb and rotator cuff; 6. systemic illnesses; 7. tape allergy; 8. were pregnant; 9. physiotherapy at least 6 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pectoralis Minor Length After Pectoralis Minor Stretching Protocol | 6 weeks after stretching | The change of the pectoralis minor muscle will be evaluated with a tape measure and electromagnetic device. The length of the muscle will be recorded in centimeters. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Scapular Kinematics After Pectoralis Minor Stretching Protocol | 6 weeks of stretching | The scapular kinematics will be evaluated with electromagnetic device. The changes in the scapular kinematics will be described in degrees. |
Countries
Brazil
Participant flow
Recruitment details
Fliers posted in the local university setting and community were used to recruit symptomatic individuals, between february of 2012 and January of 2014. Asymptomatic individuals were recruited through personal contacts of the investigators.
Pre-assignment details
If participants did not come back to second evaluation, they were not assignments to groups.
Participants by arm
| Arm | Count |
|---|---|
| Asymptomatic Subjects The stretching will be performed with the subject standing, with 90° of arm abduction and 90° of elbow flexion and palm on a flat planar surface. The subject then will place the leg opposite to the flat surface in front of the other with slight knee flexion and tilt the trunk forward like a rigid block and rotate it slightly increasing the horizontal abduction at the shoulder. This procedure will be done 4 times for 1 min and 30s interval between repetitions. | 48 |
| Subjects With Shoulder Pain The stretching will be performed with the subject standing, with 90° of arm abduction and 90° of elbow flexion and palm on a flat planar surface. The subject then will place the leg opposite to the flat surface in front of the other with slight knee flexion and tilt the trunk forward like a rigid block and rotate it slightly increasing the horizontal abduction at the shoulder. This procedure will be done 4 times for 1 min and 30s interval between repetitions. | 49 |
| Total | 97 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 17 | 4 |
| Overall Study | Lost to Follow-up | 6 | 20 |
Baseline characteristics
| Characteristic | Asymptomatic Subjects | Subjects With Shoulder Pain | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 48 Participants | 49 Participants | 97 Participants |
| Region of Enrollment Brazil | 48 participants | 49 participants | 97 participants |
| Sex: Female, Male Female | 26 Participants | 28 Participants | 54 Participants |
| Sex: Female, Male Male | 22 Participants | 21 Participants | 43 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 15 / 48 | 7 / 49 |
| serious Total, serious adverse events | 23 / 48 | 24 / 49 |
Outcome results
Primary
Pectoralis Minor Length After Pectoralis Minor Stretching Protocol
The change of the pectoralis minor muscle will be evaluated with a tape measure and electromagnetic device. The length of the muscle will be recorded in centimeters.
Time frame: 6 weeks after stretching
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Asymptomatic Subjects | Pectoralis Minor Length After Pectoralis Minor Stretching Protocol | 16.38 centimeters | Standard Deviation 1.46 |
| Subjects With Shoulder Pain | Pectoralis Minor Length After Pectoralis Minor Stretching Protocol | 16.87 centimeters | Standard Deviation 1.9 |
p-value: <0.05ANOVA
Secondary
Scapular Kinematics After Pectoralis Minor Stretching Protocol
The scapular kinematics will be evaluated with electromagnetic device. The changes in the scapular kinematics will be described in degrees.
Time frame: 6 weeks of stretching
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Asymptomatic Subjects | Scapular Kinematics After Pectoralis Minor Stretching Protocol | 30 degree | Standard Deviation 5 |
| Subjects With Shoulder Pain | Scapular Kinematics After Pectoralis Minor Stretching Protocol | 40 degree | Standard Deviation 5 |
p-value: >0.05ANOVA