Shoulder Pain
Conditions
Keywords
Pain, Rotator cuff, Stretching, Mobilization, Scapula, Posterior capsule
Brief summary
To identify biomechanical and sensibility changes in people with posterior capsule tightness in people with and without shoulder pain.
Detailed description
Some studies have shown that posterior capsule tightness can be related with shoulder dysfunctions and kinematics alterations. This study will be divided in two studies. The purpose of study 1 will be to assess the scapular and humeral kinematics, the strength of the shoulder external rotators and the pressure pain threshold in subjects with posterior capsule tightness with and without shoulder pain. Study 2 will verify the effects of two different treatments in subjects with posterior capsule tightness and shoulder pain on the same variables of study 1. One-hundred subjects will participate in the first study and will be divided in 4 groups: Group 1 - 25 subjects with shoulder pain and posterior capsule tightness; Group 2 - 25 subjects with no shoulder pain and no posterior capsule tightness; Group 3 - 25 subjects with shoulder pain and no posterior capsule tightness; and group 4 - 25 subjects with no shoulder pain and no posterior capsule tightness. All subjects will complete the DASH and Shoulder Pain and Disability Index questionnaires. External and internal rotation range of motion, strength of the external rotators, scapular kinematics and humeral translations during arm elevation, and pressure pain threshold will be measured. For the second study 50 subjects with shoulder pain and posterior capsule tightness will be recruited. The subjects will be randomly divided in 2 groups: experimental group or control group. The experimental group will receive glenohumeral posterior mobilization, stretching of posterior capsule and strengthening of the shoulder external rotators. The control group will do ultrasound;, stretching for the upper trapezius and scapular squeezing. Both groups will receive intervention for 3x/week/4 weeks. All subjects will be supervised for one physiotherapist and same variables from study 1 will be analyzed at pre and post-intervention.
Interventions
OTHERPosterior shoulder mobilizations
A second investigator performed 5min of posterior capsule shoulder mobilization for the experimental group, 3times/week during 4 weeks.
OTHERExternal rotators strengthening
Individuals performed 3x10 repetitions of external rotators strengthening in sidelying position 3times/week during 4 weeks.
OTHERPlacebo ultrasound
A second investigator performed 5min of placebo ultrassound for the control group, 3times/week during 4 weeks.
OTHERScapular squeezing
Individuals performed 3x10 repetitions scapular squeezing exercise 3times/week during 4 weeks.
OTHERUpper trapezius stretching
Individuals performed 3x30s of upper trapezius stretching, 3times/week during 4 weeks.
Individuals performed 3x30s of posterior capsule stretching, 3times/week during 4 weeks.
Sponsors
Universidade Federal de Sao Carlos
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
all subjects should have posterior capsule tightness and shoulder pain. So they should have: * low flexion test (flexion + internal rotation) \> 7°, between arms; * symptoms consistent to shoulder impingement and arm elevation close to 150° as determined by digital inclinometer. The diagnosis for SIS was made based on a clinical examination and self-reported history. To be classified as having shoulder impingement, subjects had to present with at least 3 of the following: positive Neer test, positive Hawkins test, positive Jobe test, pain with passive or isometric resisted shoulder lateral rotation, pain with active shoulder elevation, and pain in the anterolateral shoulder region.
Exclusion criteria
Individuals from both groups were excluded if they: * were pregnant; * had ligamentous laxity based on positive Sulcus test, Apprehension test or anterior drawer; * had history of clavicle, scapula or humerus fracture; * history of shoulder surgery or traumatic lesion; -had adhesive capsulitis or scoliosis; - had systemic illnesses; * transpore tape allergy; * body mass index \> 28kg/m2; * physical therapy treatment in the last 6 months; * bilateral symptoms; * steroid injection in the last 6 weeks; * drugs with muscle relaxant in the last 72 hours.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Scapular Kinematics at 4weeks (Pre and Post Treatment) | 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment) | It was assessed in degrees with 3D system pre and post treatment. |
| Humeral Translations at 4weeks (Pre and Post Treatment). | 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment) | It was assessed in millimeters with 3D system pre and post treatment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Strength of the Shoulder External Rotators at 4weeks (Pre and Post Treatment). | 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment) | The strength was evaluated with digital dynamometer in Newton pre and post treatment. |
| Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment) | It was measured by a digital algometer in kPa pre and post treatment. |
| Pain and Function at 4weeks (Pre and Post Treatment) | 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment) | For these measures, the SPADI (Shoulder Pain and Disabilities Index) questionnaire was used, pre and post treatment. The is a self-assessment questionnaire with 5 questions about pain and 8 about functional activities. The final score (0-100) of the questionnaire is provided in percentage and a maximum score of 100 implies the worst possible condition. |
Countries
Brazil
Participant flow
Recruitment details
The participation of all subjects was voluntary and no incentives were given to encourage enrollment. Fliers posted in the local university setting and surrounding community were used to recruit individuals from March 2015 to March 2016.
Participants by arm
| Arm | Count |
|---|---|
| Control Group This group will perform during 4 weeks:
* placebo ultrasound during 5min ;
* scapular squeezing in the sitting position (3x10repetitions);
* upper trapezius stretching (in sitting position, 3x30s and 30s of rest).
Posterior shoulder mobilizations: The subjects will be randomized to Experimental or control group. | 28 |
| Experimental Group This group will perform during 4 weeks:
* posterior shoulder mobilizations during 5min (mobilizations during 30s and 30s of rest);
* external rotators strengthening in sidelying positions with load (3x10repetitions);
* posterior capsule stretching (sleeper stretch in sidelying position, 3x30s and 30s of rest).
Posterior shoulder mobilizations: The subjects will be randomized to Experimental or control group. | 31 |
| Total | 59 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 3 | 4 |
Baseline characteristics
| Characteristic | Experimental Group | Control Group | 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 | 31 Participants | 28 Participants | 59 Participants |
| Age, Continuous | 41.18 years STANDARD_DEVIATION 12.84 | 40.08 years STANDARD_DEVIATION 12.08 | 40.63 years STANDARD_DEVIATION 12.46 |
| Region of Enrollment Brazil | 31 participants | 28 participants | 59 participants |
| Sex: Female, Male Female | 8 Participants | 13 Participants | 21 Participants |
| Sex: Female, Male Male | 23 Participants | 15 Participants | 38 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 28 | 0 / 31 |
| serious Total, serious adverse events | 0 / 28 | 0 / 31 |
Outcome results
Primary
Humeral Translations at 4weeks (Pre and Post Treatment).
It was assessed in millimeters with 3D system pre and post treatment.
Time frame: 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Humeral Translations at 4weeks (Pre and Post Treatment). | Pre Anterior Translation | 1.22 Millimeters | Standard Error 0.36 |
| Control Group | Humeral Translations at 4weeks (Pre and Post Treatment). | Post Anterior Translation | 0.68 Millimeters | Standard Error 0.32 |
| Control Group | Humeral Translations at 4weeks (Pre and Post Treatment). | Pre Superior Translation | 1.38 Millimeters | Standard Error 0.28 |
| Control Group | Humeral Translations at 4weeks (Pre and Post Treatment). | Post Superior Translation | 1.12 Millimeters | Standard Error 0.22 |
| Experimental Group | Humeral Translations at 4weeks (Pre and Post Treatment). | Post Superior Translation | 0.66 Millimeters | Standard Error 0.22 |
| Experimental Group | Humeral Translations at 4weeks (Pre and Post Treatment). | Pre Anterior Translation | 0.85 Millimeters | Standard Error 0.35 |
| Experimental Group | Humeral Translations at 4weeks (Pre and Post Treatment). | Pre Superior Translation | 1.21 Millimeters | Standard Error 0.27 |
| Experimental Group | Humeral Translations at 4weeks (Pre and Post Treatment). | Post Anterior Translation | 0.96 Millimeters | Standard Error 0.32 |
Primary
Scapular Kinematics at 4weeks (Pre and Post Treatment)
It was assessed in degrees with 3D system pre and post treatment.
Time frame: 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Pre Internal Rotation | 34.58 degrees | Standard Error 0.69 |
| Control Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Post Internal Rotation | 34.76 degrees | Standard Error 0.79 |
| Control Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Pre Upward Rotation | -18.12 degrees | Standard Error 0.68 |
| Control Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Post Upward Rotation | -17.85 degrees | Standard Error 0.58 |
| Control Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Pre Posterior Tilt | -3.23 degrees | Standard Error 0.59 |
| Control Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Post Posterior Tilt | -3.66 degrees | Standard Error 0.6 |
| Experimental Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Pre Posterior Tilt | -2.41 degrees | Standard Error 0.58 |
| Experimental Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Pre Internal Rotation | 36.00 degrees | Standard Error 0.68 |
| Experimental Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Post Upward Rotation | -14.37 degrees | Standard Error 0.57 |
| Experimental Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Post Internal Rotation | 35.72 degrees | Standard Error 0.77 |
| Experimental Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Post Posterior Tilt | -2.27 degrees | Standard Error 0.59 |
| Experimental Group | Scapular Kinematics at 4weeks (Pre and Post Treatment) | Pre Upward Rotation | -16.47 degrees | Standard Error 0.66 |
Secondary
Pain and Function at 4weeks (Pre and Post Treatment)
For these measures, the SPADI (Shoulder Pain and Disabilities Index) questionnaire was used, pre and post treatment. The is a self-assessment questionnaire with 5 questions about pain and 8 about functional activities. The final score (0-100) of the questionnaire is provided in percentage and a maximum score of 100 implies the worst possible condition.
Time frame: 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Pain and Function at 4weeks (Pre and Post Treatment) | Pre SPADI score | 46.01 scores on a scale | Standard Deviation 24.11 |
| Control Group | Pain and Function at 4weeks (Pre and Post Treatment) | Post SPADI score | 27.10 scores on a scale | Standard Deviation 23.75 |
| Experimental Group | Pain and Function at 4weeks (Pre and Post Treatment) | Pre SPADI score | 45.26 scores on a scale | Standard Deviation 23.22 |
| Experimental Group | Pain and Function at 4weeks (Pre and Post Treatment) | Post SPADI score | 17.22 scores on a scale | Standard Deviation 15.04 |
Secondary
Pressure Pain Threshold at 4weeks (Pre and Post Treatment).
It was measured by a digital algometer in kPa pre and post treatment.
Time frame: 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Upper Trapezius | 287.40 kPa | Standard Deviation 90.52 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Upper Trapezius | 351.47 kPa | Standard Deviation 174.59 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Infraspinatus | 351.33 kPa | Standard Deviation 129.94 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Infraspinatus | 403.25 kPa | Standard Deviation 211.7 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Supraspinatus | 259.15 kPa | Standard Deviation 86.68 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Supraspinatus | 343.88 kPa | Standard Deviation 159.75 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Deltoid | 301.78 kPa | Standard Deviation 92.58 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Deltoid | 338.00 kPa | Standard Deviation 149.94 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Levator Scapulae | 256.63 kPa | Standard Deviation 85.43 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Levator Scapulae | 267.26 kPa | Standard Deviation 108.97 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Anterior Tibialis | 711.31 kPa | Standard Deviation 227.74 |
| Control Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Anterior Tibialis | 714.12 kPa | Standard Deviation 272.46 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Anterior Tibialis | 676.57 kPa | Standard Deviation 270.6 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Upper Trapezius | 312.12 kPa | Standard Deviation 135.02 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Deltoid | 310.90 kPa | Standard Deviation 147.84 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Upper Trapezius | 355.82 kPa | Standard Deviation 161.77 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Levator Scapulae | 269.25 kPa | Standard Deviation 109.36 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Infraspinatus | 409.46 kPa | Standard Deviation 198.58 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Deltoid | 344.56 kPa | Standard Deviation 143.1 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Infraspinatus | 438.51 kPa | Standard Deviation 189.71 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Anterior Tibialis | 748.09 kPa | Standard Deviation 256.98 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Supraspinatus | 321.07 kPa | Standard Deviation 133.72 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Pre Levator Scapulae | 261.14 kPa | Standard Deviation 125.89 |
| Experimental Group | Pressure Pain Threshold at 4weeks (Pre and Post Treatment). | Post Supraspinatus | 353.40 kPa | Standard Deviation 161.16 |
Secondary
Strength of the Shoulder External Rotators at 4weeks (Pre and Post Treatment).
The strength was evaluated with digital dynamometer in Newton pre and post treatment.
Time frame: 4 weeks: Baseline (pre-treatment), and 4 weeks (post-treatment)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control Group | Strength of the Shoulder External Rotators at 4weeks (Pre and Post Treatment). | Pre External rotators strength | 89.08 Newton | Standard Deviation 32.86 |
| Control Group | Strength of the Shoulder External Rotators at 4weeks (Pre and Post Treatment). | Post External rotators strength | 88.98 Newton | Standard Deviation 34.73 |
| Experimental Group | Strength of the Shoulder External Rotators at 4weeks (Pre and Post Treatment). | Pre External rotators strength | 90.96 Newton | Standard Deviation 28.71 |
| Experimental Group | Strength of the Shoulder External Rotators at 4weeks (Pre and Post Treatment). | Post External rotators strength | 94.71 Newton | Standard Deviation 27.59 |