Acute Pain, Atrophic, Goals, Impairment, Infiltration, Injury, Muscle Weakness, Pain, Pathology, Shoulder Pain, Syndrome, Tendinopathy
Conditions
Keywords
address, atrophic, base, clinical, cost, data, disability, effectiveness, attention, biofeedback, electrical stimulation, electromyography, exercise, exertion, health care service utilization, improved, injection of therapeutic agent, innovation, intervention, knowledge, local anesthetics, measures, modeling, motor, motor control, muscle, neuroadaptation, neurophysiology, novel, outcome, outcome measure, pain inhibition, patients, pattern, programs, public health relevance, rehabilitation strategy, relating to nervous system, reporting, research, rotator cuff, shoulder, staging, strength training, success, systematic review, techniques, testing, time, training, treatment strategy, United States, work
Brief summary
The purpose of this study is to examine deficits in activation and motor patterns, as well as central drive in patients with rotator cuff tendinopathy. There are three specific aims: (1) determine the effect of acute pain relief on rotator cuff muscle activation in patients with rotator cuff tendinopathy, (2) determine the effect of exercise on rotator cuff muscle activation in patients with rotator cuff tendinopathy, and (3) compare rotator cuff muscle activation between patients with rotator cuff tendinopathy and healthy controls.
Detailed description
The long-term goal of our research agenda is to identify the mechanisms associated with rotator cuff tendinopathy (impingement syndrome) and subsequently evaluate novel treatment strategies that address these mechanisms. The objectives of this application are to study the muscle patterns in patients with rotator cuff tendinopathy as well as the effects of both pain and exercise on these patterns. Our first hypothesis is that pain relief from a shoulder injection will result in increased rotator cuff activity. Our second hypothesis is that patients with tendinopathy will demonstrate improved rotator cuff muscle activity following a six-week exercise program and that this improvement will be higher in patients that respond favorably to treatment. Our final hypothesis is that patients with cuff tendinopathy will show decreased rotator cuff activity compared to healthy subjects. The investigators plan on addressing these hypotheses using several novel techniques for muscle activity assessment.
Interventions
PROCEDURESubacromial injection
A subacromial injection consisting up 6 cc 0.5% Marcaine with Epinephrine and 1 cc DepoMedrol will be administered.
OTHERPhysical Therapy
A standardized six-week exercise protocol supervised by a physical therapist
Sponsors
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
University of Oregon
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 45 Years
Healthy volunteers
Yes
Inclusion criteria
Patient Inclusion Criteria: * pain with passive provocative maneuvers (positive Hawkins or Neer test) * pain with active elevation (positive painful arc) * pain with isometric resisted movements (Jobe's empty can test or resisted shoulder external rotation with the arm at the side) * demonstrate weakness (\>10% force deficit in external rotation) Patient
Exclusion criteria
* shoulder surgery on the symptomatic side * positive Spurling test * traumatic shoulder dislocation or instability in the past 3 months * reproduction of shoulder pain with active or passive cervical range of motion * signs of rotator cuff tear (drop-arm test, lag signs, gross external rotation weakness, or positive image findings) * current musculoskeletal, neurologic or cardiovascular compromise Control Inclusion Criteria: * no current or previous shoulder injury * matched for age (within 5 years) and sex * meet Patient
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rotator cuff activation after subacromial injection and exercise intervention, difference in rotator cuff voluntary activation between subjects and controls | 6 weeks | Assessed using voluntary activation |
| Rotator cuff activation after subacromial injection and exercise intervention, difference in specific rotator cuff muscle activation between subjects and controls | 6 weeks | Assessed using electromyography (EMG) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rotator cuff voluntary activation correlations with pain levels | 2 hours | Assessed using voluntary activation relative to self-reported pain level |
| Rotator cuff activation correlations with pain levels | 2 hours | Assessed using EMG relative to self-reported pain level |
| Rotator cuff voluntary activation after 6-week exercise intervention and subacromial injection | 6 weeks | Assessed using voluntary activation |
| Rotator cuff muscle activation after 6-week exercise intervention and subacromial injection | 6 weeks | Assessed using EMG |
| Rotator cuff voluntary activation correlation with improvements in pain relief | 6 weeks | Assessed using voluntary activation relative to self-reported pain relief |
| Rotator cuff voluntary activation correlation with improvements in clinical outcome measures | 6 weeks | Assessed using voluntary activation relative to changes in questionnaire scores |
| Rotator cuff voluntary activation after subacromial injection | 2 hours | Assessed using voluntary activation |
| Rotator cuff muscle activation correlation with improvements in clinical outcome measures | 6 weeks | Assessed using EMG relative to changes in questionnaire scores |
| Prior to treatment, rotator cuff voluntary activation in patients relative to healthy controls | 6 weeks | Assessed using voluntary activation |
| Prior to treatment, rotator cuff muscle activation in patients relative to healthy controls | 6 weeks | Assessed using EMG |
| After both a subacromial injection and a six-week exercise program, differences in rotator cuff voluntary activation between patients and healthy controls | 6 weeks | Assessed using voluntary activation |
| After both a subacromial injection and a six-week exercise program, differences in rotator cuff muscle activation between patients and healthy controls | 6 weeks | Assessed using EMG |
| Rotator cuff muscle activation correlation with improvements in pain relief | 6 weeks | Assessed using EMG relative to self-reported pain relief |
| Rotator cuff muscle activation after subacromial injection | 2 hours | Assessed using EMG |
Countries
United States
Outcome results
None listed