Pain, Subacromial Impingement Syndrome
Conditions
Keywords
Subacromial impingement syndrome, Rotator cuff tendenitis, shoulder impingement syndrome, supraspinatus tendenitis
Brief summary
The goal of this clinical trial study is to determine efficacy of adding cervical stabilization exercises (CSEs) to conventional physical therapy (PT) program on pain severity, shoulder function disability, kinesiophobia, shoulder range of motion (ROM), isometric muscle strength and upper limb (UL) functional activity in closed kinetic chain in patients with SIS. The main questions it aims to answer is: What are the effects of adding cervical stabilization exercises to a conventional physical therapy program in the management of shoulder impingement syndrome? Researchers will compare two groups: one group will receive CSEs beside the conventional PT program to the another group will receive the conventional PT program.
Detailed description
Shoulder impingement syndrome is a mechanical compression of the subacromial structures; specifically the subacromial bursa, rotator cuff, and long head of biceps tendons in the subacromial space. There are painful arm motions and functional restrictions. The treatment of SIS focuses on improving pain and upper limb (UL) functions. Conservative treatments are effective in stages I or II of SIS. Conservative treatments include non-steroidal anti-inflammatory drugs, corticosteroid injections, and exercise therapy such as strengthening for RC, and scapular muscles, stretching , proprioceptive neuromuscular facilitation (PNF), range of motion (ROM), and scapular stabilization exercises. Cervical stabilization exercises (CSEs) can improve cervical spine stability, flexibility, muscular strength and endurance, and joint position sense. Shoulder stability extends beyond the shoulder joint as the head, neck, and shoulder are interconnected through muscles, tendons, and fascia. Alteration of spine alignment leads to change mechanics of the shoulder. Forward head posture (FHP) can cause abnormal scapular orientation (internal rotation, elevation, and anterior tilting), decrease shoulder muscle strength, ROM, and increase humeral head translations that may predispose an individual to SIS. Also, increase thoracic kyphosis may cause increase scapular anterior tipping and retraction. Crucially, the proper action of key scapular muscles, like the trapezius, requires the correct orientation of the cervical spine. This stability is achieved by the deep neck flexors (DNFs)-specifically the longus capitis and longus colli- which act as essential stabilizers for maintaining proper posture of the head and neck. Delayed timing of DNFs was shown to compromise spinal control during upper extremity function. Also, increased DNFs strength can enhance electromyographic (EMG) activity of scapular muscles (SA, UT, and LT). One possible mechanism to describe the effect of CSEs in reducing pain is that stimulation of mechanoreceptors, including the muscle spindle and proprioceptors of joints. Signals from these receptors cause the release of endogenous opioids and beta-endorphins from the pituitary gland. Another possible mechanism of pain improvement is that the effect of these exercises in improving the coordination between the recruitment of the superficial and deep neck muscles. However, up to authors' knowledge, studies investigating the specific effects of adding CSEs to conventional SIS treatment are insufficient.
Interventions
OTHERConventional Physical Therapy
* Rotator Cuff Strengthening Exercise: (Full Can Exercise, External Rotation Exercise, and Internal Rotation Exercise). * Scapular Stabilization Exercise: (Prone Extension Exercise, Prone Horizontal Abduction with External Rotation Exercise, Prone Elevation Exercise, and Serratus Anterior Supine Punch ). * Stretching Exercise: (Self-Sleeper Stretching for Posterior Capsule, Self-stretching for Pectoralis Minor, and Self-Stretching for Upper Trapezius:). Intervention period will last for 6 weeks, 3 sessions per week. The duration of the session will be approximately forty minutes.
* Rotator Cuff Strengthening Exercise: (Full Can Exercise, External Rotation Exercise, and Internal Rotation Exercise). * Scapular Stabilization Exercise: (Prone Extension Exercise, Prone Horizontal Abduction with External Rotation Exercise, Prone Elevation Exercise, and Serratus Anterior Supine Punch ). * Stretching Exercise: (Self-Sleeper Stretching for Posterior Capsule, Self-stretching for Pectoralis Minor, and Self-Stretching for Upper Trapezius:). * Cervical Stabilization Exercises: (Cranio-Cervical Flexion Exercise and Deep Cervical Extensors Exercise). Intervention will be performed 3 times per week for 6 weeks. The duration of the session will be approximately one hour (40 min of conventional PT program and 15-20 min of CSEs with the progression).
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
20 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Male and female patients with unilateral SIS. * Age is 20-40 years old. * Presence of pain on anterolateral aspect of the shoulder for at least three months. * At least 3 of the following criteria; positive Neer, Hawkins, and Empty can tests, Painful arc, and pain during resisted isometric abduction or external rotation.
Exclusion criteria
* Shoulder surgery, injury and arthritis. * Any anatomical anomalies as hooked acromion. * Cervical radiculopathy. * Other systemic diseases: cardiovascular diseases, respiratory diseases and neurological diseases.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain severity will be assessed by Visual Analog Scale | Visual Analog Scale will be assessed before the intervention and then after the end of the intervention at 6 weeks. | Visual Analog Scale consists of a 10 cm horizontal line anchored by "no pain" at one end and "worst pain imaginable" at the other end. The patient will elevate the arm to the available end- range then the patient will mark on the Visual Analog Scale the point that represents the pain severity during elevation. The score will be determined by measuring millimeters from the left-hand end of the line to the point that the patient marks. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Shoulder Disability will be assessed by shoulder pain and disability index | Shoulder Pain and Disability Index will be assessed before the intervention and then after the end of the intervention at 6 weeks. | shoulder pain and disability index is a questionnaire that consists of two sections of 13 questions, one section for pain and the other for functional activities. The pain section forms of five questions regarding the severity of the patient's pain. Functional activities are evaluated with eight questions designed to measure the degree of difficulty the patient has with various activities of daily living, The patient will answer by placing a mark on a 10 cm visual analogue scale for each question. The score will be determined by measuring millimeters from the left-hand end of the line to the point that the patient marks. The scores from both dimensions are averaged to derive a total score. The means of the two subscales will be averaged to produce a total score ranging from 0 (best) to 100 (worst). |
| Kinesiophobia will be assessed by Tampa Scale of Kinesiophobia | Tampa Scale of Kinesiophobia will be assessed before the intervention and the after the end of the intervention at 6 weeks. | Tampa Scale of Kinesiophobia is a self-report questionnaire consisting of 17 statements rated on a 4-point Likert scale (1=strongly disagree, 2= disagree, 3=agree, 4=strongly agree). The patient will answer each question of the tampa scale of Kinesiophobia through the 4-point likert scale to show how much fear of pain the patient feels. A total score will be calculated after inversion of the individual scores of items (4, 8, 12 and 16) and it can range from 17 (no kinesiophobia) to 68 (sever kinesiophobia. |
| Shoulder range of motion by inclinometer | Shoulder Range of Motion will be assessed before the intervention and then after the end of the intervention at 6 weeks. | Inclinometer is a handheld device with high accuracy sensor used to measure the angular position of the body part relative to the horizontal or vertical planes. |
| Muscles strength will be assessed by Hand Held Dynamometer. | Muscles strength will be assessed before the intervention and then after the end of the intervention at 6 weeks. | Hand Held Dynamometer is an instrument for measuring isometric muscles strength. |
| Closed Kinetic Chain Upper Extremity Test | Closed Kinetic Chain Upper Extremity Test will be assessed before the intervention and then after the end of the intervention at 6 weeks. | Closed Kinetic Chain Upper Extremity Test is a method that provides quantitative data for Upper limb functional activity in closed kinetic chain. Males will perform the test by assuming a push-up position; while females by assuming a modified (kneeling) push-up position, both with back flat parallel to the floor and hands at 36-inches (90 cm) apart at the floor. Two parallel lines will be marked on the floor to determine the initial placement of the hands. Then, during 15 seconds, the subject will lean over one hand and will touch the opposite hand and then the hand will return to the starting position. Then the subject will perform the same movement with the other hand. |
Countries
Egypt
Contacts
CONTACTMona M Ibrahim, Doctoral Degree
CONTACTKarima A Hassan, Assistant professor
PRINCIPAL_INVESTIGATORMona M Ibrahim, Doctoral Degree
Cairo University
Outcome results
None listed