No abstract

The purpose of this clinical trial is to compare the effectiveness of a scapular-focused treatment with a control therapy in patients with shoulder impingement syndrome. Therefore, a randomized clinical trial with a blinded assessor was used in 22 patients with shoulder impingement syndrome. The primary outcome measures included self-reported shoulder disability and pain. Next, patients were evaluated regarding scapular positioning and shoulder muscle strength. The scapular-focused treatment included stretching and scapular motor control training. The control therapy included stretching, muscle friction, and eccentric rotator cuff training. Main outcome measures were the shoulder disability questionnaire, diagnostic tests for shoulder impingement syndrome, clinical tests for scapular positioning, shoulder pain (visual analog scale; VAS), and muscle strength. A large clinically important treatment effect in favor of scapular motor control training was found in self-reported disability (Cohen's d = 0.93, p = 0.025), and a moderate to large clinically important improvement in pain during the Neer test, Hawkins test, and empty can test (Cohen's d 0.76, 1.04, and 0.92, respectively). In addition, the experimental group demonstrated a moderate (Cohen's d = 0.67) improvement in self-experienced pain at rest (VAS), whereas the control group did not change. The effects were maintained at three months follow-up.

No abstract

Objective-Evidence for effective management of shoulder impingement is limited. The present study aimed to quantify the clinical, neurophysiological, and biomechanical effects of a scapular motor control retraining for young individuals with shoulder impingement signs.Method-Sixteen adults with shoulder impingement signs (mean age 22 ± 1.6 years) underwent the intervention and 16 healthy participants (24.8 ± 3.1years) provided reference data. Shoulder function and pain were assessed using the Shoulder Pain and Disability Index (SPADI) and other questionnaires. Electromyography (EMG) and 3-dimensional motion analysis was used to record muscle activation and kinematic data during arm elevation to 90° and lowering in three planes. Patients were assessed pre and post a 10-week motor control based intervention, utilising scapular orientation retraining.Results-Pre-intervention, patients reported pain and reduced function compared to the healthy participants (SPADI in patients 20 ± 9.2; healthy 0±0). Post-intervention the SPADI scores reduced significantly (p<0.001) by a mean of 10 points (±4). EMG showed delayed onset and early termination of serratus anterior and lower trapezius muscle activity pre-intervention, which improved significantly post-intervention (p<0.05-0.01). Pre-intervention, patients exhibited on average 4.6-7.4° less posterior tilt, which was significantly less in two arm elevation planes (p<0.05) than healthy participants. Post-intervention, upward rotation and posterior tilt increased significantly (p<0.05) during two arm movements, approaching the healthy values.Conclusions-A 10 week motor control intervention for shoulder impingement increased function and reduced pain. Recovery mechanisms were indicated by changes in muscle recruitment and scapular kinematics. The efficacy of the intervention requires further examined in a randomised control trial.

No abstract