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Background/objective: Previous studies have indicated that mind-body exercises can reduce pain and improve function for patients with musculoskeletal conditions. Yi Jin Bang is a novel home-based Chinese mind-body Qigong exercise for shoulder pain. However, few studies have evaluated its effects on subacromial pain syndrome. This study aimed to compare the effects of Yi Jin Bang with conventional exercises for subacromial pain syndrome. Methods: Adults with subacromial pain syndrome (N = 105; mean [SD] age, 37 [16] years; 73 females [70%]; median [IQR] duration of symptoms, 12 [6–24] months) were randomly assigned to either the experimental group (n = 53) or the control group (n = 52). The experimental group performed home-based Yi Jin Bang exercises, whereas the control group performed home-based conventional exercises (stretching, strengthening, and motor control exercises). Both interventions were performed four times a week for 16 weeks. The primary outcome was the Shoulder Pain and Disability Index (SPADI). Secondary outcomes included current shoulder pain intensity, active shoulder range of motion, back scratch test, isometric shoulder strength, and health-related quality of life. Assessments were performed at baseline and weeks 4, 8, 12, and 16. The primary endpoint was week 16. Results: No significant between-group difference was observed in the SPADI score at week 16 (mean difference, Yi Jin Bang minus conventional exercise, 0.14, 95% confidence interval −2.96 to 3.24; p = 0.93). Conclusion: There were no differences between Yi Jin Bang and conventional exercises in improving pain, disability, shoulder mobility, shoulder strength, and quality of life for people with subacromial pain syndrome.

Background: Subacromial impingement syndrome is a common disorder associated with functional impairment and disability of the shoulder. Internal/external glenohumeral rotation is important for shoulder function. However, because it is difficult to measure the glenohumeral joint rotation angle physically, the relationship between this angle and the clinical symptoms of subacromial impingement syndrome is still largely unknown. Using advanced cine-magnetic resonance imaging techniques, we designed a study to improve our understanding of the nature of this relationship. Methods: We evaluated 100 shoulders with subacromial impingement syndrome. Patients underwent cine-magnetic resonance imaging during axial rotation with the arm adducted. During imaging, patients rotated their shoulder from maximum internal rotation to maximum external rotation over 10 seconds and then to maximum internal rotation over 10 seconds. The rotation angles were then evaluated using a series of axial images. The Constant–Murley (Constant) and UCLA scores for each patient were determined, and the correlation between the scores and rotational angles was assessed. Patients were divided into 3 groups according to the Constant pain score, and the rotational angles of each group were compared. Rotational angles were also compared between shoulders with and without night pain. Results: The external rotation angle showed a significant but low correlation with the Constant and UCLA scores (ρ = 0.24 and 0.24, respectively), whereas the internal rotation angle did not. In comparing the pain groups of Constant score and UCLA score, the external rotation angle significantly decreased as pain increased (P

Transdermal glyceryl trinitrate patches have been investigated as an alternative therapeutic intervention for a range of tendinopathies, due to the ease of titration of dosage and the ease of their application. Glyceryl trinitrate has been inferred to reduce pain and inflammation secondary to their nitric oxide-producing action. Shoulder impingement syndrome is a soft tissue condition that manifests as anterior shoulder pain, weakness, and difficulty in daily activities. This review will evaluate the efficacy of glyceryl trinitrate patches in treating a variety of rotator cuff tendinopathies related to shoulder impingement, based on human and animal trials, and suggest its practical application in future trials and management.

Subacromial impingement syndrome (SAIS) is one of the most diagnosed causes of pain in the upper extremity. The purpose of this study was to investigate muscle activity between asymptomatic and SAIS shoulders on the same subject while understanding the effectiveness of EMG biofeedback training (EBFB) on bilateral overhead movements. Ten participants (7 male), that tested positive for 2/3 SAIS clinical tests, volunteered for the study. Bilateral muscle activity was measured via electrodes on the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and lumbar paraspinals (LP). Participants performed bilateral scapular plane overhead movements before and after EBFB. EBFB consisted of 10 bilateral repetitions of I, W, T, and Y exercises focused on reducing UT and increasing LT and SA activity. Prior to EBFB, no significant difference in muscle activity was present between sides. A significant main effect of time indicated that after EBFB both sides exhibited reduced UT activity at 60° (p = 0.003) and 90° (p = 0.036), LT activity was increased at all measured humeral angles (p < 0.0005), and SA muscle activity was increased at 110° (p = 0.001). EBFB in conjunction with scapular based exercise effectively alters muscle activity of asymptomatic and symptomatic scapular musculature., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Question: What are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain?, Design: Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis., Participants: A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region., Interventions: Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks., Outcome Measures: The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant's perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers., Results: There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE -2 (95% CI -9 to 5), GE minus HE -2 (95% CI -9 to 5) and HE minus IE 1 (95% CI -6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens' effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups., Conclusion: In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs., Trial Registration: ClinicalTrials.gov: NCT03055117., (Copyright © 2021 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Background: Evidence-based guidelines recommend exercise-therapy as first line treatment for subacromial pain syndrome, but no previous study has mapped the content of care for subacromial pain syndrome and knowledge about adherence to clinical guidelines are lacking. We aim to describe the content and outcome of current care and investigate the relationship between content and outcome of care., Methods: We invited all patients diagnosed with subacromial pain syndrome at any Danish hospital to participate in this nationwide retrospective population-based cohort-study. Patient-reported information on content of care was collected using a validated questionnaire. Outcome of care was assessed using global impression of change (GIC) and patient acceptable symptom state (PASS). Invitations were sent 14 weeks after diagnosis., Results: In total, 3306 eligible patients participated. At follow-up, 45% had completed the recommended 12 weeks of exercise-therapy. From the total cohort, 12% underwent surgery without completing 12 weeks of exercise-therapy. For patients undergoing non-operative care, 43% reached PASS while 61% were improved since diagnosis at the hospital. Completing 12 weeks with exercise-therapy did not increase the odds of improvement (OR 1.05, 95%CI:0.88-1.24), but having conducted strengthening exercises did (OR 1.65, 95%CI:1.25-2.19)., Conclusion: More than half of patients diagnosed with subacromial pain syndrome in specialist care settings do not adhere to recommendations regarding duration of exercise-therapy, but this is not related to symptom improvement. Conversely, conducting strengthening exercises relates to higher chance of symptom improvement. This challenges current clinical guidelines, indicating that a time-based cut-point may not be relevant while specific types of exercises are., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Individuals with subacromial pain present with a variety of contributing impairments related to the movement problem. The scapular assistance test (SAT) and scapula reposition test (SRT) are proposed to identify shoulder pain related to abnormal scapular movement or position. It remains unknown if scapular movement related impairments are present in those with positive tests., Objectives: To determine if scapular motion related impairments differ based on the result of the SAT or SRT in individuals with subacromial pain syndrome., Design: Cross-sectional METHOD: Sixty individuals with subacromial pain syndrome were included. Prior to obtaining results of the SAT and SRT, a single examiner measured scapular upward rotation and posterior tilt active and passive motion, pectoralis minor length, and strength of the middle trapezius, lower trapezius, and serratus anterior. Dynamic scapular motion was qualitatively assessed with the Scapular Dyskinesis Test. The Mann-Whitney U test assessed for differences based on the outcome of the SAT and SRT., Results: There was a significant difference (P = .023) in pectoralis minor length for the SAT. Participants with a positive SAT had decreased muscle length compared to those who tested negative. There were no significant differences in scapular motion or strength based on the result of either the SAT or SRT., Conclusions: A positive SAT was associated with greater pectoralis minor length impairment, but not muscle strength or mobility. The SRT did not identify greater impairments in any of the scapular movement related impairments assessed. Individuals may vary in contributing impairments related to SAT or SRT results., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To assess the association between changes in pain or function with changes in scapular dyskinesis in participants with subacromial shoulder pain., Method: Forty-four participants with subacromial shoulder pain were assessed at baseline and 8 weeks later. The outcome measures included 'pain at rest' and 'pain during movement' using Numeric Pain Rating Scale (NPRS), shoulder function using Patient Specific Functional Scale (PSFS), and observation of scapular movement pattern using the scapular dyskinesis test. Robust paired t-tests were used to compare scores between baseline and follow-up. Repeated measures correlation coefficient was used to assess the association between changes in pain or function with changes in scapular dyskinesis scores., Results: A fair association was found between improvement in function and improvement in scapular dyskinesis (correlation coefficient = -0.4, 95% CI: -0.6 to -0.1). No associations were found between changes in 'pain at rest' (correlation coefficient = -0.1, 95% CI: -0.2 to 0.2) or 'pain during movement' (correlation coefficient = 0.28, 95% CI: 0.0 to 0.5) with changes in scapular dyskinesis., Conclusion: Our findings showed improvement in function is associated with improvement in scapular dyskinesis scores. Future studies should explore whether there is causal effect between improvement in scapular dyskinesis and function., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Middle-aged individuals cocontract with adductor muscles during abduction. This may be crucial for counteracting deltoid forces, depressing the humerus and ensuring free passage of subacromial tissues underneath the acromion during abduction. We questioned whether adductor co-contraction is always present, or develops during ageing, in which case it may explain the age-related character of common shoulder conditions such as Subacromial Pain Syndrome. In a cross-sectional analysis with electromyography (EMG), activation patterns of the latissimus dorsi, teres major, pectoralis major and deltoid muscle were assessed during isometric force tasks in 60 asymptomatic individuals between 21 and 60 years old. Cocontraction was expressed as the degree of antagonistic activation relative to the same muscle's degree of agonistic activation, resulting in an activation ratio between -1 and 1, where lower values indicate more cocontraction. Using linear regression analyses, we found age-related decreases in the activation ratio of the latissimus dorsi (regression estimate: -0.004, 95% CI: -0.007 to 0.0, p-value: 0.042) and teres major (regression estimate: -0.013, 95% CI: -0.019 to -0.008, p-value: <0.001). In contrast to young individuals, middle-aged individuals showed a high degree of adductor cocontraction during abduction. This may indicate that during ageing, alterations in activation patterns are required for preserving pain-free shoulder function., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Subacromial Impingement Syndrome (SIS) is frequently diagnosed, but treatment results vary greatly. It is increasingly reported that SIS symptoms are caused by various underlying mechanisms that need distinctive treatment strategies. We evaluated a set of specific MRI Arthrography (MRA) characteristics that have been related with underlying mechanisms for SIS in the literature, in patients with SIS., Methods: In 47 patients diagnosed with SIS, MRA characteristics were evaluated and categorized into categories of potential underlying mechanisms: (1) extrinsic: e.g. acromion shape; (2) intrinsic: e.g. tendinosis; (3) dynamic: e.g. signs of glenohumeral (micro-)instability. Control values were obtained from the literature. With cluster analysis, potential patient subgroups were assessed., Results: In 17 (36.2%) patients originally diagnosed with SIS, specific other conditions were found, including rotator cuff tears and labrum lesions. In the remaining 30, all had positive signs of at least one of the predefined underlying mechanisms. Patients could be categorized into 2 groups: predominantly findings corresponding with extrinsic/structural causes, or with dynamic/(micro)instability., Conclusions: MRA characteristics in patients with SIS symptoms are heterogeneous and many patients have specific other shoulder conditions causing symptoms. Patients without specific other conditions have MRA characteristics associated with either extrinsic (structural), or dynamic (e.g. micro-instability) underlying mechanisms., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Transdermal glyceryl trinitrate patches have been investigated as an alternative therapeutic intervention for a range of tendinopathies, due to the ease of titration of dosage and the ease of their application. Glyceryl trinitrate has been inferred to reduce pain and inflammation secondary to their nitric oxide-producing action. Shoulder impingement syndrome is a soft tissue condition that manifests as anterior shoulder pain, weakness, and difficulty in daily activities. This review will evaluate the efficacy of glyceryl trinitrate patches in treating a variety of rotator cuff tendinopathies related to shoulder impingement, based on human and animal trials, and suggest its practical application in future trials and management.

Background: Various studies have investigated scapulothoracic muscle activity and recruitment patterns in relation to shoulder complaints in different populations, but a consensus review is lacking., Hypothesis/purpose: To systematically review the state of the art regarding scapulothoracic muscle activity and recruitment timing in subjects with shoulder pain compared to pain free controls., Study Design: Systematic review., Methods: The search for relevant articles was performed in Pubmed and Web of Science, including Web of Knowledge, using key words related to shoulder pain, scapulothoracic muscle activity or recruitment timing. Articles were included till November 2012. Case-control studies concerning the scapulothoracic region and muscle recruitment using electromyography (EMG) were included. Articles regarding rotator cuff muscles or neck-shoulder pathologies or studies handling a treatment outcome, were excluded. The methodological quality of the articles was assessed using appropriate risk of bias criteria for case-control studies., Results: A total of 12 articles were included in the systematic review, containing patients with Shoulder Impingement Syndrome (SIS) or glenohumeral instability. In patients with SIS 3 out of 6 articles showed increased upper trapezius muscle (UT) activity, 3 out of 5 studies showed decreased lower trapezius muscle (LT) activity and 3 out of 5 articles showed decreased serratus anterior muscle (SA) activity. Patients with glenohumeral instability showed contradictory results on scapulothoracic muscle activity patterns. In both SIS and glenohumeral instability patients, no consensus was found on muscle recruitment timing., Conclusion: Patients with SIS and glenohumeral instability display numerous variations in scapulothoracic muscle activity compared to healthy controls. In the SIS-group, the LT and SA muscle activity is decreased. In addition, the UT muscle activity is increased among the SIS patients, whereas no clear change is seen among patients with glenohumeral instability. Although the scapulothoracic muscle activity changed, no consensus could be made regarding muscle recruitment timing., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Shoulder impingement syndrome (SIS) is a complex, multi-factorial problem that is treated with a variety of different conservative options. One conservative option that has shown effectiveness is manual therapy to the thoracic spine. Another option, manual therapy to the cervical spine, has been studied only once with good results, evaluating short-term outcomes, in a small sample size. The purpose of this study was to investigate the benefit of neck manual therapy for patients with SIS. The study was a randomised, single blinded, clinical trial where both groups received pragmatic, evidence-based treatment to the shoulder and one group received neck manual therapy. Subjects with neck pain were excluded from the study. Comparative pain, disability, rate of recovery and patient acceptable symptom state (PASS) measures were analyzed on the 68 subjects seen over an average of 56.1 days (standard deviation (SD)=55.4). Eighty-six percent of the sample reported an acceptable change on the PASS at discharge. There were no between-groups differences in those who did or did not receive neck manual therapy; however, both groups demonstrated significant within-groups improvements. On average both groups improved 59.7% (SD=25.1) for pain and 53.5% (SD=40.2) for the Quick Disabilities of the Shoulder and Hand Questionnaire (QuickDASH) from baseline. This study found no value when neck manual therapy was added to the treatment of SIS. Reasons may include the lack of therapeutic dosage provided for the manual therapy approach or the lack of benefit to treating the neck in subjects with SIS who do not have concomitant neck problems., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objectives: The first aim of this study was to investigate whether kinesiotaping (KT) can increase the acromiohumeral distance (AHD) in asymptomatic subjects in the short term. The second aim was to investigate whether the direction of kinesiotaping application influences AHD., Background: In recent years, the use of KT has become increasingly popular for a range of musculoskeletal conditions and for sport injuries. To date, we are unaware of any research investigating the effect of kinesiotaping on AHD. Moreover, it is unknown whether the direction of kinesiotaping application for the shoulder is important., Methods: Forty nine participants were randomly assigned to one of three groups: kinesiotaping group 1 (KT1), kinesiotaping group 2 (KT2) and sham kinesiotaping (KT3). AHD ultrasound measurements at 0° and 60° of shoulder elevation were collected at baseline and immediately after kinesiotape application., Results: The results showed significant improvements in AHD after kinesiotaping, compared with sham taping. The mean difference in AHD between KT1 and KT3 groups was 1.28 mm (95% CI: 0.55, 2.03), and between KT2 and KT3 was 0.98 mm (95% CI: 0.23, 1.74). Comparison of KT1 and KT2 groups, which was performed to identify whether the direction of taping influences the AHD, indicated there were no significant differences., Conclusion: KT increases AHD in healthy individuals immediately following application, compared with sham kinesiotape. No differences were found with respect to the direction in which KT was applied., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Our objective was to assess the effectiveness of Diacutaneous Fibrolysis on pain intensity, range of motion and functional status in patients suffering from Subacromial Impingement Syndrome. A randomised controlled trial was conducted in two Spanish National Health Service Primary Health Care Centres. Participants (n = 120) were randomly assigned to one of three groups (intervention, placebo or control groups). All three groups received a protocolised treatment based on therapeutic exercises, analgesic electrotherapy and cryotherapy. Additionally, the intervention group received six sessions of Diacutaneous Fibrolysis treatment; the placebo group received six sessions of sham Diacutaneous Fibrolysis treatment, while the control group received only the protocolised treatment. Pain intensity, available active range of motion and function were measured pre-treatment, post-treatment, and at a three-month follow-up. At the post-treatment assessment, differences between intervention and control groups were statistically significant or clinically relevant in function, flexion, extension and external rotation movements. Differences between placebo and control groups were significant only in extension movement. No significant differences were found in pain intensity. At the 3 month follow-up assessment, between-groups differences were not statistically significant and clinical relevance was achieved only for external rotation movement between intervention and control groups. At the post-treatment assessment 89% of the participants in the intervention group, 76% of the participants in the placebo group and 67% of the participants in the control group reported subjective improvement (p < 0.01). In conclusion, adding Diacutaneous Fibrolysis to the conservative treatment of Subacromial Impingement Syndrome improves function and external rotation movements and also gives significantly higher patient satisfaction., (Copyright © 2013 Elsevier Ltd. All rights reserved.)