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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. 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. 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). 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. [ABSTRACT FROM AUTHOR]

To evaluate the 3-month effects of pulsed electromagnetic field therapy (PEMF) in the treatment of subacromial impingement syndrome (SIS). Planned analysis of a randomized controlled trial with 4- and 12-week follow-ups. Physical medicine and rehabilitation clinic, treatment unit. Of the 250 individuals screened for eligibility, participants with a diagnosis of SIS (N=80) were randomized to intervention or control groups. The first group received PEMF + exercise and the second group received sham PEMF + exercise 5 days a week for a total of 20 sessions. Visual Analog Scale (VAS), Constant Murley Score (CMS), Shoulder Pain and Disability Index (SPADI), Short Form-36 (SF-36) Quality of Life Questionnaire, and shoulder muscle strength measurement with an isokinetic dynamometer. Evaluations were performed before treatment (T0), after treatment (T1), and 12th week (T2). Evaluation at T1 and T2 showed improvement in most parameters in both groups compared with baseline. In the comparison between the 2 groups at T1 and T2, more improvement was found in the PEMF group in most parameters. In our study, PEMF was found to be superior to sham PEMF in terms of pain, ROM, functionality, and quality of life at the first and third months. [ABSTRACT FROM AUTHOR]

Subacromial pain syndrome (SPS) is a common cause of shoulder pain, and is associated with functional limitation, workdays lost, disability, and poor quality of life. Our purpose was to investigate the effects of scapular stabilization exercises in patients with SPS. Sixty-four patients with SPS who also exhibit observable scapular dyskinesis defined by the scapular dyskinesis test were recruited and randomized to scapular stabilization exercise training group or to control group. All participants received the same rehabilitation protocol including glenohumeral and scapular mobilization, pendulum exercises, shoulder stretching, range of motion exercises, strengthening, and proprioceptive exercises. Patients in the scapular stabilization exercise training group performed additional scapular stabilization exercises. The presence of scapular dyskinesis, shoulder pain severity, motion, muscle strength, scapular upward rotation, and shoulder disability were assessed before and after the four-week rehabilitation program. The scapular stabilization exercise training group had better improvement in scapular dyskinesis, pain, muscle strength, and shoulder disability compared to the control group (p < 0.05). However, there was no statistically significant time-group interaction regarding shoulder motion and scapular upward rotation (p > 0.05). Scapular stabilization exercises added to the shoulder mobilization, stretching, and strengthening are effective in improving scapular dyskinesis, reducing pain, increasing muscle strength and shoulder function in patients with SPS accompanied by scapular dyskinesis. [ABSTRACT FROM AUTHOR]

To explore the subacromial motion metrics in patients with and without subacromial impingement syndrome (SIS) and to investigate whether the abnormality was associated with rotator cuff pathologies. This cross-sectional observational study used dynamic quantitative ultrasonography imaging for shoulder joint assessment. Outpatient rehabilitation clinic. Individuals with SIS on at least 1 shoulder (n=32) and asymptomatic controls (n=32) (N=64). Not applicable. Frame-by-frame, the humeral greater tuberosity against the lateral edge of the acromion was traced to obtain the minimal vertical acromiohumeral distance (AHD). The rotation angle and radius of the humerus were computed using the least-squares curve fitting method. Approximately two-thirds of the shoulders with SIS did not have any sonographically identifiable rotator cuff pathologies. There was a consistent trend of nonsignificantly increased humeral rotation angles in painful shoulders. The generalized estimating equation demonstrated that the decreased minimal vertical AHD was associated with painful subacromial impingement (β coefficient: −0.123cm, 95% confidence interval [CI], −0.199 to −0.047). The area under the curve for the minimal vertical AHD to discriminate painful or impinged shoulders ranged from 0.624-0.676. The increased rotation angle (β coefficient: 10.516°; 95% CI, 3.103-17.929) and decreased rotation radius (β coefficient: −2.903cm; 95% CI, −5.693 to −0.111) were shown to be significantly related to the presence of supraspinatus tendinopathy. Shoulders with SIS were characterized by a decreased minimal vertical AHD during dynamic examination. Abnormal subacromial metrics can develop in patients with mild (or no) rotator cuff pathologies. More prospective cohort studies are warranted to investigate the changes in subacromial motion metrics in populations at risk for painful or impinged shoulders. [ABSTRACT FROM AUTHOR]

To investigate whether muscle energy technique (MET) to the thoracic spine decreases the pain and disability associated with shoulder impingement syndrome (SIS). Single-center, 3-arm, randomized controlled trial, single-blind, placebo control with concealed allocation and a 12-month follow-up. Private osteopathic practice. Three groups of 25 participants (N=75) 40 years or older with SIS received allocated intervention once a week for 15 minutes, 4 consecutive weeks. Participants were randomly allocated to MET to the thoracic spine (MET-only), MET plus soft tissue massage (MET+STM), or placebo. Primary outcome measure: Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary outcome measures: Shoulder Pain and Disability Index (SPADI) questionnaire; visual analog scale (VAS) (mm/100): current, 7-day average, and 4-week average; Patient-Specific Functional Scale (PSFS); and Global Rating of Change (GROC). Measures recorded at baseline, discharge, 4-week follow-up, 6 months, and 12 months. Also baseline and discharge thoracic posture and range of motion (ROM) measured using an inclinometer. Statistical analysis included mixed-effects linear regression model for DASH, SPADI, VAS, PSFS, GROC, and thoracic posture and ROM. MET-only group demonstrated significantly greater improvement in pain and disability (DASH, SPADI, VAS 7-day average) than placebo at discharge (mean difference, DASH=−8.4; 95% CI, −14.0 to −2.8; SPADI=−14.7; 95% CI, −23.0 to −6.3; VAS=−15.5; 95% CI, −24.5 to −6.5), 6 months (−11.1; 95% CI, −18.6 to −3.7; −14.9; 95% CI, −26.3 to −3.5; −14.1; 95% CI, −26.0 to −2.2), and 12 months (−13.4; 95% CI, −23.9 to−2.9; −19.0; 95% CI, −32.4 to −5.7; −17.3; 95% CI, −30.9 to −3.8). MET+STM group also demonstrated greater improvement in disability but not pain compared with placebo at discharge (DASH=−8.2; 95% CI, −14.0 to −2.3; SPADI=−13.5; 95% CI, −22.3 to −4.8) and 6 months (−9.0; 95% CI, −16.9 to −1.2; −12.4; 95% CI, −24.3 to −0.5). For the PSFS, MET-only group improved compared with placebo at discharge (1.3; 95% CI, 0.1-2.5) and 12 months (1.8; 95% CI, 0.5-3.2); MET+STM at 12 months (1.7; 95% CI, 0.3-3.0). GROC: MET-only group improved compared with placebo at discharge (1.5; 95% CI, 0.9-2.2) and 4 weeks (1.0; 95% CI, 0.1-1.9); MET+STM at discharge (1.2; 95% CI, 0.5-1.9) and 6 months (1.2; 95% CI, 0.1-1.3). There were no differences between MET-only group and MET+STM, and no between-group differences in thoracic posture or ROM. MET of the thoracic spine with or without STM improved the pain and disability in individuals 40 years or older with SIS and may be recommended as a treatment approach for SIS. [ABSTRACT FROM AUTHOR]

To determine whether dextrose prolotherapy offers clinical benefits in patients with shoulder pain and bursitis. Double-blinded, randomized controlled trial. Outpatient rehabilitation department of a single medical center. Patients (N=50) who had received a diagnosis of shoulder pain and bursitis through clinical tests and ultrasound examination. Participants were randomly assigned to the 15% dextrose injection (D15W) group or the placebo group to receive either D15W or normal saline injection, respectively. All participants received ultrasound-guidance bursal injection every 2 weeks for a total of 3 injections. The primary outcome was maximal pain level while performing activities. The secondary outcomes included resting pain level, function and disability assessment results, and ultrasonographic parameters. Participants were followed up for 3 months after completion of the injection course. No significant differences in baseline characteristics were observed between the D15W and placebo groups. Significant time effects were observed for all outcome parameters (all P <.05); however, time × group effects were nonsignificant for all outcomes, except for tissue elasticity (P =.026). Supporting evidence is insufficient regarding the clinical benefits of 15% dextrose bursal injection administered through 3 sessions in patients with chronic shoulder pain and bursitis. The findings indicate that these injections may increase the tissue stiffness of the supraspinatus tendon, as indicated by elastography assessment results, but further research is required to determine the nature of such changes in elastography findings. [ABSTRACT FROM AUTHOR]

Infraspinatus is one of the main muscles that is involved in the subacromial impingement syndrome. Dry needling and routine physical therapy can improve this syndrome. However, the dry needling technique is not well defined. randomized controlled clinical trial, single-blind study. Sixty-six patients diagnosed with shoulder impingement syndrome were recruited and randomly divided into three groups. In 1st group; patients received deep dry needling technique in addition to routine physical therapy, in Hong's group; patients received Hong's dry needling technique in addition to routine physiotherapy and in third group; patient just received routine physical therapy. Before, immediately after and 4 weeks after the intervention, pain, disability and the pressure pain threshold were measured. The findings of this study indicated that in DDN group, pain and disability reduction was significantly more than two other groups. Although, the pressure pain tolerance increased in all three groups after treatment, but the increase between groups was not significantly different. All study groups showed reduction in pain, while there was no significant difference between the three groups. Pain and disability reduction in the DDN group compared to the other two groups may reveal the treatment with deep dry needling technique along with routine physiotherapy is more effective than receiving dry needling with Hong's technique or routine physiotherapy alone. However, there was no significant difference between the three groups in pressure pain tolerance threshold and pain reduction. [ABSTRACT FROM AUTHOR]

To perform a systematic review of clinical practice guidelines (CPGs) and semantic analysis of specific clinical recommendations for the management of rotator cuff disorders in adults. A systematic bibliographic search was conducted up until May 2018 in Medline, Embase, and Physiotherapy Evidence Database, or PEDro, databases, in addition to 12 clinical guidelines search engines listed on the Appraisal of Guidelines for Research and Evaluation (AGREE) website. Nine CPGs on the management of rotator cuff disorders in adults or workers, available in English or French, and published from January 2008 onward, were included and screened by 2 independent reviewers. CPG methodology was assessed with the AGREE II checklist. A semantic analysis was performed to compare the strength of similar recommendations based on their formulation. The recommendations were categorized in a standardized manner considering the following 4 levels: "essential," "recommended," "may be recommended," and "not recommended." Methodological quality was considered high for 3 CPGs and low for 6. All CPGs recommended active treatment modalities, such as an exercise program in the management of rotator cuff disorders. Acetaminophen or nonsteroidal anti-inflammatory drug prescriptions and corticosteroid injections were presented as modalities that may be recommended to decrease pain. Recommendations related to medical imagery and surgical opinion varied among the guidelines. The most commonly recommended return-to-work strategies included intervening early, use of a multidisciplinary approach, and adaptation of work organization. Only 3 CPGs were of high quality. The development of more rigorous CPGs is warranted. [ABSTRACT FROM AUTHOR]

Background: Round shoulder posture (RSP) is one of the potential risks for shoulder impingement syndrome (SIS) due to alignment deviation of the scapula. Evidence on how the characteristics of a shoulder brace affecting the degree of RSP, shoulder kinematics, and associated muscle activity during movements is limited.Research Question: The purposes of this study were (1) to compare the effects of a shoulder brace on clinical RSP measurements, muscle activities and scapular kinematics during arm movements in subjects with shoulder impingement syndrome (SIS) and RSP; and (2) to compare the effects of two configurations (parallel and diagonal) and two tensions (comfortable and forced tension) of the brace straps on muscle activities and scapular kinematics during arm movements in subjects with SIS and RSP.Methods: Twenty-four participants (12 males; 12 females) with SIS and RSP were randomly assigned into 2 groups (comfortable then forced, and forced then comfortable) with 2 strap configurations in each tension condition. The pectoralis minor index (PMI), acromial distance (AD) and shoulder angle (SA) were used to assess the degree of RSP. Three-dimensional electromagnetic motion analysis and electromyography were used to record the scapular kinematics and muscle activity during arm movements.Results: All clinical measurements with the brace were significantly improved (p < 0.05). Under forced tension, muscle activities were higher with the diagonal configuration than with the parallel configuration in the lower trapezius (LT) (1.2-2.3% MVIC, p < 0.05) and serratus anterior (SA) (2.3% MVIC, p = 0.015). For upward rotation and posterior tilting of the scapula, the diagonal configuration was larger than the parallel configuration (1.5°, p = 0.038; 0.4°-0.5°, p < 0.05, respectively).Significance: Different characteristics of the straps of the shoulder brace could alter muscle activity and scapular kinematics at different angles during arm movement. Based on the clinical treatment preference, the application of a shoulder brace with a diagonal configuration and forced tension is suggested for SIS and RSP subjects. [ABSTRACT FROM AUTHOR]

To investigate the effects of Kinesio Taping® (KT) on scapular kinematics and electromyographic (EMG) activity in subjects with shoulder impingement syndrome (SIS). Twenty subjects with a diagnosis of SIS performed abduction, scaption, and flexion movements in two load conditions: (1) without load and (2) holding a dumbbell. The same movements were evaluated again with the use of KT over the deltoid muscle with a 20% tension. Scapular kinematics data of the shoulder complex were captured with BTS SMART-DX at a frequency rate of 100 Hz. EMG activity was evaluated for the upper trapezius, lower trapezius, middle deltoid, and serratus anterior muscles with BTS FREE EMG 1000 at a frequency rate of 1000 Hz. The root mean square values normalized by the maximal voluntary contraction and the peak values of upward rotation, internal rotation, and posterior tilt were compared with the KT conditions through repeated-measures ANOVA (α = 0.05) using SPSS software. No significant differences between KT conditions were found for scapular kinematics (p > 0.05). For EMG activity, a reduction in the lower trapezius was found (p < 0.05) during abduction with load (p < 0.05) and elevation without load (p < 0.05). According to the results of this study, it was not possible to verify changes in scapular kinematics in subjects with SIS. However, a reduction in EMG activity was observed for the lower trapezius muscle. Therefore, caution should be taken in prescribing KT for SIS subjects, who already have a reduction in EMG activity in this muscle, as KT may have an adverse effect. [ABSTRACT FROM AUTHOR]

Subacromial analgesia (SAA) is hypothesized to reduce pain after arthroscopic shoulder surgery by delivering a continuous infusion of local anesthetic directly to the surgical site. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of SAA vs. placebo for pain relief after arthroscopic subacromial shoulder procedures. MEDLINE, Embase, PubMed, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials comparing SAA with placebo after arthroscopic shoulder surgery. Outcomes collected included pain scores (converted to equivalent ordinal visual analog scores; minimal clinically important difference 1.4 cm), oral morphine equivalents used postoperatively, and catheter-related complications. Meta-analysis was performed via a random-effects model. Included trials underwent a risk of bias and quality of evidence assessment. Nine studies involving 459 participants were included. There were no clinically significant changes for pain scores in SAA at 6-, 12-, 24-, and 48-hour postoperative timepoints. Patients receiving SAA used less morphine equivalents of pain medication at 12 hours only (−0.37 mg, 95% confidence interval: −0.63 to −0.11), but there was no significant difference at 24 and 48 hours. There were no major complications (infection or reoperation). Included trials demonstrated a moderate risk-of-bias, and low to very low quality of evidence for primary outcomes. Subacromial continuous infusion of local anesthetic does not provide a clinically significant benefit compared with placebo as part of a multimodal analgesia regime after arthroscopic subacromial surgical procedures. Future, high-quality trials are required to further assess the efficacy of SAA against placebo. [ABSTRACT FROM AUTHOR]

Round shoulder posture (RSP) may exaggerate symptoms of subacromial impingement. The effects of kinesiology taping with exercise on posture, pain, and functional performance were investigated in subjects with impingement and RSP. This study was a single-blinded randomized controlled trial. An outpatient rehabilitation clinic in a university hospital. Thirty-four subjects with subacromial impingement and RSP. Kinesiology taping with and without tension was applied 2 times per week for 4 weeks. Both groups also performed strengthening and stretching exercises 3 times per week for 4 weeks. The pain level, shoulder angle and self-reported score were evaluated at pre-intervention, 2-week post-intervention and 4-week post-intervention time points. Functional performance improved after intervention in both groups (p = 0.027). A greater decrease in pain level was related to better functional performance of the shoulder in both groups (r = −0.760 and −0.674; p < 0.010). Moderate correlations were found for posture and functional performance of the shoulder in the intervention group (0.48). Four weeks of strengthening and stretching exercises with or without kinesiology taping improved functional performance in subjects with impingement and RSP. Improvement in clinical symptoms was related to better performance of posture. • Four weeks of strengthening and stretching exercises improves functional performance in subjects with impingement and RSP. • Kinesiology taping did not demonstrate an additional effect on RSP in our sample. • For subjects with SIS and RSP, improvement in clinical symptoms like pain and functional activity are related to better performance of posture. [ABSTRACT FROM AUTHOR]

Shoulder impingement syndrome is considered to be associated with an altered muscular activity, which is related to strategy changes in the movement plan. The present study aimed to investigate the differences in timing and intensity of activity of shoulder girdle muscles while performing a forehand topspin loop between elite table tennis players with and without shoulder impingement syndrome. The timing and activity amplitude of these shoulder girdle muscles have not been evaluated in other studies in table tennis elite athletes. Activation timing and activity levels of the upper trapezius, lower trapezius, and serratus anterior, anterior deltoid, supraspinatus, and biceps brachii muscles were measured in 30 table tennis players (Premier League tournament level or higher) with shoulder impingement syndrome and compared with 30 same-level healthy players while performing the forehand topspin loop. The results indicated that the activity levels of the serratus anterior (P =.007) and supraspinatus (P =.001) muscles significantly decreased; however, the activity level of the upper trapezius significantly increased in the impingement compared with the healthy group (P =.009). The serratus anterior (P =.001) was activated significantly later, but the upper trapezius (P =.004) was activated significantly earlier in the impingement group. Results of the present study support the theory that the activation and sequence of recruiting of the shoulder muscles are altered in people with impingement symptoms, suggesting that impingement syndrome may be associated with disturbed timing and activity level of shoulder girdle muscles. [ABSTRACT FROM AUTHOR]

Background Enhancement of arm adductor activity during abduction (ie, adductor co-contraction), may be effective in the treatment of subacromial pain syndrome (SAPS). We assessed whether an increase of adductor co-contraction is associated with a favorable course of SAPS. Methods At baseline and after nearly 4 years of follow-up, electromyography of the latissimus dorsi (LD), teres major (TM), pectoralis major, and deltoid muscle was obtained during isometric abduction and adduction tasks in 26 patients with SAPS. Changes in co-contraction were assessed with change in the activation ratio (Δ AR). The AR ranges between −1 and 1, where lower values indicate more co-contraction. Clinical course was determined from an anchor question (reduced, persistent, or increased complaints), the visual analog scale for pain (VAS), and the Western Ontario Rotator Cuff score (WORC). Results In patients indicating persistent complaints (31%), the VAS and WORC remained stable. In patients who indicated reduced complaints (69%), the VAS reduced (z score, −3.4; P =.001) and WORC increased (z score, 3.6; P <.001). Unchanged ARs associated with complaints persistence, whereas decreased AR of the LD (Δ AR LD , −0.21; 95% confidence interval [CI], −0.36 to −0.06) and TM (ΔAR TM , −0.17; 95% CI, −0.34 to −0.00) coincided with reduced complaints. There was a significant between-group difference in Δ AR LD (−0.35; 95% CI, −0.60 to 0.10) and Δ AR TM (−0.36; 95% CI, −0.66 to –0.05). Conclusions Increased co-contraction of the LD and TM is associated with a favorable course of SAPS. This may be explained by widening of the subacromial space accomplished by adductor co-contraction. [ABSTRACT FROM AUTHOR]

Objective To evaluate the intra- and inter-rater reliability of fleximetry in the measurement of range of motion (ROM) in individuals with chronic shoulder pain. Design Reliability study. Setting Physiotherapy clinic. Participants Thirty individuals of both genders, ages between 18 and 45 years, with chronic shoulder pain. Main outcome measures Fleximetry was used to measurement shoulder ROM (flexion, hyperextension, abduction, medial and lateral rotation, and horizontal abduction and adduction). Two examiners performed the evaluations of the shoulder ROM at two time points (interval of one week between them). Results In the intra-rater reliability, substantial to excellent reliability was found, with intraclass correlation coefficient (ICC) values ranging from 0.79 to 0.92, standard error of the measurement (SEM) values ranging from 5.70 to 8.72°, and minimum detectable change (MDC) values varying between 15.80 and 25.18°. Regarding the inter-rater reliability, moderate to excellent reliability was observed, with ICC values ranging from 0.68 to 0.96, SEM values ranging from 4.98 to 11.53°, and MDC values ranging from 13.82 to 31.97°. Conclusion The use of the fleximeter to measure shoulder ROM presents acceptable reliability values in individuals with chronic shoulder pain, which supports the use of this method of evaluation in research and clinical practice. [ABSTRACT FROM AUTHOR]

Objective To determine inter- and intraexaminer reliability of examiners without clinical experience in identifying and classifying myofascial trigger points (MTPs) in the shoulder muscles of subjects asymptomatic and symptomatic for unilateral subacromial impact syndrome (SIS). Design Within-day inter- and intraexaminer reliability study. Setting Physical therapy department of a university. Participants Fifty-two subjects participated in the study, 26 symptomatic and 26 asymptomatic for unilateral SIS. Interventions Two examiners, without experience for assessing MTPs, independent and blind to the clinical conditions of the subjects, assessed bilaterally the presence of MTPs (present or absent) in 6 shoulder muscles and classified them (latent or active) on the affected side of the symptomatic group. Each examiner performed the same assessment twice in the same day. Main Outcome Measures Reliability was calculated through percentage agreement, prevalence- and bias-adjusted kappa (PABAK) statistics, and weighted kappa. Results Intraexaminer reliability in identifying MTPs for the symptomatic and asymptomatic groups was moderate to perfect (PABAK, .46–1 and .60–1, respectively). Interexaminer reliability was between moderate and almost perfect in the 2 groups (PABAK, .46–.92), except for the muscles of the symptomatic group, which were below these values. With respect to MTP classification, intraexaminer reliability was moderate to high for most muscles, but interexaminer reliability was moderate for only 1 muscle (weighted κ=.45), and between weak and reasonable for the rest (weighted κ=.06–.31). Conclusions Intraexaminer reliability is acceptable in clinical practice to identify and classify MTPs. However, interexaminer reliability proved to be reliable only to identify MTPs, with the symptomatic side exhibiting lower values of reliability. [ABSTRACT FROM AUTHOR]

Objective To determine the feasibility and efficacy of using a structured Nintendo Wii protocol to improve range of motion, strength, and quality of life in patients with shoulder impingement syndrome. Methods A total of 14 patients with shoulder pain were randomized to perform a structured Wii protocol ( n = 8) or conventional therapy ( n = 6). Pain-free shoulder range of motion, strength, shoulder pain and disability, and quality of life were assessed pre- and post-treatment. Results All 8 patients completed the Wii protocol, and 3 completed conventional therapy. The Wii protocol conferred significant improvements in shoulder range of motion, pain and disability, and quality of life but not strength, whereas conventional therapy conferred a significant improvement in strength. Conclusions As compared to conventional treatment, the structured Wii protocol implemented in this pilot study was a viable adjunct to therapy for shoulder impingement syndrome. Gaming may have a supplemental benefit by increasing motivation, pleasure, and/or adherence. Further investigation in larger cohorts is warranted. [ABSTRACT FROM AUTHOR]

• Biomechanical rationale for improving function with joint mobilization is unclear. • Adding scapular mobilization to exercises did not further improve function. • Only the exercise program improved upper limb function. Scapular mobilization is a manual therapy technique widely used in the management of musculoskeletal disorders of the shoulder. To determine the effects of scapular mobilization in addition to an exercise program in people with subacromial impingement syndrome (SIS). Seventy-two adults with SIS were randomly allocated to 1 of 2 groups. The control group (n=36) participated in a 6-week exercise program, and the intervention group (n = 36) participated in the same exercise program plus passive manual scapular mobilization. Both groups were assessed at baseline and 6 weeks (end of treatment). The primary outcome measure was upper limb function assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcome measures were the Constant-Murley questionnaire, pain (visual analog scale [VAS]), and scapular upward rotation. All participants completed the trial. The between-group difference in DASH was -1.1 points (Cohen d = 0.05; p = 0.911), Constant-Murley 2.1 points (Cohen d = 0.08; p = 0.841), VAS rating of pain at rest -0.1 cm (Cohen d = 0.05; p = 0.684), and VAS rating of pain during movement -0.2 cm (Cohen d = 0.09; p = 0.764); scapular upward rotation at rest (arm by the side) was 0.6° (Cohen d = 0.09; p = 0.237), at 45° shoulder abduction was 0.8° (Cohen d = 0.13; p = 0.096), at 90° was 0.1° (Cohen d = 0.04; p = 0.783), and at 135° was 0.1° (Cohen d = 0.07; p = 0.886). Most differences were in favor of the intervention group; however, the effect sizes were weak and not statistically significant. In the short-term, the addition of scapular mobilization did not provide significant clinical benefits in terms of function, pain or scapular motion in participants with SIS. Brazilian registry of clinical trials UTN number U1111-1226-2081. Registered February 25, 2019. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to examine the effects of 3 different elastic therapeutic taping methods on the subacromial joint space in healthy adults. Methods Pre-/post-test laboratory study method was used in this study. Forty-eight healthy adults with no prior history of shoulder injury or surgery and no history of dominant shoulder pain in the past 6 months were enrolled in the study. Participants were placed into 3 groups (8 males and 8 females per group) on the basis of a consecutively assigned allocation design. A baseline measurement of the acromiohumeral distance (AHD) was taken by using diagnostic ultrasonography for every participant. On the basis of group assignment, participants were then taped according to the Kinesio Tape (Kinesio Tex Classic Tape) guidelines in one of 3 conditions: (1) taping of the supraspinatus from insertion to origin; (2) taping of the anterior and posterior deltoids from insertion to origin; and (3) a combination of both techniques. After a 5-minute wait period, the AHD was remeasured with the tape intervention in place, with each participant serving as his or her own control. Results Data analysis showed a statistically significant increase in AHD when using the taping technique over the anterior and posterior deltoids (Condition 2). The subacromial space increased in both males and females when the supraspinatus was taped from insertion to origin (Condition 1), but not at a statistically significant level. Condition 3, in which both taping techniques were used simultaneously, did not show an increase at a statistically significant level. Conclusions The application of the Kinesio Tape from insertion to muscle origin of the supraspinatus or the anterior and posterior deltoid increased the subacromial joint space. [ABSTRACT FROM AUTHOR]

Background The treatment effect of acromioplasty for chronic subacromial pain syndrome (SAPS) on long-term shoulder function and rotator cuff deterioration has still to be determined. This study aimed to determine the long-term clinical and radiologic treatment effect of arthroscopic acromioplasty in patients with chronic SAPS. Methods In this double-blind, randomized clinical trial, 56 patients with chronic SAPS (median age, 47 years; age range, 31-60 years) were randomly allocated to arthroscopic bursectomy alone or to bursectomy combined with acromioplasty and were followed up for a median of 12 years. The primary outcome was the Constant score. Secondary outcomes included the Simple Shoulder Test, visual analog scale (VAS) for pain, VAS for shoulder functionality, and rotator cuff integrity assessed with magnetic resonance imaging or ultrasound. Results A total of 43 patients (77%) were examined at a median of 12 years' follow-up. Intention-to-treat analysis at 12 years' follow-up did not show a significant additional treatment effect of acromioplasty on bursectomy alone in improvement in Constant score (5 points; 95% confidence interval, −5.1 to 15.6), Simple Shoulder Test score, VAS score for pain, or VAS score for shoulder function. The prevalence of rotator cuff tears was not significantly different between the bursectomy group (17%) and acromioplasty group (10%). Conclusions There were no relevant additional effects of arthroscopic acromioplasty on bursectomy alone with respect to clinical outcomes and rotator cuff integrity at 12 years' follow-up. These findings bring the effectiveness of acromioplasty into question and may support the idea of a more conservative approach in the initial treatment of SAPS. [ABSTRACT FROM AUTHOR]

Objective To evaluate the correlations between subacromial bursitis (bursal thickening and effusion) on ultrasonography and its response to subacromial corticosteroid injection in patients with rotator cuff disease. Design Prospective, longitudinal comparison study. Setting University-affiliated tertiary care hospital. Participants Patients with rotator cuff disease (N=69) were classified into 3 groups based on ultrasonographic findings; (1) normative bursa group (group 1, n=23): bursa and effusion thickness <1mm; (2) bursa thickening group (group 2, n=22): bursa thickness >2mm and effusion thickness <1mm; and (3) bursa effusion group (group 3, n=24): bursa thickness <1mm and effusion thickness >2mm. Intervention A single subacromial injection with 20mg of triamcinolone acetonide. Main Outcome Measures Visual analog scale (VAS) of shoulder pain, Shoulder Disability Questionnaire (SDQ), angles of active shoulder range of motion (flexion, abduction, external rotation, and internal rotation), and bursa and effusion thickness at pre- and posttreatment at week 8. Results There were no significant differences between the 3 groups in demographic characteristics pretreatment. Groups 2 and 3 showed a significant difference compared with group 1 in changes on the VAS and abduction; group 3 showed a significant difference compared with group 1 in changes of the SDQ, internal rotation, and external rotation; and all groups showed significant differences when compared with each other (groups 1 and 3, 2 and 3, and 1 and 2) in changes of thickness. Conclusions A patient with ultrasonographic observation of subacromial bursitis, instead of normative bursa, can expect better outcome with subacromial corticosteroid injection. Therefore, we recommend a careful selection of patients using ultrasonography prior to injection. [ABSTRACT FROM AUTHOR]

Study Design: Parallel-group intervention with repeated measures. Introduction: Shortening of the pectoralis minor (PM) may contribute to alterations in scapular kinematics. Purpose of the Study: To evaluate the effects of a stretching protocol on function, muscle length, and scapular kinematics in subjects with and without shoulder pain. Methods: A sample of 25 patients with shoulder pain and 25 healthy subjects with PM tightness performed a daily stretching protocol for 6 weeks. Outcome measures included Disabilities of the Arm, Shoulder, and Hand questionnaire, PM length, and scapular kinematics. Results: Disabilities of the Arm, Shoulder, and Hand scores decreased (P < .05) in the patient group at post-intervention. No differences (P > .05) were found for PM length in both groups. Scapular anterior tilt increased (P < .05) at 90° of flexion in the healthy group. Discussion: This study demonstrated that a daily home stretching protocol significantly decreases pain and improves function in subjects with shoulder pain. The mechanism responsible for these improvements does not appear directly related to PM muscle length or scapula kinematics, suggesting that other neuromuscular mechanisms are involved. Conclusion: The PM stretching protocol did not change the PM length or scapular kinematics in subjects with or without shoulder pain. However, pain and function of the uppei limbs improved in patients with shoulder pain. Level of Evidence: 2b. [ABSTRACT FROM AUTHOR]

Background Coordinated muscle activity is needed for synchronized joint motion and stability. Characterizing relative scapular muscle activity deficits in participants with shoulder pain will provide foundational knowledge to develop rehabilitation programs. Methods Participants were recruited with subacromial pain syndrome and an asymptomatic control group matched for age, gender, and dominant arm (N = 56). Surface electromyographic muscle activity was recorded from the upper, middle, and lower trapezius (UT, MT, LT) and serratus anterior (SA) during 5 repetitions of a weighted arm elevation task. Muscle activity was normalized to a reference contraction and then expressed as UT/MT, UT/LT, UT/SA, and LT/SA ratios. Ratios were compared between groups and across 3 arm angle intervals during ascending and descending elevation. Results A 2 × 3 mixed-model analysis of variance yielded a group main effect for the UT/LT ratio, with a higher ratio in the subacromial pain group during ascending (mean difference, 0.92; P  = .008) and descending (mean difference, 0.70; P  = .030). For the LT/SA ratio, there was a group effect: a lower ratio in the subacromial group during ascending (mean difference, −0.25; P  = .026) and descending (mean difference, −0.51; P  = .032). There were no differences for the UT/MT or UT/SA. Discussion There is a disruption in coordination between the LT and SA and the UT and LT during an arm elevation task in patients with subacromial pain syndrome. The LT was part of both altered ratios, indicating the relative importance of the LT. Future research should determine if exercises aimed at restoring the dysfunctional LT/SA and UT/LT force couples are beneficial to reduce shoulder pain and disability in patients with unilateral shoulder pain. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective To determine the efficacy of prolotherapy for refractory rotator cuff disease. Design Retrospective case-control study. Setting University-affiliated tertiary care hospital. Participants Patients with nontraumatic refractory rotator cuff disease (N=151) who were unresponsive to 3 months of aggressive conservative treatment. Of the patients, 63 received prolotherapies with 16.5% dextrose 10-ml solution (treatment group), and 63 continued conservative treatment (control group). Interventions Not applicable. Main Outcome Measures Visual analog scale (VAS) score of the average shoulder pain level for the past 1 week, Shoulder Pain and Disability Index (SPADI) score, isometric strength of the shoulder abductor, active range of motion (AROM) of the shoulder, maximal tear size on ultrasonography, and number of analgesic ingestions per day. Results Over 1-year follow-up, 57 patients in the treatment group and 53 in the control group were analyzed. There was no significant difference between the 2 groups in age, sex, shoulder dominance, duration of symptoms, and ultrasonographic findings at pretreatment. The average number of injections in the treatment group is 4.8±1.3. Compared with the control group, VAS score, SPADI score, isometric strength of shoulder abductor, and shoulder AROM of flexion, abduction, and external rotation showed significant improvement in the treatment group. There were no adverse events. Conclusions To our knowledge, this is the first study to assess the efficacy of prolotherapy in rotator cuff disease. Prolotherapy showed improvement in pain, disability, isometric strength, and shoulder AROM in patients with refractory chronic rotator cuff disease. The results suggest positive outcomes, but one should still take caution in directly interpreting it as an effective treatment option, considering the limitations of this nonrandomized retrospective study. To show the efficacy of prolotherapy, further studies on prospective randomized controlled trials will be required. [ABSTRACT FROM AUTHOR]

The objective of this preliminary study was to evaluate the ability of individual 0.1-s long pulses of intense focused ultrasound (iFU) emitted with a carrier frequency of 2 MHz to evoke diagnostic sensations when applied to patients whose shoulders have rotator cuff tears or tendinopathy. Patients were adults with painful shoulders and clinical and imaging findings consistent with rotator cuff disease. iFU stimulation of the shoulder was performed using B-mode ultrasound coupled with a focused ultrasound transducer that allowed image-guided delivery of precisely localized pulses of energy to different anatomic areas around the rotator cuff. The main outcome measure was iFU spatial average–temporal average intensity (I_SATA), and location required to elicit sensation. In control patients, iFU produced no sensation throughout the range of stimulation intensities (≤2000 W/cm 2 I_SATA). In patients with rotator cuff disease, iFU was able to induce sensation in the tendons of the rotator cuff, the subacromial bursa, and the subchondral bone in patients with chronic shoulder pain and rotator cuff disease, with an average ± standard deviation intensity equaling 680 ± 281 W/cm 2 I_SATA. This result suggests a primary role for these tissues in the pathogenesis of shoulder pain related to rotator cuff tendinopathy. [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis on the efficacy of therapeutic ultrasound (US) in adults suffering from rotator cuff tendinopathy. A literature search was conducted in four databases for randomized controlled trials (RCT) published until 12/2013, comparing the efficacy of US to any other interventions in adults suffering from rotator cuff tendinopathy. The Cochrane Risk of Bias tool was used to evaluate the risk of bias of included studies. Data were summarized qualitatively or quantitatively. Eleven RCTs with a low mean methodological score (50.0% ± 15.6%) were included. Therapeutic US did not provide greater benefits than a placebo intervention or advice in terms of pain reduction and functional improvement. When provided in conjunction with exercise, US therapy is not superior to exercise alone in terms of pain reduction and functional improvement (pooled mean difference of the Constant-Murley score: -0.26 with 95% confidence interval of -3.84 to 3.32). Laser therapy was found superior to therapeutic US in terms of pain reduction. Based on low to moderate level evidence, therapeutic US does not provide any benefit compared to a placebo or advice, to laser therapy or when combined to exercise. More methodologically sound studies on the efficacy of therapeutic US are warranted. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the immediate effects of mobilization with movement (MWM) to a sham technique in patients with shoulder impingement syndrome. Methods: A randomized controlled trial was performed. Forty-two patients (mean ± SD age, 55 ± 9 years; 81% female) satisfied eligibility criteria, agreed to participate, and were randomized into an MWM group (n = 21 ) or sham manual contact (n = 21 ). The primary outcome measures including pain intensity, pain during active range of motion, and maximal active range of motion were assessed by a clinician blinded to group allocation. Outcomes were captured at baseline and after 2 weeks of MWM treatment or sham intervention. The primary analysis was the group x time interaction. Results: The 2 x 2 analysis of variance revealed a significant group x time interaction for pain intensity during shoulder flexion (F = 7.054; P = .011), pain-free shoulder flexion (F = 32.853; P < .001), maximum shoulder flexion (F= 18.791; P < .01), and shoulder external rotation (F = 7.950; P < .01) in favor of the MWM group. No other significant differences were found. Conclusions: Patients with shoulder impingement syndrome who received 4 sessions of MWM exhibited significantly better outcomes for pain during shoulder flexion, pain-free range of shoulder flexion, maximal shoulder flexion, and maximal external rotation than those patients who were in the sham group. [ABSTRACT FROM AUTHOR]

Objective To characterize scapular kinematics and shoulder muscle activity in patients with subacromial impingement syndrome, with and without visually identified scapular dyskinesis. Design Cross-sectional study. Setting Laboratory. Participants Participants with subacromial impingement syndrome (N=38) were visually classified using a scapular dyskinesis test with obvious scapular dyskinesis (n=19) or normal scapular motion (n=19). Interventions Not applicable. Main Outcome Measures An electromagnetic motion capture system measured 3-dimensional kinematics of the thorax, humerus, and scapula. Simultaneously, surface electromyography was used to measure muscle activity of the upper, middle, and lower trapezius; serratus anterior; and infraspinatus during ascending and descending phases of weighted shoulder flexion. Separate mixed-model analyses of variance for the ascending and descending phases of shoulder flexion compared kinematics and muscle activity between the 2 groups. Shoulder disability was assessed with the Pennsylvania Shoulder Score (Penn). Results The group with obvious dyskinesis reported 6 points lower on Penn shoulder function (0–60 points), exhibited a main group effect of less scapular external rotation of 2.1° during ascent and 2.5° during descent, and had 12.0% higher upper trapezius muscle activity during ascent in the 30° to 60° interval. Conclusions Patients with obvious dyskinesis and subacromial impingement syndrome have reduced scapular external rotation and increased upper trapezius muscle activity, along with a greater loss of shoulder function compared with those without dyskinesis. These biomechanical alterations can lead to or be caused by scapular dyskinesis. Future studies should determine if correction of these deficits will eliminate scapular dyskinesis and improve patient-rated shoulder use. [ABSTRACT FROM AUTHOR]

Abstract: Background: Rotator cuff tear is a common problem either after trauma or after degenerative tear in old age group. Arthroscopic repair is the current concept of rotator cuff repair. Here, we are trying to evaluate the functional outcome after arthroscopic repair of full thickness rotator cuff tear (single row) in Indian population. Materials and methods: Twenty five patients (14 males and 11 females) who underwent arthroscopic repair of full thickness rotator cuff tear at a single institution were included in the study. Postoperatively patient's shoulder was rated according to UCLA score, pain was graded according to the visual analog score. The range of motion was analysed and documented. Results: The mean age of the patients were 50.48 years. The preoperative VAS score mode was 7 and post operative VAS was 1 (p value <0.001). The UCLA grading was good in 80% (n = 20), fair in 12% (n = 3), excellent in 8% (n = 2) and poor results were seen in none of the patients. The mean UCLA improved from a score of 15.84 to 30.28 with a p value <0.001. Mean postoperative forward flexion was 161.6°, mean abduction was 147.6° and mean external rotation was 45.4°. Conclusion: Arthroscopic repair is a good procedure for full thickness rotator cuff tear with minimal complications. The newer double row repair claims to be biomechanically superior with faster healing rates without functional advantages, hence we used a single row repair considering the Indian population and the cost effectiveness of the surgery with good to excellent results. [Copyright &y& Elsevier]

Abstract: 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 &y& Elsevier]

Abstract: 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 &y& Elsevier]

Abstract: Objective: To evaluate the effects of pulsed electromagnetic field (PEMF) and exercises in reducing pain and improving function and muscle strength in patients with shoulder impingement syndrome (SIS). Design: Double-blind, randomized controlled trial with a 3-month posttreatment follow-up. Setting: Outpatient rehabilitation of a public hospital. Participants: Patients (N=56) between 40 and 60 years of age, with a diagnosis of SIS, were randomly assigned to receive active PEMF (n=26; mean age, 50.1y) or placebo PEMF (n=30; mean age, 50.8y). Interventions: After 3 weeks of active or placebo PEMF, both groups performed the same program of exercises that focused on shoulder strengthening. Main Outcome Measures: A visual analog scale, the University of California/Los Angeles shoulder rating scale, the Constant-Murley shoulder score, and handheld dynamometry for muscle strength were used as outcome measures at baseline (pretreatment), at 3 weeks (after active or placebo PEMF), at 9 weeks (postexercise), and at 3 months posttreatment. Results: Patients in the active PEMF group had a higher level of function and less pain at all follow-up time frames compared with baseline (P<.05). However, the placebo PEMF group had increased function and reduced pain only at the 9-week and 3-month follow-ups (P<.05)—that is, after performing the associated exercises. For the shoulder dynamometry, the active PEMF group had increased strength for lateral rotation at 9 weeks (P<.05), and increased strength for medial rotation at 9 weeks and 3 months (both P<.05) when compared with baseline. There was no significant difference for shoulder strength in the placebo PEMF group (P>.05), as well as no significant differences (P>.05) for all outcome measures. Conclusions: The combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SIS. However, these results should be carefully interpreted because of the lack of differences between groups. [Copyright &y& Elsevier]

Abstract: Background: Arm adductor co-activation during abduction has been reported as a potential compensation mechanism for a narrow subacromial space in patients with rotator cuff dysfunction. We assessed differences in acromiohumeral distance at rest and the amount of humerus translation during active abduction and adduction in patients with rotator cuff tears (n =20) and impingement (n =30) and controls (n =10), controlled for deltoid, pectoralis major, latissimus dorsi and teres major activation (electromyography). Methods: During the acquirement of shoulder radiographs, subjects performed standardized isometric arm abduction and adduction tasks. EMG's were normalized between −1 and 1 using the “Activation Ratio”, where low values express (pathologic) co-activation, e.g. adductor activation during abduction. Findings: In patients with cuff tears mean rest acromiohumeral distance was 7.6mm (SD=1.6): 3.5mm narrower compared to patients with impingement (95%-CI: 2.4–4.5) and 1.3mm narrower compared to controls (95%-CI: −0.1–2.7). Both during abduction and adduction tasks, cranial translation was observed with equal magnitudes for patients and controls, with average values of 2.3 and 1.7mm, respectively. Where patients with cuff tears had lower adductor Activation Ratios (i.e. more adductor co-activation during abduction), no association between abductor/adductor muscle activation and acromiohumeral distance was found. Interpretation: The subacromial space is narrower in patients with rotator cuff tears compared to patients with impingement and controls. We found additional subacromial narrowing during isometric abduction and, to a lesser amount, during adduction in all subjects and more adductor co-activation in patients with cuff tears. We found no association between subacromial space and activation of the deltoid and main adductors. [Copyright &y& Elsevier]

Abstract: 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 &y& Elsevier]

Deficits in movement and muscle activation of scapulohumeral joint are related to Subacromial Pain Syndrome. Electromyography biofeedback during exercise may enhance muscle activation and coordination, and consequently improve pain and shoulder function. This study compared the effects of an exercise protocol with and without using electromyographic biofeedback on pain, function and movement of the shoulder complex in subjects with Subacromial Pain Syndrome. A total of 24 patients with subacromial pain (mean age = 46.2 + 8.1;18 women) were randomized to either therapeutic exercise or exercise plus biofeedback to the trapezius and serratus muscles. Pain and shoulder function were evaluated as the primary outcome and range of motion, muscle strength, electromyographic activity and scapulohumeral kinematics as secondary outcomes. The subjects underwent eight weeks of intervention and comparisons were made between groups in baseline, at 4 weeks, 8 weeks, and at 4 weeks post intervention. There were differences between groups for pain [mean difference = 1.5 (CI 0.3, 3.2) p = 0.01] at 8 weeks in the Exercise group and scapular upward rotation at 60° of arm elevation [mean difference = 13.9 (CI 0.9, 9.3), p = 0.006] in the Biofeedback group. There was no difference for the other variables of scapular kinematics as well as for shoulder function (DASH), muscle strength, range of motion and electromyographic variables. The addition of Biofeedback to the exercise protocol increased upward rotation of the scapula. However, the volunteers who performed only the Exercises had a better response in reducing pain. • Exercise was more effective in improving subacromial pain versus exercise + biofeedback. • The addition of biofeedback did not result in better pain and function over exercise alone. • Electromyographic biofeedback influences in scapular upward rotation. [ABSTRACT FROM AUTHOR]

Abstract: 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 &y& Elsevier]

Abstract: Objectives: This study aimed to investigate torque steadiness of shoulder internal and external rotations in regularly training overhead athletes with and without impingement symptoms. Design: Cross-sectional laboratory study. Methods: Three groups were evaluated: athletes with impingement symptoms (n =21), asymptomatic athletes (n =25) and non-athletes (n =21). To assess torque steadiness, the participants performed 3 submaximal contractions (35% of peak torque) for 10s each, with the arm at 90° of shoulder abduction and 90° of external rotation. The standard deviation, coefficient of variation, mean exerted torque and time to stability were measured from the steadiness trials. Results: The standard deviation of internal rotation was higher in asymptomatic athletes than in non-athletes (p <0.01); however, there was no difference between the athletes with impingement symptoms and the other groups. The other variables presented no differences among the groups. Conclusions: Higher torque fluctuation of shoulder internal rotation in asymptomatic athletes may point to neuromuscular adaptations related to throwing training. However, the steadiness patterns of athletes with impingement symptoms did not differ from those of asymptomatic athletes or non-athletes. [Copyright &y& Elsevier]

Abstract: Background: Rotator cuff tears strongly affect the biomechanics of the shoulder joint in their role to regulate the joint contact force needed to prevent the joint from dislocation. The aim of this study was to investigate the influence of simulated progressed rotator cuff tears on the (in)stability of the glenohumeral joint and the risk for impingement during wheelchair and handbike propulsion. Methods: The Delft Shoulder and Elbow Model was used to calculate the magnitude of the glenohumeral joint reaction force and the objective function J, which is an indication of the effort needed to complete the task. Full-thickness tears were simulated by virtually removing muscles from the model. Findings: With larger cuff tears the joint reaction force was higher and more superiorly directed. Also extra muscle force was necessary to balance the external force such that the glenohumeral joint did not dislocate. Interpretation: A tear of only the supraspinatus leads only to a minor increase in muscle forces and a minor shift of the force on the glenoid, indicating that it is possible to function well with a torn supraspinatus muscle. A massive tear shifts the direction of the joint reaction force to the superior border of the glenoid, increasing the risk for impingement. [Copyright &y& Elsevier]

Abstract: Objective: To present an evidence-based overview of the effectiveness of pharmaceutical interventions, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, and other injections, used to treat the subacromial impingement syndrome (SIS). An overview can help physicians select the most appropriate pharmaceutical intervention, and it can identify gaps in scientific knowledge. Data Sources: The Cochrane Library, PubMed, Embase, PEDro, and CINAHL databases. Study Selection: Two reviewers independently selected relevant reviews and randomized clinical trials. Data Extraction: Two reviewers independently extracted the data and assessed the methodologic quality. Data Synthesis: A best evidence synthesis was used to summarize the results. Three reviews and 5 randomized clinical trials were included. Although we found limited evidence for effectiveness in favor of 2 sessions with corticosteroid injections versus 1 session, for the effectiveness of corticosteroid injections versus placebo, nonsteroidal anti-inflammatory drugs, or acupuncture, only conflicting and no evidence for effectiveness was found. Moderate evidence was found in favor of immediate release oral ibuprofen compared with sustained-released ibuprofen in the short-term. Also, moderate evidence for effectiveness was found in favor of glyceryltrinitrate patches versus placebo patches in the short-term and mid term. Furthermore, injections with disodium ethylene diamine tetraacetic acid plus ultrasound with ethylene diamine tetraacetic acid gel were more effective (moderate evidence) than was placebo treatment in the short- and long-term. Conclusions: This article presents an overview of the effectiveness of pharmaceutical interventions for SIS. Some treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn. [Copyright &y& Elsevier]

Background: Previous studies have shown a relationship between shoulder posterior capsule tightness and shoulder pain in overhead athletes. However, this relationship has not been studied in tennis players. Objectives: Assessment of the shoulder range of motion (ROM), strength and posterior capsule lightness of skilled amateur tennis players who had complaints of dominant shoulder pain in comparison with tennis players without pain. Method: Forty- nine skilled amateur tennis players were distributed in 2 groups: Control Group (n=22) and Painful Group (n=27). The first group was composed of asymptomatic subjects, and the second was composed of subjects with shoulder pain on the dominant side. These groups were evaluated to determine the dominant and non-dominant shoulder ROM (internal and external rotation), isometric shoulder strength (internal and external rotation) and posterior shoulder tightness by blind evaluators. Results: The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (p<0.05). The intragroup analysis (dominant versus non-dominant) in the Painful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (p<0.05). Conclusions: The tennis players with pain in the dominant shoulder presented greater posterior capsule tightness, internal rotation deficit (ROM), external rotation gain (ROM) and deficits in external rotation strength than the tennis players without pain. [ABSTRACT FROM AUTHOR]

Summary: The aim of the study was to identify the differences in functionality of the upper limb in subjects suffering from shoulder impingement syndrome after intervention by two manual therapy protocols. Randomized, single-blind study with a sample of 22 subjects (58 ± 10.86 years old) divided into two groups. The conventional-group (n = 11) received mobilizations of the shoulder and the experimental-group (n = 11) was treated with soft tissue techniques in the cervical and upper thoracic regions. These two groups received electrotherapy and postural advices. The treatment lasted three weeks (15 daily sessions of 1 h and 30 min). Both active and passive range of motion (ROM) and self-perceived functionality of the upper limb (DASH questionnaire) were measured. The experimental group showed a significant improvement in the DASH scores and both groups improved mobility in the intra-group comparison pre-intervention versus post-intervention (p < .05), but not statistically significant differences were found in the between-group comparison (p > .05). Our results suggest that a combined treatment with electrotherapy, postural hygiene and manual therapy, regardless of the protocol, improves shoulder mobility and functionality. [Copyright &y& Elsevier]

Objective and purpose: The aim of this study was to determine the acromio-humeral, coraco-humeral, and coraco-clavicular distances with magnetic resonance imaging (MRI) in the diagnosis of shoulder impingement syndrome. Subjects and methods: All the acromiohumeral, coraco-humeral, and coraco-clavicular intervals of all patients were reviewed retrospectively. A total of 132 shoulders (76 right and 56 left shoulders) with impingement syndrome (40 males and 92 females, with 79 cases surgically confirmed and the remaining 53 cases clinically and radiologically suspected) and 40 control group patients were included. Statistical correlation of this research was assessed by Fisher's Exact t test and Pearson chi-square test-correlation coefficients. Results: In the correlation of average acromio-humeral, coracohumeral, and coraco-lavicular intervals (AHI, CHI, and CCI, respectively), there were significant statistical differences between patient and control groups; all the intervals were found to be higher in the control group. A moderate positive relation between average AHI and CHI, between AHI and CCI, and between CCI and CHI has been found. All intervals in the patient group increase or decrease dependently on each other. No proper cut-off values were determined using a receiver operating characteristic curve for all intervals between patient and control groups. Conclusion: Acromio-humeral, coraco-humeral, and coraco-clavicular intervals were extremely lower in the shoulder impingement syndrome and had significant importance in the diagnosis of subacromial and subcoracoid impingements. [ABSTRACT FROM AUTHOR]

Abstract: Nawoczenski DA, Riek LM, Greco L, Staiti K, Ludewig PM. Effect of shoulder pain on shoulder kinematics during weight-bearing tasks in persons with spinal cord injury. Objective: To assess 3-dimensional scapulothoracic and glenohumeral kinematics between subjects with spinal cord injury and disease (SCI/D) with and without shoulder pain during a weight-relief raise and transfer task. Design: Case-control, repeated-measures analysis of variance. Setting: Movement analysis laboratory. Participants: Subjects (N=43; 23 with clinical signs of impingement and 20 without) between 21 and 65 years of age, at least 1 year after SCI/D (range, 1–43y) resulting in American Spinal Injury Association Impairment Scale T2 motor neurologic level or below, and requiring the full-time use of a manual wheelchair. Interventions: Weight-relief raises and transfer tasks. Main Outcome Measures: An electromagnetic tracking system acquired 3-dimensional position and orientation of the thorax, scapula, and humerus. Dependent variables included angular values for scapular upward and downward rotation, posterior and anterior tilt, and internal and external rotation relative to the thorax, and glenohumeral internal and external rotation relative to the scapula. The mean of 3 trials was collected, and angular values were compared at 3 distinct phases of the weight-relief raise and transfer activity. Comparisons were also made between transfer direction (lead vs trail arm) and across groups. Results: Key findings include significantly increased scapular upward rotation for the pain group during transfer (P=.03). Significant group differences were found for the trailing arm at the lift pivot (phase 2) of the transfer, with the pain group having greater anterior tilt (mean difference ± SE, 5.7°±2.8°). The direction of transfer also influenced kinematics at the different phases of the activity. Conclusions: Potentially detrimental magnitude and direction of scapular and glenohumeral kinematics during weight-bearing tasks may pose increased risk for shoulder pain or injury in persons with SCI/D. Consideration should be given to rehabilitation strategies that promote favorable scapular kinematics and glenohumeral external rotation. [Copyright &y& Elsevier]

Abstract: Objectives: To establish the test–retest reliability of ultrasound measurements on acromio-humeral distance (AHD) and supraspinatus tendon thickness; and to explore their relationships with shoulder rotational strengths. Design: Test–retest observational study. Methods: Thirty-seven individuals (age: 21.5±1.4 years) participated in this study. Twenty-four were University volleyball players with 15 healthy and 9 players with shoulder impingement syndrome (SIS). Thirteen participants were healthy untrained individuals. Ultrasound measurements of AHD and supraspinatus tendon thickness were taken, and isokinetic testing of concentric shoulder internal rotation (IR) and external rotation (ER) at a speed of 90°/s was performed. Results: The measurement of the AHD and the supraspinatus tendon thickness indicated excellent reliability (ICC=0.922, and ICC=0.933 respectively), and the minimum detectable difference (MDD) were 2.10mm and 0.64mm respectively. A cut-off AHD distance of 23.9mm had a sensitivity of 0.67 and specificity of 0.71 (area under curve (AUC): 0.70; p =0.05) in identifying individuals with and without SIS. Hence, individuals with AHD larger than 23.9mm had greater possibility of having SIS. Positive correlations were found in AHD with supraspinatus tendon thickness (r =0.36, p <0.05) and shoulder external rotational strengths (r =0.47–0.62, all p <0.05) and ER/IR ratios (r =0.56–0.58, all p <0.05). Conclusions: Ultrasound measurements of AHD and tendon thickness have excellent reliability. The reported cut-off AHD highlighted the potential role of ultrasound measurements in volleyball players for early identification of SIS. The AHD was related to the supraspinatus tendon thickness and shoulder external rotation strengths. Our findings provide a scientific basis for muscle training in overhead athletes such as volleyball players. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this study was to compare the efficacy of Mobilization with Movement (MWM) and kinesiotaping (KT) techniques with a supervised exercise program in participants with patients with shoulder pain. Methods: Twenty subjects with shoulder pain were included if subjects were diagnosed by the referring physician with either rotator cuff lesion with impingement syndrome or impingement shoulder syndrome. Participants were randomly assigned to 1 of 2 groups after clinical and radiologic assessment: group 1 was treated with MWM and KT techniques, whereas group 2 was treated with a supervised exercise program. The main outcome measures were active pain-free shoulder abduction and flexion tested on days 0, 5, and 10. Results: Improvement in active pain-free shoulder range of motion was significantly higher in the group treated with MWM and KT. Repeated-measures analysis of variance indicated significant effects of treatment, time, and treatment × time interaction. Conclusion: This study suggests that MWM and KT may be an effective and useful treatment in range of motion augmentation of subjects with rotator cuff lesion and impingement syndrome or impingement shoulder syndrome. [Copyright &y& Elsevier]

Background: Shoulder pain is the third leading musculoskeletal complaint seen by general practitioners. Physical therapy is often the first line of intervention in this population; however, there is limited description of what constitutes effective physical therapy treatment. No study has examined the effectiveness of therapeutic exercise across all painful shoulder conditions. Our purpose was to examine the effectiveness of therapeutic exercise as an intervention across all pathoanatomic mechanisms of shoulder pain in terms of range of motion (ROM), pain, and function. Methods: Medline via Ovid, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials were searched from 1997 through March 2011. Randomized controlled trials comparing physical therapist–prescribed exercises against any other type of intervention were included. Articles were qualitatively evaluated by use of the Physiotherapy Evidence Database scale by 5 separate reviewers. Data from included studies were extracted and synthesized with respect to the primary outcomes of ROM, pain, and function. Individual effect sizes were calculated with a standard formula, and overall effect was calculated by use of random- and fixed-effects models. Results: We qualitatively reviewed 19 articles; 17 achieved the criterion of 6 or better on the Physiotherapy Evidence Database scale. Significant heterogeneity in reporting among included studies limited quantitative assessment. Overall, therapeutic exercise has a positive effect on pain and function above all other interventions. The findings for ROM were inconclusive. Conclusion: Therapeutic exercise is an effective intervention for the treatment of painful shoulder conditions; however, subsequent research is necessary for translation into clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Hong JY, Yoon S-H, Moon DJ, Kwack K-S, Joen B, Lee HY. Comparison of high- and low-dose corticosteroid in subacromial injection for periarticular shoulder disorder: a randomized, triple-blind, placebo-controlled trial. Objective: To determine whether subacromial injection with high-dose corticosteroid in patients with periarticular shoulder disorders is better than low-dose corticosteroid or placebo in improving pain, function, and active range of motion (AROM). Design: Multicenter, randomized, triple-blind, placebo-controlled trial. Setting: Primary (n=2) and university-affiliated (n=1) tertiary-care hospitals. Participants: Volunteers (N=79) with periarticular shoulder disorders with at least 1 month''s duration of pain. Intervention: Participants were randomly assigned to receive ultrasound-guided subacromial injection with triamcinolone acetonide, 40 or 20mg, or placebo. After a single injection, participants were followed up for 8 weeks. Main Outcome Measures: Visual analog scale (VAS) of average shoulder pain level during the past 1 week, Shoulder Disability Questionnaire (SDQ), and angles of shoulder AROM (including flexion, abduction, external rotation, internal rotation) pre- and posttreatment at weeks 2, 4, and 8. Results: There were no significant differences among the 3 groups (triamcinolone acetonide, 40mg, group 1, n=27; triamcinolone acetonide, 20mg, group 2, n=25; placebo, group 3, n=27) in terms of demographic and clinical characteristics at baseline. (1) Within-group comparison: VAS score, SDQ score, and AROM for groups 1 and 2 significantly improved at weeks 2, 4, and 8 (P<.0167). However, there was no difference in VAS score, SDQ score, and AROM scores for group 3. (2) Between-group comparison: significant differences in VAS score, SDQ score, and abduction, external rotation, and internal rotation of AROM were shown between groups 1 and 2 and group 3 at weeks 2, 4, and 8 (P<.05). Conclusions: This was the first study to assess the efficacy of corticosteroid according to 2 different doses, which are the most widely used in subacromial injection for participants with periarticular shoulder disorders. This study showed no significant differences between the high- (triamcinolone acetonide, 40mg) and low-dose (20mg) corticosteroid groups, indicating preferred use of a low dose at the initial stage. [Copyright &y& Elsevier]

Abstract: Gebremariam L, Hay EM, Koes BW, Huisstede BM. Effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome: a systematic review. Objective: To provide an evidence-based overview of the effectiveness of surgical and postsurgical interventions for the subacromial impingement syndrome. Data Sources: The Cochrane Library, PubMed, Embase, PEDro, and CINAHL were searched. Study Selection: Two reviewers independently selected relevant systematic reviews and randomized controlled trials (RCTs). Data Extraction: Two reviewers independently extracted data and assessed the methodologic quality. Data Synthesis: If pooling of data was not possible, a best-evidence synthesis was used to summarize the results. Results: One review and 5 RCTs reporting on various surgical techniques, and postsurgical interventions were included. Moderate evidence was found in favor of adding platelet-leukocyte gel versus open subacromial decompression. No evidence was found for the superiority of subacromial decompression versus conservative treatment in the short, mid, and long term or in favor of 1 surgical technique when compared with another. Limited evidence was found in favor of early activation after arthroscopic decompression in the short and long term. Conclusions: This review shows that there is no evidence that surgical treatment is superior to conservative treatment or that1 particular surgical technique is superior to another. Because of possibly lower risks for complications, conservative treatment may be preferred. When choosing for surgery, arthroscopic decompression may be preferred because of the less invasive character of the procedure. [Copyright &y& Elsevier]