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Context: Increasing soft tissue flexibility and joint mobility is one of the important aims of studies to treat subacromial impingement syndrome (SIS)., Objective: The aim of this study was to investigate the effects of a stretching program on posterior capsule tightness, pectoralis minor tightness, pain severity, and disability status in SIS., Design: Single-group pretest posttest design., Setting: University outpatient clinic., Participants: 18 participants diagnosed with SIS (34.8±9.4 y, symptoms duration 5.8±4.9 months) were included in the study., Intervention: The 6-week self-stretching program for pectoralis minor, posterior capsule, levator scapula, and latissimus dorsi was performed., Main Outcome Measures: Posterior capsule tightness, pectoralis minor tightness, pain severity (visual analog scale), and self-reported shoulder-related pain and disability status (Shoulder Pain and Disability Index) were used to assess changes in flexibility and symptoms., Results: Comparisons showed that there was significantly less posterior capsule and pectoralis minor tightness, less pain severity on activity and at night, and a lower disability score reported after the 6-week stretching program (P < 0.05). There was no statistically significant difference in pain severity at rest after the 6-week stretching program (P > 0.05)., Conclusions: The findings of the study showed that flexibility, pain severity, and disability gains can be achieved with a 6-week stretching exercise training for participants with SIS. Therefore, shoulder girdle stretching exercises should be recommended early in shoulder rehabilitation program.

Objective: To investigate the effects of 2 different exercise programs on 3-dimensional scapular kinematics, disability, and pain in participants with subacromial impingement syndrome (SIS)., Design: Randomized controlled trial., Setting: Outpatient clinic and research laboratory., Participants: Participants who were diagnosed with SIS and who also exhibited scapular dyskinesis (N=30)., Interventions: The participants were randomized in 2 different exercise groups: (1) shoulder girdle stretching and strengthening with additional scapular stabilization exercises based on a kinetic chain approach (intervention group), and (2) shoulder girdle stretching and strengthening exercises only (control group)., Main Outcome Measures: Three-dimensional scapular kinematics, self-reported shoulder pain, and disability were evaluated at baseline, after 6 weeks of training, and after 12 weeks of training., Results: Significant differences were observed between the control and intervention groups in external rotation and posterior tilt after 6 weeks of training and in external rotation, posterior tilt, and upward rotation after 12 weeks of training. All groups showed improvement in self-reported pain and disability scores; however, there were no significant differences between the groups., Conclusions: Progressive exercise training independent from specific scapular stabilization exercises provides decreased disability and pain severity in impingement syndrome., (Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Study Design: Cross-sectional and controlled laboratory study using pretest-posttest design., Introduction: Patients with distal radius fracture (DRfx) report proximal segment problems. Taping is commonly recommended because it provides improved posture and function., Purpose of the Study: This study aimed to investigate the 3-dimensional scapular kinematics and the effect of taping on the kinematics in participants with DRfx., Methods: Twenty participants with a unilateral history of DRfx and 20 healthy controls participated. Scapular kinematics was assessed using an electromagnetic system. Three separate strips of elastic taping were applied for participants with DRfx over the arm, scapula, and middle and lower trapezius muscles through the paravertebral muscles. Afterward, the scapular kinematics was reassessed in taped condition., Results: When participants with DRfx and healthy controls compared, the scapula was more downwardly rotated at 120° of humerothoracic elevation (mean difference [MD], 9.06°) and at 120° (MD, 9.04°), 90° (MD, 5.6°) of humerothoracic lowering, more upwardly rotated at 30° of humerothoracic lowering (MD, 5.1°). Taping showed a significant effect on kinematics; specifically, the scapula was more externally rotated (38.9° untaped vs 31.1° taped) and posteriorly tilted (-9.2° untaped vs -4.8° taped) during humerothoracic elevation and lowering for participants with DRfx., Discussion: Participants with DRfx showed different scapular kinematics and taping resulted in changes on tested kinematic parameters during humeral movements. Differences in scapular motion during elevation with taping showed a specific pattern., Conclusions: Overall, taping maintained a position likely to produce optimal rotator cuff function during early rehabilitation of patients with DRfx., Level of Evidence: N/A., (Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Background: This study analyzed the dynamic three-dimensional scapular kinematics and scapular asymmetry in participants with and without shoulder impingement syndrome., Methods: Twenty-nine participants with shoulder impingement syndrome, have been suffering from unilateral shoulder pain at the dominant arm lasting more than six weeks and thirty-seven healthy controls participated in the study. Scapular kinematics was measured with an electromagnetic tracking device during shoulder elevation in the sagittal plane. Data for bilateral scapular orientation were analyzed at 30°, 60°, 90°, and 120° of humerothoracic elevation and lowering. The symmetry angle was calculated to quantify scapular asymmetry throughout shoulder elevation., Findings: Statistical comparisons indicated that the scapula was more downwardly rotated (p<0.001) and anteriorly tilted (p=0.005) in participants with shoulder impingement syndrome compared to healthy controls. Side-to-side comparisons revealed that the scapula was more anteriorly tilted on the involved side of participants with shoulder impingement syndrome (p=0.01), and the scapula was rotated more internally (p=0.02) and downwardly (p=0.01) on the dominant side of healthy controls. Although there were side-to-side differences in both groups, symmetry angle calculation revealed that the scapular movement was more asymmetrical for scapular internal and upward rotation in individuals with shoulder impingement syndrome when compared with healthy controls (p<0.05)., Interpretation: The findings of the study increase our knowledge and understanding of scapular alterations in symptomatic and asymptomatic populations, which creates biomechanical considerations for shoulder assessment and rehabilitation., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The combination of open kinetic chain (OKC) and closed kinetic chain (CKC) exercises is commonly recommended in shoulder rehabilitation, aiming at improving strength and sport-specific performance. This study aimed to investigate the three-dimensional (3-D) scapular kinematics and bilateral symmetry of scapular motion during dynamic OKC and CKC movements in asymptomatic and symptomatic shoulders. Fifty subjects with unilateral shoulder pain (symptomatic subjects diagnosed with subacromial impingement syndrome, n=20) or without shoulder pain during active shoulder elevation (asymptomatic subjects, n=30) participated in the study. Furthermore, 3-D scapular kinematics were recorded using an electromagnetic tracking device in the sagittal plane of shoulder elevation for both the OKC and CKC conditions performed with slings. Data for scapular kinematics and symmetry angle (SA) were analyzed at 30°, 45°, 60°, 90°, and 120° of humerothoracic elevation. Analysis of variance models and Student׳s t-test were used to make comparisons between conditions. In general, the scapula was more externally rotated, upwardly rotated and anteriorly tilted for asymptomatic shoulders, and more upwardly rotated for symptomatic shoulders during CKC shoulder elevation. Further, comparisons of SA obtained during OKC and CKC movements revealed that during CKC, scapular motion was more symmetrical for upward-downward rotation and anterior-posterior tilt in asymptomatic shoulders and for anterior-posterior tilt in symptomatic shoulders, especially above 90° humerothoracic elevation. Differences in scapular motion during the CKC condition were in a specific pattern and enhanced symmetry, which would be considered to be a position less likely to produce compression of the rotator cuff tendons for both training in asymptomatic populations and for treatment in early rehabilitation of patients, such as those who have shoulder impingement syndrome., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Subacromial impingement syndrome (SAIS) is a major contributing factor of shoulder pain; and treatment approaches (Kinesio® taping [KT], Exercise [EX], manual therapy [MT], and high-intensity laser therapy [HILT]) have been developed to treat the pain. The key objective of this study was to compare the effects of KT, MT, and HILT on the pain, the range of motion (ROM), and the functioning in patients with SAIS. Seventy patients with SAIS were randomly divided into four groups based on the treatment(s) each group received [EX (n = 15), KT + EX (n = 20), MT + KT + EX (n = 16), and MT + KT + HILT + EX (n = 19)]. All the patients were assessed before and at the end of the treatment (15th day). The main outcome assessments included the evaluation of severity of pain by visual analogue scale (VAS) and shoulder flexion, abduction, and external rotation ROM measurements by a universal goniometry. Shoulder pain and disability index (SPADI) was used to measure pain and disability associated with shoulder pathology. Statistically significant differences were found in the treatment results of all parameters in MT + KT + EX and HILT + MT + KT + EX groups (p < 0.05). When the means of ROM and SPADI results of three groups were compared, statistically significant differences were found between all the groups (p < 0.05). These differences were significant especially between the groups MT + KT + EX and KT + EX (p < 0.05) and HILT + MT + KT + EX and KT + EX (p < 0.05). HILT and MT were found to be more effective in minimizing pain and disability and increasing ROM in patients with SAIS. Further studies with follow-up periods are required to determine the advantages of these treatments conclusively.

Objective: To determine the effects of scapular mobilization on function, pain, range of motion, and satisfaction in patients with subacromial impingement syndrome (SAIS)., Design: Randomized, double-blind, placebo-controlled clinical trial., Setting: University hospital clinics in Turkey., Participants: 66 participants (mean ± SD age 52.06 ± 3.71 y) with SAIS., Interventions: Participants were randomized into 3 groups: scapular mobilization, sham scapular mobilization, and supervised exercise. Before the interventions transcutaneous electrical stimulation and hot pack were applied to all groups. Total intervention duration for all groups was 3 wk with a total of 9 treatment sessions., Main Outcome Measures: Shoulder function and pain intensity were primary outcome measures; range of motion and participant satisfaction were secondary outcome measures. Shoulder function was assessed with the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). A visual analog scale was used to evaluate pain severity. Active range of motion was measured with a universal goniometer. A 7-point Likert scale was used to evaluate satisfaction. Outcome measurements were performed at baseline, before visits 5 and 10, 4 wk after visit 9, and 8 wk after visit 9., Results: There was no group difference for DASH score (P = .75), pain at rest (P = .41), pain with activity (P = .45), pain at night (P = .74), and shoulder flexion (P = .65), external rotation (P = .63), and internal rotation (P = .19). There was a significant increase in shoulder motion and function and a significant decrease in pain across time when all groups were combined (P < .001). The level of satisfaction was not significantly different for any of the questions about participant satisfaction between all groups (P > .05)., Conclusion: There was not a significant advantage of scapular mobilization for shoulder function, pain, range of motion, and satisfaction compared with sham or supervised-exercise groups in patients with SAIS.

Background: Turkish version of the Upper Extremity Functional Index (UEFI) may help to assess shoulder function in patients with shoulder impingement syndrome (SAIS)., Objective: To translate and cross-culturally adapted UEFI into Turkish and to assess its acceptability, reliability, validity in patients with SAIS., Methods: This study conducted with 93 SAIS participants. UEFI, the short version of the Disability of the Arm, Shoulder and Hand scale (Quick DASH), the Shoulder Pain and Disability Index, and the Short Form-36 Health Survey (SF-36) were administered. Acceptability was assessed in terms of refusal rate, rates of missing responses, and administration time. Test-retest reliability was assessed with intra class correlation coefficient (ICC), internal consistency was assessed with Cronbach's alpha coefficient. Validity was assessed by floor and ceiling effects, skew of distributions and Pearson's correlation coefficients., Results: Cronbach's alpha coefficients for the UEFI at Time 1 and Time 2 were as follows: α = 0.89 and α = 0.89. Average measure ICC was 0.80. The UEFI score demonstrated strong negative correlations with SPADI total score and Quick DASH score. There was not a significant correlation between the UEFI and mental health subscale score derived from SF-36., Conclusions: The Turkish version of UEFI is acceptable, valid, and reliable.

Objective: The purpose of this study was to compare the effects of manual therapy with exercise to kinesiotaping with exercise for patients with subacromial impingement syndrome., Methods: Randomized clinical before and after trial was used. Fifty-four patients diagnosed as having subacromial impingement syndrome who were referred for outpatient treatment were included. Eligible patients (between 30 and 60 years old, with unilateral shoulder pain) were randomly allocated to 2 study groups: kinesiotaping with exercise (n = 28) or manual therapy with exercise (n = 26). In addition, patients were advised to use cold packs 5 times per day to control for pain. Visual analog scale for pain, Disability of Arm and Shoulder Questionnaire for function, and diagnostic ultrasound assessment for supraspinatus tendon thickness were used as main outcome measures. Assessments were applied at the baseline and after completing 6 weeks of related interventions., Results: At the baseline, there was no difference between the 2 group characteristics (P > .05). There were significant differences in both groups before and after treatment in terms of pain decrease and improvement of Disability of Arm and Shoulder Questionnaire scores (P < .05). No difference was observed on ultrasound for tendon thickness after treatment in both groups (P > .05). The only difference between the groups was at night pain, resulting in favor of the kinesiotaping with exercise group (P < .05)., Conclusion: For the group of subjects studied, no differences were found between kinesiotaping with exercise and manual therapy with exercise. Both treatments may have similar results in reducing pain and disability in subacromial impingement in 6 weeks., (Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aims to compare the efficacy of manual therapy in the frozen shoulder patients with or without diabetes mellitus., Patients and Methods: Between May 2006 and January 2008, 50 patients (10 males, 40 females; mean age 52 ± 10 years; range 40 to 65 years) orthopedic surgeons referred to the Sports Physiotherapy Unit were included in the study. The patients were divided into two groups, including patients with primary frozen shoulder with type II diabetes mellitus (n=12) and non diabetics (n=38). All patients underwent a rehabilitation program including cold application, manual therapy and exercises twice a week. A total of 16 treatment sessions were performed. The most important part of the manual therapy included scapular mobilization and posterior capsule stretching. The range of motion was measured by goniometry. Functional activity status was assessed by Constant's score. The pain level was evaluated by visual analog scale, while muscle strength was evaluated by hand-held dynamometer. Student t-test was used to compare between the parameters of groups, while Paired sample t-test was used to compare pre- and post-treatment parameters of the patients., Results: The range of motion, functional activity status and muscular strength were improved and the pain level was reduced after rehabilitation in all of the patients in both groups (p<0.05). There was no difference in duration of the treatment between the groups (p>0.05). There were no differences in range of motion, functional activity status, pain level, and muscle strength before and after rehabilitation between the groups (p>0.05)., Conclusion: Manual therapy approaches may be safely applied in diabetic patients with frozen shoulder.

Objectives: The aim of this randomized controlled study was to assess the efficacy of manual therapy in the treatment of patients with symptomatic supraspinatus tendinopathy., Methods: Seventy-seven patients (age range, 30 to 55 years) with supraspinatus tendinopathy, were randomly assigned to one of the three treatment groups: a supervised exercise program (Group 1), a supervised exercise program combined with joint and soft tissue mobilization (Group 2), or a home-based rehabilitation program (Group 3). All patients had rehabilitation for 12 weeks. Pain level was evaluated with a visual analogue scale (VAS) and the range of motion (ROM) was measured with a goniometer. The Modified American Shoulder and Elbow Surgery (MASES) score was used in functional assessment. Flexion, abduction, internal and external rotation strengths were measured with a manual muscle test. All patients were evaluated before, and at the 4th and 12th week of the rehabilitation., Results: All groups experienced significant decrease in pain and an increase in shoulder muscle strength and function by both the 4th and 12th weeks of treatment (p<0.05). There was no significant difference between the groups in terms of function (p>0.05). However, the greatest improvement in functionality was found in Group 2., Conclusion: Supervised exercise, supervised and manual therapy, and home-based exercise are all effective and promising methods in the rehabilitation of the patients with subacromial impingement syndrome. The addition of an initial manual therapy may improve the results of the rehabilitation with exercise.

Objective: The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function., Design: Pretest-posttest for 3 groups (SM, sham, and control)., Setting: A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic., Participants: 39 subjects (22 women, 17 men; mean age 54.30 +/- 14.16 y, age range 20-77 y)., Interventions: A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program., Main Outcome Measures: Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function., Results: After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05)., Conclusions: SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.

The aim of this prospective, randomized clinical study was to compare the effectiveness of two physical therapy treatment approaches for impingement syndrome, either by joint and soft tissue mobilization techniques or by a self-training program. Thirty patients (Group 1, n = 15; Group 2, n = 15) with the diagnosis of an outlet impingement syndrome of the shoulder were treated either by strengthening the depressors of the humeral head with a guided self-training program (Group 1, age 49.5 +/- 7.9 years), or by joint and soft tissue mobilization techniques (Group 2, age 48.1 +/- 7.5 years). Group 1 was instructed with the active range of motion (ROM), stretching and strengthening exercise program including rotator cuff muscles, rhomboids, levator scapulae and serratus anterior with an elastic band at home at least seven times a week for 10-15 min and Group 2 received a prescription for 12 sessions of joint and soft tissue mobilization techniques, ice application, stretching and strengthening exercise programs and patient education in clinic for three times per week. All patients were tested with visual analog scale (VAS) for pain level, goniometric measurement for ROM and algometry for the pain threshold. Function was measured with a functional assessment questionnaire. The VAS (10 cm) used to measure pain with functional activities and the functional assessment questionnaire (Neer) were also measured 3 months after the initiation of treatment. Subjects in both groups experienced significant decreases in pain and increases in shoulder function, but there was significantly more improvement in the manual therapy group compared to the exercise group. For example, pain in the manual therapy group was reduced from a pre-treatment mean (+/-SD) of 6.7 (+/-0.3) to a post-treatment mean of 2.0 (+/-2.0). In contrast, pain in the exercise group was reduced from a pre-treatment mean of 6.6 (+/-1.4) to a post-treatment mean of 3.0 (+/-1.8). ROM at flexion, abduction and external rotation in the manual therapy group improved significantly while ROM in the exercise group did not. There were statistically differences among the groups in function (P > 0.05). Group 2 showed significantly greater improvements in the Neer Questionnaire score and shoulder satisfaction score than Group 1. The patients treated with manual physical therapy applied by experienced physical therapists combined with supervised exercise in a brief clinical trial showed improvement of symptoms including increasing strength, decreasing pain and improving function earlier than with exercise program.

The shoulder joint, the most mobile joint in the human body, is at greater risks for injuries. Several factors contribute to shoulder impingement syndrome including rotator cuff weakness, capsular tightness, poor scapulohumeral rhythm, and muscle imbalance of the scapular upward rotation force couple. Rehabilitation and training of the shoulder in throwing and overhead athletes has dramatically improved during the last decade. There are numerous reasons for rapid return to athletic training and competition. A preventive program designed for the glenohumeral joint is mainly based on an appropriate preparation, which should include overall body conditioning, flexibility, and strengthening of the musculature around the glenohumeral joint and the scapula. Activity levels represent a helpful guide in determining an appropriate rehabilitation program for shoulder patients ranging from disabled to those competing at the highest levels of athletics. This article discusses issues related to prophylactic measures, non-operative treatment, postoperative treatment, and rehabilitation programme of impingement syndrome in athletes.