Abstract | STUDY DESIGN: Case series. BACKGROUND: CASE DESCRIPTION: Ten patients (age range, 19-70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks. OUTCOMES: Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least "moderately better." At 6 weeks, 6 of 10 patients had a successful (mean +/- SD) DASH outcome score (initial, 33.9 +/- 16.2; 6 weeks, 8.1 +/- 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 +/- 14; 12 weeks, 8.3 +/- 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients). DISCUSSION: A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional improvement in 8 of 10 patients in 6 to 12 weeks. LEVEL OF EVIDENCE:
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Authors | Angela R Tate, Philip W McClure, Ian A Young, Renata Salvatori, Lori A Michener |
Journal | The Journal of orthopaedic and sports physical therapy
(J Orthop Sports Phys Ther)
Vol. 40
Issue 8
Pg. 474-93
(Aug 2010)
ISSN: 0190-6011 [Print] United States |
PMID | 20710088
(Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adult
- Aged
- Disability Evaluation
- Exercise Therapy
- Female
- Humans
- Male
- Manipulation, Orthopedic
- Middle Aged
- Muscle Strength
- Pain Measurement
- Patient Education as Topic
- Shoulder Impingement Syndrome
(therapy)
- Young Adult
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