PNF in Subacromial Impingement Syndrome

NCT04794933 | Completed DMC

• 1 other identifier: 2015
• Study Type: interventional
• Target: 45
• Locations: 1 country
• Sites: 1

Brief Summary

Although proprioceptive neuromuscular facilitation (PNF) techniques have been used in the treatment of different shoulder problems, PNF techniques in scapular and upper trunk patterns with extremity pattern have not been considered as a possible option for the treatment of Subacromial Impingement Syndrome (SIS). The aim of this study was to evaluate the effects of different PNF patterns in SIS.

Conditions

Subacromial Impingement Syndrome

Keywords

subacromial impingement; posture; pain; Proprioceptive Neuromuscular Facilitation

Outcome Measures

Primary Outcomes (4)

• Scapular stability

  The lateral scapular slide test (LSST) was applied to evaluate scapular stability. In the first position (LSST 1), both arms are relaxed at the sides with the glenohumeral joint in a neutral position. In the second position (LSST 2), the subject places both hands on the ipsilateral hips with the humerus in medial rotation in 45° of abduction in the coronal plane. In position 3 (LSST 3), the subject actively extends both elbows and places the upper extremities in a position of maximum medial rotation in 90° of abduction in the coronal plane. The inferomedial angle of the scapula is palpated and marked on both the affected and unaffected sides, and the spinous process of the thoracic vertebra in the same horizontal plane (the reference vertebra) is then marked. The measurements from the reference point on the spine to the medial border of the scapula are measured on both sides in all 3 test positions.

  Change from baseline scapular stability at 6 weeks

• Anterior tilt of the head

  The distance was measured from the sternal notch to the tip of the chin with a tape measure.

  Change from baseline anterior tilt of the head at 6 weeks

• Rounded shoulder

  The subject stood in a relaxed position with their heels against a wall. The posterolateral acromion was marked and the ruler was held square. The measurement was taken from the acromion to the wall behind the subject to determine the amount of forward displacement.

  Change from baseline rounded shoulder at 6 weeks

• Thoracic kyphosis

  The gravity-dependent inclinometer (BASELINEᴿ Bubble inclinometer-USA) was used to measure kyphosis. In the first measurement, the inclinometer was placed over the region of the 1st and 2nd thoracic spinous processes and in the second, over the region of the 12th thoracic and 1st lumbar spinous processes. The total of the angles in each measurement was recorded.

  Change from baseline thoracic kyphosis at 6 weeks

Secondary Outcomes (2)

• Pain severity

  Just before the treatment and at the end of 6-week treatment

• Functional status

  Just before the treatment and at the end of 6-week treatment

Study Arms (3)

Conventional therapy (CT)

ACTIVE COMPARATOR

Cold pack (15 minutes); pulsed ultrasound therapy (1 watt/cm², 3 MHz, 1:2 pulsed mode; 3 minutes); transcutaneous electrical nerve stimulation (60-120 Hz; 20 minutes) and exercises (20 minutes). The exercises included stretching, strengthening and posture exercises.

Other: Conventional therapy

CT+ PNF in extremity pattern

EXPERIMENTAL

PNF in the extremity pattern, were instructed to actively move through the PNF flexion-abduction-external rotation diagonal pattern for 10 repetitions with manual facilitation and the treatment was performed within the range in which pain did not occur. Rhythmic stabilization and repeated contractions were applied from the PNF techniques.

Other: Conventional therapy; Other: CT+ PNF in extremity pattern

CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns

EXPERIMENTAL

PNF in scapula and upper trunk patterns in addition to PNF in the extremity pattern. The scapular pattern application was performed by positioning the affected extremity in a relaxed position above the stable side in the side-lying position. Rhythmic stabilization and repeated contractions were applied from the anterior-elevation position in the direction of posterior-depression. Extension, lateral flexion and rotation to the affected side were performed in the trunk patterns in rhythmic stabilization and repeated contractions.

Other: Conventional therapy; Other: CT+ PNF in extremity pattern; Other: CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns

Interventions

Conventional therapy OTHER

CT+ PNF in extremity pattern; CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns; Conventional therapy (CT)

CT+ PNF in extremity pattern OTHER

CT+ PNF in extremity pattern; CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns

CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns OTHER

CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• patients diagnosed with SIS,
• aged between 18 and 65 years,
• shoulder pain ongoing for more than four weeks,
• loss of active shoulder motion or painful ROM,
• no treatment related to the shoulder in the last 6 months.

You may not qualify if:

• history of frozen shoulder,
• disorders of the acromioclavicular joint,
• possession of a curved or hooked acromion,
• shoulder instability,
• degenerative arthritis of the glenohumeral joint,
• calcifying tendonitis,
• post-traumatic disorders,
• shoulder surgery and/or elbow, hand, wrist and cervical spine disorders,
• diseases that can cause positional vertigo.

Sponsors & Collaborators

• Ankara Yildirim Beyazıt University: lead

Study Sites (1)

Ankara Yıldırım Beyazıt University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation

Ankara, Turkey (Türkiye)

Location

Related Publications (8)

• Cools AM, Struyf F, De Mey K, Maenhout A, Castelein B, Cagnie B. Rehabilitation of scapular dyskinesis: from the office worker to the elite overhead athlete. Br J Sports Med. 2014 Apr;48(8):692-7. doi: 10.1136/bjsports-2013-092148. Epub 2013 May 18.

  PMID: 23687006 BACKGROUND

• Escamilla RF, Yamashiro K, Paulos L, Andrews JR. Shoulder muscle activity and function in common shoulder rehabilitation exercises. Sports Med. 2009;39(8):663-85. doi: 10.2165/00007256-200939080-00004.

  PMID: 19769415 BACKGROUND

• Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003;2003(2):CD004258. doi: 10.1002/14651858.CD004258.

  PMID: 12804509 BACKGROUND

• Gumina S, Di Giorgio G, Postacchini F, Postacchini R. Subacromial space in adult patients with thoracic hyperkyphosis and in healthy volunteers. Chir Organi Mov. 2008 Feb;91(2):93-6. doi: 10.1007/s12306-007-0016-1. Epub 2008 Mar 3.

  PMID: 18320381 BACKGROUND

• Hanratty CE, McVeigh JG, Kerr DP, Basford JR, Finch MB, Pendleton A, Sim J. The effectiveness of physiotherapy exercises in subacromial impingement syndrome: a systematic review and meta-analysis. Semin Arthritis Rheum. 2012 Dec;42(3):297-316. doi: 10.1016/j.semarthrit.2012.03.015. Epub 2012 May 18.

  PMID: 22607807 BACKGROUND

• Hickey D, Solvig V, Cavalheri V, Harrold M, Mckenna L. Scapular dyskinesis increases the risk of future shoulder pain by 43% in asymptomatic athletes: a systematic review and meta-analysis. Br J Sports Med. 2018 Jan;52(2):102-110. doi: 10.1136/bjsports-2017-097559. Epub 2017 Jul 22.

  PMID: 28735288 BACKGROUND

• Holmgren T, Hallgren HB, Oberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. Br J Sports Med. 2014 Oct;48(19):1456-7. doi: 10.1136/bjsports-2014-e787rep.

  PMID: 25213604 BACKGROUND

• Hunter DJ, Rivett DA, McKeirnan S, Smith L, Snodgrass SJ. Relationship Between Shoulder Impingement Syndrome and Thoracic Posture. Phys Ther. 2020 Apr 17;100(4):677-686. doi: 10.1093/ptj/pzz182.

  PMID: 31825488 BACKGROUND

MeSH Terms

Conditions

Shoulder Impingement Syndrome; Pain

Condition Hierarchy (Ancestors)

Joint Diseases; Musculoskeletal Diseases; Shoulder Injuries; Wounds and Injuries; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Ertuğrul Demirdel, PhD

  Ankara Yildirim Beyazıt University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: Patients who met the inclusion criteria and agreed to participate were randomly allocated to Group 1 \[Conventional therapy (CT)\], Group 2 \[CT+ PNF in extremity pattern\] and Group 3 \[CT+ PNF in extremity pattern+PNF in scapula and upper trunk patterns\].

Study Record Dates

• First Submitted: March 9, 2021
• First Posted: March 12, 2021
• Study Start: December 1, 2013
• Primary Completion: April 1, 2015
• Study Completion: April 1, 2015
• Last Updated: June 30, 2021

Record last verified: 2021-06

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)