The Effects of Manual Therapy and Scapular Exercise for the Pectoralis Minor in Individuals With Shoulder Pain

NCT05104060 | Completed

• 1 other identifier: YM110136E
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 2

Brief Summary

Shoulder pain is the third common problem, after problems of spine. Abnormal scapular kinematics, so called scapular dyskinesis, is believed to be associated with shoulder pain. Studies showed that individuals with shoulder problems demonstrate less upward rotation, posterior tilt and external rotation during shoulder movement. The shortness of the pectoralis minor (PM) is one of the factors leading to scapular dyskinesis. Short pectoralis minor has been shown to prevent scapula from tilting posterior and rotating externally during shoulder motion. The decreased scapular posterior tilt and external rotation may decrease subacromial space and result in impingement. However, although many assessment methods have been used to assess PM tightness or shortness, no study has tested the validity of these testing methods. Moreover, although stretching exercises for PM have been shown to increase the PM length, previous studies found that PM stretching exercises did not restore scapular kinematics and did not further decrease pain and improve function. Shoulder pain and discomfort has also been reported during stretching. Therefore, rather than stretching exercise, other types of treatment that can specifically increase the PM length and restore scapular kinematics may be needed. Manual therapy could specifically increase the flexibility of PM, and scapular orientation exercises could improve scapular kinematics. These types of treatment may be better options. However, to our knowledge, no study has investigated whether manual therapy combined with scapular orientation exercises could improve scapular kinematics, pain and function. Therefore, the first part of this study is to investigate which tests for length or tightness of PM can predict the scapular dyskinesis. The second part of the study is to investigate the effects of manual therapy and scapular orientation training on PM length, scapular kinematics, pain, and function in subjects with shoulder pain. In the first part of the study, 67 healthy subjects will be recruited. In the second part, 62 patients with shoulder pain will be recruited and randomized into either a PM treatment group or a control group. While no treatment will be provided for the healthy subjects in the first part, subjects with shoulder pain in the second part will receive 12 sessions of treatment in 4-6weeks, with 30-40 minutes per session. Patients in the control group will receive general shoulder strengthening exercise, while patients in the PM treatment group will have additional manual therapy and scapular orientation exercise. The measures include tests of PM length, scapular kinematics in the first and second parts, and pain and shoulder disability were also additionally assessed in the second part.

Conditions

Shoulder Pain; Shoulder Impingement; Scapular Dyskinesis

Keywords

pectoralis minor length; pectoralis minor index; scapular kinematic

Outcome Measures

Primary Outcomes (7)

• Pectoralis minor length

  Measurement of pectoralis minor length: distance between coracoid process and fourth rib taken with a tape measure on resting position.

  Change from baseline pectoralis minor length after 12 times intervention up to 6 weeks

• Pectoralis minor index

  The pectoralis minor length was divided by the participant's height and multiplied by 100 to calculate the pectoralis minor index

  Change from baseline pectoralis minor index after 12 times intervention up to 6 weeks

• Pectoralis minor tightness test I

  Pressed the coracoid process of the subjects to make the scapula flat on the treatment bed.If flat the bed for negative,unable to flat the bed for positive.

  Change from baseline pectoralis minor tightness test I after 12 times intervention up to 6 weeks

• Pectoralis minor tightness test II

  Subjects will forward flexion 30 degrees,and pressed the coracoid process.If physical therapist felt tightness for positive.

  Change from baseline pectoralis minor tightness test II after 12 times intervention up to 6 weeks

• Round shoulder posture test I

  Measured the distance between the posterior border of the acromion and the table surface.

  Change from baseline round shoulder posture test I after 12 times intervention up to 6 weeks

• Round shoulder posture test II

  Measured the vertical distance between the posterior acromion and the treatment bed,then divided by thorax thickness and multiplied by 100.

  Change from baseline round shoulder posture test II after 12 times intervention up to 6 weeks

• Scapular kinematics

  Scapular kinematics, including anterior/posterior tilt, upward/downward rotation, and internal/external rotation in scapula plan elevation at 30°, 60°, 90°, and 120°, will be calculated and will be described with degree (°).

  Change from baseline scapular kinematics after 12 times intervention up to 6 weeks

Secondary Outcomes (4)

• Visual analog scale

  Change from baseline visual analog scale after 12 times intervention up to 6 weeks

• Disabilities of the Arm, Shoulder, and Hand (DASH)

  Change from baseline DASH after 12 times intervention up to 6 weeks

• Patient-Specific Functional Scale (PSFS)

  Change from baseline PSFS after 12 times intervention up to 6 weeks

• Global rating of change (GRC)

  After 12 times intervention up to 6 weeks

Study Arms (3)

pectoralis minor intervention group

EXPERIMENTAL

The participants in pectoralis minor group will received manual therapy for pectoralis minor by investigators, the technique including stretch and soft tissue mobilization. The participants asked to perform the scapular control exercise and shoulder strength exercise. Participants will be correct scapular resting position and then do elevation in scapular plane.Four exercises for shoulder strength will do shoulder flexion, abduction, internal and external rotation with thera-band.

Procedure: pectoralis minor intervention group

shoulder strengthening group

ACTIVE COMPARATOR

The participants in the scapular strengthening group will be asked to do four exercises for shoulder strength, including shoulder flexion, abduction, internal and external rotation with thera-band.

Procedure: shoulder strengthening group

Healthy subject group

NO INTERVENTION

Healthy participants will be recruited. No Intervention will be provided. The correlation between measures of pectoralis minor length and scapular kinematics will be assessed. Measurement will be the same as pectoralis minor intervention group and shoulder strengthening group

Interventions

pectoralis minor intervention group PROCEDURE

The subjects in pectoralis minor group will received manual therapy for pectoralis minor by physical therapist, the technique including stretch and soft tissue mobilization. The subjects asked to perform the scapular control exercise and shoulder strength exercise.Subjects will be correct scapular resting position and then do elevation in scapular plane.Four exercises for shoulder strength will do shoulder flexion, abduction, internal and external rotation with thera-band.

pectoralis minor intervention group

shoulder strengthening group PROCEDURE

The subjects in the scapular strengthening group will be asked to do four exercises for shoulder strength, including shoulder flexion, abduction, internal and external rotation with thera-band.

shoulder strengthening group

Eligibility Criteria

• Age: 20 Years - 60 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• the patients with shoulder pain from 20 - 60 years old
• Active arm elevation close to 150 degrees
• Shoulder pain at least 3 months
• the people from 20 - 40 years old
• no any symptoms or injuries on shoulder one year ago

You may not qualify if:

• Adhesive capsulitis
• Pathologies of cervical origin
• History of acute trauma, previous surgery, or fracture in the affected shoulder
• Corticoid injection in the last 3 months
• Platelet Rich Plasma injection in the last 1 year
• Other manual and exercise physical therapy in the last 6 weeks
• Anyone suffering from neurological diseases and nerve damage
• Vulnerable subjects

Sponsors & Collaborators

• National Yang Ming Chiao Tung University: lead
• Cheng-Hsin General Hospital: collaborator

Study Sites (2)

National Yang-Ming University

Taipei, 112, Taiwan

Location

Cheng Hsin General Hospital

Taipei, Taiwan

Location

MeSH Terms

Conditions

Shoulder Pain; Shoulder Impingement Syndrome

Condition Hierarchy (Ancestors)

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

Study Officials

• Yin-Liang Lin, PhD

  National Yang Ming Chiao Tung 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

Study Record Dates

• First Submitted: September 28, 2021
• First Posted: November 2, 2021
• Study Start: November 17, 2021
• Primary Completion: August 12, 2022
• Study Completion: March 22, 2023
• Last Updated: March 23, 2023

Record last verified: 2023-03

Data Sharing

• IPD Sharing: Will not share

Locations

TW (2)