Comprehensive supervised heavy training program versus home training regimen in patients with subacromial impingement syndrome: a randomized trial

Background There is no consensus on the best training regimen for subacromial impingement syndrome (SIS). Several have been suggested, but never tested. The purpose of the study is to compare a comprehensive supervised training regimen (STR) based on latest evidence including heavy slow resistance training with a validated home-based regimen (HTR). We hypothesized that the STR would be superior to the HTR. Methods Randomised control trial with blinded assessor. 126 consecutive patients with SIS were recruited and equally randomised to 12 weeks of either supervised training regimen (STR), or home-based training regimen (HTR). Primary outcomes were Constant Score (CS) and Shoulder Rating Questionnaire (SRQ) from baseline and 6 months after completed training. Results were analyzed according to intention-to treat principles. The study was retrospectively registered in ClinicalTrials.gov. Date of registration: 07/06/2021. Identification number: NCT04915430. Results CS improved by 22.7 points for the STR group and by 23,7 points for the HTR (p = 0.0001). The SRQ improved by 17.7 and 18.1 points for the STR and the HTR groups respectively (p = 0.0001). The inter-group changes were non-significant. All secondary outcomes (passive and active range of motion, pain on impingement test, and resisted muscle tests) improved in both groups, without significant inter-group difference. Conclusion We found no significant difference between a comprehensive supervised training regimen including heavy training principles, and a home-based training program in patients with SIS.

Scapula Dyskinesis

Scapular dyskinesis is any alteration of its static position or kinematics during movements in the shoulder joint. The correct scapula orientation is associated with the tone of the muscles attached to it. The prevalence of scapular dyskinesis is high among patients with subacromial impingement syndrome, partial rotator cuff tears, shoulder joint instability and SLAP injuries. Scapular dyskinesis can be caused by a whole range of factors, including upper cross syndrome and postural adaptations predisposing to it, neurological disorders. However, instrumental diagnosis of scapular dyskinesis is difficult, which makes the use of clinical tests the main method of its detection. In this lecture, the etiology of scapular dyskinesis, classification, diagnostic tests and treatment methods are analyzed in detail. The detection of scapular dyskinesis and its type determination in patients with shoulder joint pathologies allows us to form an optimal rehabilitation therapy protocol, including techniques of myofascial release, passive and active stretching of spasmodic and training of weak muscle groups aimed at correcting postural disorders, pathology of the scapulohumeral rhythm, restoration of the glenohumeral joint normal biomechanics.

How do people perceive different labels for rotator cuff disease? A content analysis of data collected in a randomised controlled experiment

ObjectivesExplore how people perceive different labels for rotator cuff disease in terms of words or feelings evoked by the label and treatments they feel are needed.SettingWe performed a content analysis of qualitative data collected in a six-arm, online randomised controlled experiment.Participants1308 people with and without shoulder pain read a vignette describing a patient with rotator cuff disease and were randomised to one of six labels: subacromial impingement syndrome, rotator cuff tear, bursitis, rotator-cuff-related shoulder pain, shoulder sprain and episode of shoulder pain.Primary and secondary outcomesParticipants answered two questions (free-text response) about: (1) words or feelings evoked by the label; (2) what treatments they feel are needed. Two researchers iteratively developed coding frameworks to analyse responses.Results1308/1626 (80%) complete responses for each question were analysed. Psychological distress (21%), uncertainty (22%), serious condition (15%) and poor prognosis (9%) were most often expressed by those labelled with subacromial impingement syndrome. For those labelled with a rotator cuff tear, psychological distress (13%), serious condition (9%) and poor prognosis (8%) were relatively common, while minor issue was expressed least often compared with the other labels (5%). Treatment/investigation and surgery were common among those labelled with a rotator cuff tear (11% and 19%, respectively) and subacromial impingement syndrome (9% and 10%) compared with bursitis (7% and 5%).ConclusionsWords or feelings evoked by certain labels for rotator cuff disease and perceived treatment needs may explain why some labels drive management preferences towards surgery and imaging more than others.

A rare cause of insidious shoulder pain in a young female: A soft tissue aneurysmal bone cyst in supraspinatus muscle

Aneurysmal bone cyst (ABC) is an expansile cystic lesion which may affect any bone of the skeleton. Although extremely rare, lesions with histomorphological characteristics of an ABC occur in the soft tissue. Herein, we report the first case of ABC involving the supraspinatus muscle and mimicking common pathologies, such as myofascial pain syndrome or subacromial impingement syndrome.

Comparison of the Effectiveness of Isometric, Isotonic Eccentric And Isotonic Concentric Exercises in Pain Management

Aim: To compare the effect of isometrics, isotonic concentric and isotonic eccentric strengthening techniques on patients diagnosed with subacromial impingement syndrome. Methods: The study design used is randomized clinical trial. 36 patients are allocated in 3 groups with 12 patients in each group with age limit from 30-50 years treated for 6 weeks on alternate days with isometrics, isotonic concentric and isotonic eccentric with baseline exercise plan respectively. Each patient received 18 sessions of exercise plan. Intervention plan is divided into 2 phases, with each phase of 3 weeks. Outcome measuring tools used are Numeric Pain Rating Scale(NPRS) to measure pain, Manual Muscle Testing (MMT) to measure muscle strength was assessed at Day 0, Week3, and Week 6. Result: Results are generated by using SPSS 21. Post treatment ONE WAY ANOVA showed no significant difference in reduction of pain assessed by NPRS in GROUP1 treated with isometric exercise plan and GROUP2 & GROUP3 treated with isotonic eccentric and isotonic concentric exercise plan respectively. Post treatment One way anova showed p value .117 which is greater than 0.05. Post treatment ONE WAY ANOVA showed significant difference for strength of all the rotator cuff muscles. Conclusion: Isometric exercise plan conclusively proved to be better as compared to isotonic eccentric and isotonic concentric program in strengthening of patients with subacromial impingement syndrome. Keywords: Subacromial Impingement Syndrome, Isometric, Isotonic Eccentric, Isotonic Concentric.

Impingement on the internet: evaluating the quality and readability of online subacromial impingement information

Patients increasingly access the internet to learn about their orthopaedic conditions. Despite this, online information may be unregulated, of questionable quality and difficulty to read.ObjectivesTherefore, this study aimed to evaluate the readability and quality of the online information concerning subacromial impingement syndrome.MethodsA search using Australia’s three most popular online search engines was undertaken using the search terms ‘subacromial impingement syndrome’ and ‘shoulder impingement’. The first 15 websites for each term were evaluated. Duplicates, advertisements and sponsored links were removed.The quality and readability of each website were calculated using the DISCERN and Flesch-Kincaid Reading Ease (FKRE) tools, respectively. The differences in quality and readability between each website type (healthcare/academic, commercial, news outlet, charitable/not-for-profit, layperson, government) was assessed using analysis of variance. The correlation between quality and readability was assessed using the Pearson correlation coefficient.ResultsThe majority of 35 unique websites analysed were of ‘poor’/’fair’ quality (determined via the DISCERN instrument) and ‘difficult’ readability (per the FKRE tool), with no correlation established between the scores. There was no statistically significant difference in quality across website types, however layperson, news outlet and government websites were found to be significantly more readable than alternate website categories (p<0.05).ConclusionsWe determined that much of the online information concerning subacromial impingement syndrome may be difficult to read and/or of poor quality. By recognising the shortcomings of information accessed by patients online, it is hoped clinicians may be prompted to better educate their patients.