Effect of therapeutic kinesio-taping in patients with shoulder impingement syndrome: A pilot study

Kinesio-taping is widely used in sports rehabilitation for prevention and treatment of sports-related injuries. The role of Kinesio-taping has recently received renewed interest in patients with shoulder problems like shoulder impingement or rotator cuff tendinopathy.This pilot study was undertaken to check the effect of therapeutic kinesio-taping versus placebo kinesio-taping on shoulder pain, acromio-humeral distance (AHD), mobility and disability in patients with shoulder impingement syndrome.8 patients diagnosed with shoulder impingement syndrome were included in the study and they were allocated into the experimental and control group. The patients in experimental group received ultrasound therapy for 8 minutes followed by application of therapeutic kinesio-taping and in control group patients received ultrasound therapy for 8 minutes followed by application of placebo kinesio-taping. Outcome measure were pain intensity by NPRS, shoulder range of motion by goniometry, acromio-humeral distance (AHD) using ultrasonography and functional disability by SPADI assessed at baseline, immediate after taping application and 3 days post intervention. Data analyzed with Kruskal-Wallis H test and p value less than 0.05 consider as significant.Therapeutic kinesio-taping group showed significant change in AHD (p=0.04), pain.(p=0.0001), shoulder range of motion including abduction (p=0.04), internal rotation (p=0.001) and functional disability (0.04), whereas placebo kinesio-taping showed no significant improvement in outcomes. Therapeutic kinesio-taping found to be effective in increasing AHD, range of motion, decreasing pain and functional disability when compare with placebo kinesio-taping. It can be used as adjunct treatment option in patient with shoulder impingement.

Acromiohumeral distance and supraspinatus tendon thickness in people with shoulder impingement syndrome compared to asymptomatic age and gender-matched participants: a case control study

Background Shoulder impingement syndrome (SIS) is the most common form of shoulder pain. Conservative and surgical treatments for SIS are often not effective. One such surgical intervention is subacromial decompression, aimed at widening the subacromial space (SAS). A better understanding of the changes in the SAS may help explain the relative ineffectiveness of current interventions. Objective: To measure the acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT) in people with SIS using a case control study. Methods The AHD and STT of 39 participants with SIS ≥3 months and 39 age, gender and dominant arm matched controls were measured using ultrasound imaging. Between-group differences for AHD and STT were compared using t-tests. A linear regression was used to determine if there was a relationship between AHD and STT measures, with group as a covariate. Results Compared to controls (mean age 55.7 years, SD 10.6), individuals with SIS (mean age 57.1 years, SD 11.1) had a significantly larger AHD (mean difference 2.14 mm, 95% CI 1.21, 3.07, p < 0.001) and STT (mean difference 1.25 mm, 95% CI 0.60, 1.90, p < 0.001). The linear regression model indicated an association between AHD and STT (β = 0.59, 95% CI 0.29, 0.89, p < 0.01, R2 = 0.35, n = 78), suggesting that as STT increases in size, so does the AHD. Conclusion Individuals with SIS had a larger AHD and greater STT than controls. These results suggest the SAS is already wider in people with SIS and that the symptoms associated with SIS may be more related to an increased STT than a smaller SAS.

Thermotherapy for shoulder pain: a protocol for systematic review

Review question / Objective: Shoulder pain is a common musculoskeletal disorder prompting many patients to seek treatment. Thermotherapy is a common treatment for shoulder which has been widely used in hospitals. But its efficiency has not been scientifically and methodically evaluated. This protocol aims to evaluate the efficacy and safety of Thermotherapy for treating shoulder pain. Information sources: Eight databases will be searched from their inception to October 2021. They are as follows: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, China Knowledge Resource Integrated Database (CNKI), Weipu Database for Chinese Technical Periodicals (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang Database. There will be no limitation to study publication status or language. The search terms include shoulder impingement syndrome, rotator cuff, bursitis, adhesive capsulitis, frozen shoulder, shoulder pain, thermotherapy, diathermy, heat therapy, Moxibustion, and RCTs. The equivalent search words will be used in the Chinese databases.

International impact of large multi-centre surgical trials of arthroscopic subacromial decompression

Objectives To examine temporal trends in incidence of arthroscopic subacromial decompression (ASAD) surgery internationally during conduct and after publication of placebo controlled trials finding no evidence of meaningful benefit of ASAD for shoulder impingement. Design Observational study of incidence rates. Setting Large routinely collected datasets were used: outpatient data from Belgium and UK, and insurance claims and outpatient data from US. UK data were from Clinical Practice Research Datalink and Belgium and US data were from IQVIA. US and UK data spanned 2005 - 2019 and Belgium data 2011 - 2019. Participants Patients were eligible for inclusion in the study if they had at least one visit recorded in the database in a given year and cases were defined as patients undergoing ASAD for the first time in their records in a given year. Outcome measures We calculated incidence of ASAD over time, overall and stratified by age and sex. Characteristics of patients undergoing ASAD were also assessed over time. Results UK incidence has fallen since a peak of 4.7 per 10,000 person years in 2011 (when the CSAW trial began) to 1.8 in 2019. US incidence shows no clear pattern and remains consistently higher than the UK, at 11.5 per 100,000 person years in 2019. Changes in incidence patterns were similar across different age groups and sexes. The number of cases in Belgium was too small for meaningful conclusions. Conclusions We found ASAD rates have fallen in the UK during conduct and after publication of two large surgical RCTs from the UK and Finland that questioned the effectiveness of ASAD for shoulder impingement. A similar impact on clinical practice has not been seen in US. Further work to understand the barriers or concerns preventing international uptake of high quality evidence into clinical practice is needed.

Outcome of Dynamic Compression Plate versus Interlock Intramedullary Nail for Management of Humeral Shaft Fractures

Objective: To compare outcomes of interlock intramedullary nails with Dynamic compression plates for the treatment of humerus shaft fractures in terms of hospital stay time and shoulder Impingement. Subjects and Methods: In this comparative study, a total number of 74 patients having age 20-60 years who presented with closed and open Gustilo type I or II in middle third of humerus were included. Study was conducted in Islam hospital Sialkot and and Rajib Tayyip Erdogan Hospital, Muzaffargarh from June-2019 to June-2020. Group A (n=37) patients underwent dynamic compression plating (DCP) for treatment of fractures and group B (n=37) underwent interlocking intramedullary nailing (ILN) for humerus shaft fractures. We noted post-operative hospital stay, shoulder impingement and bone union rate in all patients. Results: The mean of patients included in this study was 42.45 (SD 9.89) years. There were 57 (77.03%) males and 17 (22.97%) females. The mean duration of fracture at the time of surgery was 39.98±7.23 days. Mean hospital stay was 4.72±1.23 days in in group A and 4.89±1.40 days in group B (p-value 0.60). There were 4 (10.8%) patients in group B in whom shoulder impingement occurred but there was no patient in group A with shoulder impingement (p-value 0.04). Complete union occurred in 35 (94.6%) patients in DCP group and in 34 (91.8%) patients in ILN group (p-value 0.64). Conclusion: Both DCP and ILN are associated with high bone union rates. The complications rate of ILN is higher in comparison to DCP group. Keywords: Humerus shaft fractures, dynamic compression plates, interlocking intramedullary nailing.

Return to work after subacromial decompression, diagnostic arthroscopy, or exercise therapy for shoulder impingement: a randomised, placebo-surgery controlled FIMPACT clinical trial with five-year follow-up

Background Arthroscopic subacromial decompression is one of the most commonly performed shoulder surgeries in the world. It is performed to treat patients with suspected shoulder impingement syndrome, i.e., subacromial pain syndrome. Only few studies have specifically assessed return-to-work rates after subacromial decompression surgery. All existing evidence comes from open, unblinded study designs and this lack of blinding introduces the potential for bias. We assessed return to work and its predictors in patients with shoulder impingement syndrome in a secondary analysis of a placebo-surgery controlled trial. Methods One hundred eighty-four patients in a randomised trial had undergone arthroscopic subacromial decompression (n = 57), diagnostic arthroscopy, a placebo surgical intervention, (n = 59), or exercise therapy (n = 68). We assessed return to work, defined as having returned to work for at least two follow-up visits by the primary 24-month time point, work status at 24 and 60 months, and trajectories of return to work per follow-up time point. Patients and outcome assessors were blinded to the assignment regarding the arthroscopic subacromial decompression vs. diagnostic arthroscopy comparison. We assessed the treatment effect on the full analysis set as the difference between the groups in return-to-work rates and work status at 24 months and at 60 months using Chi-square test and the predictors of return to work with logistic regression analysis. Results There was no difference in the trajectories of return to work between the study groups. By 24 months, 50 of 57 patients (88%) had returned to work in the arthroscopic subacromial decompression group, while the respective figures were 52 of 59 (88%) in the diagnostic arthroscopy group and 61 of 68 (90%) in the exercise therapy group. No clinically relevant predictors of return to work were found. The proportion of patients at work was 80% (147/184) at 24 months and 73% (124/184) at 60 months, with no difference between the treatment groups (p-values 0.842 and 0.943, respectively). Conclusions Arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy or exercise therapy on return to work in patients with shoulder impingement syndrome. We did not find clinically relevant predictors of return to work either. Trial registration ClinicalTrials.gov identifier NCT00428870.

Low level Laser Therapy versus Ultrasonic therapy for the Treatment of Shoulder Impingement Syndrome A Systematic Review of randomized controlled trials

Background Shoulder impingement syndrome is a common cause of shoulder pain in primary health care settings. Many physical modalities of treatment are available in clinical practice, however there is insufficient evidence on their relative effectiveness. This review compares the effectiveness of Low Level Laser Therapy (LLLT) with ultrasonic therapy. Objectives To assess the effectiveness of LLLT vs. ultrasonic therapy in patients with subacromial impingement syndrome Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE (Pubmed), Embase, Scopus. We searched trials registries on ClinicalTrials.gov (www.ClinicalTrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) Search Portal (apps.who.int/trialsearch/). We also hand-searched reference lists of all included primary studies, relevant conference proceedings and academic literature, and relevant systematic reviews (both Cochrane and non Cochrane), to identify additional studies missed from the original electronic searches (e.g., unpublished or in press citations). We did not use date or language restrictions. Selection criteria Randomized controlled trials comparing LLLT vs. US therapy in adult patients with subacromial impingement syndrome. Data collection Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected our primary outcomes information from the trials and assessed the quality of evidence for key outcomes using GRADE. Results We included 2 RCTs, contributing 67 participants to our qualitative synthesis. The overall risk of bias is high for both studies. Very low-quality evidence from 1 RCT shows slightly increased mean change in pain severity after LLLT compared to ultrasonic therapy in the short term (3 months) (MD 4.69, 95% CI -5.76 to -3.62).[13]. Very low-quality evidence from 1 RCT shows little to no difference in functional improvement after LLLT compared to ultrasonic therapy in the short term (after 3 months) (MD -0.63, 95% CI -5.53 to 4.27) [13]. No studies investigated Range of Motion in the short term. Verylow certainty evidence showed little to no difference in pain severity and function in the immediate post-treatment phase (up to 1 month). No studies addressed long term follow-up. conclusion There is insufficient evidence regarding the difference in effects between LLLT and Ultrasonic therapy for the treatment of shoulder impingement syndrome.