Effectiveness of Neuromuscular Electrical Stimulation in Patients With Subacromial Impingement Syndrome
Condition: Subacromial Impingement Syndrome
MeSH terms: Shoulder Impingement Syndrome; Syndrome; Rotator Cuff Injuries
Study type: Interventional

Summary: 
      Subacromial Impingement Syndrome (SIS) is one of the musculoskeletal system problems. SIS,
      which is the most common cause of shoulder pain, constitutes 44-65% of complaints of shoulder
      pain. Studies have shown that exercise is effective in treating patients with SIS, but the
      effectiveness and superiority of Neuromuscular Electrical Stimulation (NMES) to each other is
      uncertain. NMES is widely applied in physiotherapy. In the SIS, the lower trapezius and
      serratus anterior muscle are affected. Therefore, our aim is to determine the effects of
      exercises and NMES used in patients with SIS on pain, range of motion (ROM), muscle strength
      and functional status, neck pain and sleep quality.
    

Detailed description: 
      The aim of this study investigate exercise training (ET) and ET combined with Neuromuscular
      Electrical Stimulation (NMES) on pain, range of motion (ROM), functional capacity, neck pain,
      sleep quality. The study will be included 48 volunteers with Subacromial Impingement Syndrome
      (SIS). The study's inclusion criteria are as follows: Having a diagnosis of subacute /
      chronic extrinsic SIS, 18 to 65 years of age and being volunteer. The exclusion criteria are
      as follows: Fracture or surgical history in the shoulder region, another diagnosis that can
      affect shoulder function, having received local corticosteroid injection / treatment in the
      shoulder joint within the last 3 months, neuromuscular disease, pregnancy, cancer, unstabil
      angina, communication problems, systemic inflammatory joint disease, situations where
      electrical stimulation and exercise are contraindicated, orthopedic, rheumatologic or
      congenital disease of the affected upper extremity. The sociodemographic data of the patients
      will be questioned. ET will be applied daily and NMES will be applied 2 days a week for 8
      weeks. In addition, both groups will apply these exercises as a home program 3 times a day,
      10 repetitions of each exercise. Pain intensity with Visual Analog Scale (VAS), range of
      motion (ROM) with goniometer, muscle strength with Hand-held Dynamometer, upper extremity
      function evaluation with Quick Disabilities of the Arm, Shoulder and Hand (DASH)
      Questionnaire, disability of neck level with Neck Disability Index, sleep quality with
      Pittsburgh Sleep Quality Index will be evaluated before and after treatment. All parameters
      will be compared between ET and ET+NMES group.
    

Intervention name(s): Neuromuscular Electrical Stimulation (NMES); Exercise Training (ET)
Intervention type(s): Procedure; Procedure
Intervention description(s): In Neuromuscular Electrical Stimulation (NMES) application, 4 surface electrodes will be placed in the swollen part of the lower trapezius and serratus anterior muscles of each patient.
NMES will be applied for 20 minutes in rehabilitation mode with a 4-channel device.
Frequency: 80 Hz Amplitude: 0-100 mA (0-0.01 V) Current time-Pulse: 200 μsec Wave form: Biphasic Cycle time: 8 seconds of tetanic muscle stimulation for all patients, with a 2 second rise and fall time and stimulation It will be set as 3 seconds between. It is important to visually observe the contraction to determine the intensity of stimulation.; Patients will do Wand exercises under the supervision of a physiotherapist. Wand exercises will include shoulder flexion, external rotation and abduction in the scaption position. In the first and second week, these exercises will be performed on the back, and from the third week on standing exercises.
Exercises with the Theraband will be done in 3 sets, each set will consist of 10 repetitions. There will be a 1 minute rest period between sets. When the three sets are easily completed and there is no reported fatigue by the patient, the resistance will be increased by moving from yellow to red, from red to green, respectively, after 4 weeks.
*For shoulder external rotators and serratus anterior muscles are strengthened without weight for the first 2 weeks, then 0.5 kg of dumbbells, in the supine position.
While standing, the lower trapezius, upper trapezius and shoulder external rotators will be strengthened with theraband.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The sample of the study will consist of patients with subacromial impingement syndrome (SIS) who were referred to Istanbul University Cerrahpaşa Physical Therapy and Rehabilitation Department by an orthopedist. Forty eight SIS patients will be included in the study. Patients who meet the inclusion criteria will be divided into two groups.
Group 1: Exercise Training+ Neuromuscular Electrical Stimulation Group 2: Exercise Training
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Shoulder impingement syndrome; Visual Analog Scale; Range of motion; Muscle strength; Sleep