Progressive Resistance Training of the Biceps in Subacromial Impingement Syndrome
Condition: Shoulder Impingement Syndrome
MeSH terms: Shoulder Impingement Syndrome; Syndrome; Rotator Cuff Injuries
Study type: Interventional

Summary: 
      The aim of this study was to evaluate the influence of progressive resistance training of the
      biceps in shoulder rehabilitation in patients with subacromial impingement syndrome (SIS).

      Method: a randomized controlled clinical trial, with analysis intention-to-treat, approved by
      the Ethics and Research (1019/08), containing sixty patients of both sexes, SIS, evaluated at
      the initial time (T0), with 45 days (T45) and 90 days of treatment (T90). We analyzed the
      pain at rest (VAS), range of shoulder movement, strength, function by The Disabilities of
      Arm, Shoulder and Hand (DASH) and quality of life by Short Form-36 (SF-36) and Western
      Ontario Rotator Cuff Index (WORC). They recommended the use of NSAIDs and analgesics in the
      presence of pain exacerbated, every eight hours. Study groups will perform therapeutic
      exercises for the shoulder and scapula stabilizers. In the experimental group associate
      progressive resistance training of the biceps.
    

Detailed description: 
      Sixty patients in the Physical Therapy Clinic at the University of Health Sciences of
      Alagoas, of both sexes with a clinical diagnosis of SIS, according to the criteria of Neer.
      Included will be those with a diagnosis of injury to one or more rotator cuff tendons, with
      pain for three months or more, ranging from 3 to 8, based on visual analogic scale(VAS)
      ranging from 0 to 10. Hawkins' test and Neer positive and aged between 18 and 65. The
      presence of total rupture of the long head of biceps, and associated rheumatic shoulder
      surgery represented exclusion criteria. After approval by the IRB (1019/08) were prepared
      sealed envelopes, to maintain the secrecy of allocation, and the patients were divided into
      control and experimental group and evaluated by a blind assessor, at the initial time (T0),
      after 45 days of treatment (T45) and 90 days of treatment (T90). The shoulder will be
      assessed in the degree of active motion for flexion, extension, medial and lateral rotation
      and abduction, with the patient in standing position using manual goniometer. To determine
      the movement of flexion and extension, the upper limb was positioned in the sagittal plane,
      goniometer along the mid-axillary line of the trunk and the axle in the humeral head. The
      movable arm of the goniometer was placed over the body surface of the humerus toward the
      lateral epicondyle. Abduction to the fixed arm of the goniometer was positioned over the
      posterior axillary line of the trunk, aligned with the blade and the moving arm was placed on
      the posterior surface of the arm along the longitudinal axis of the humerus. The medial and
      lateral rotation was accomplished by positioning the shoulder in abduction of 90 degrees, the
      axle of the goniometer positioned on the olecranon and the movable arm along the axis of the
      forearm.

      The strength of manual pressure was assessed using the hydraulic dynamometer, manufactured in
      Korea. The instrument is graduated in two scales - kilogram force (Maximum 90 pounds),
      form-fitting and catcher with five adjustment positions to accommodate any size hand during
      the evaluation. During the strength assessment, the upper limb was positioned at rest beside
      the body with elbow flexed 90 degrees, forearm and wrist in neutral position.

      Pain assessment will be conducted at rest, using VAS ranging from 0 (no pain) to 10 cm
      (intolerable pain). The Disabilities of The Arm, Shoulder and Hand (DASH) questionnaire was
      used for the evaluation of impairment and physical symptoms of upper limbs. It consists of 30
      mandatory items related to function and symptoms (DASH 1) and two optional areas, divided
      into four issues for work activities (DASH 2) and 4 questions for activities of daily living
      (DASH 3). The Western Ontario Rotator Cuff Index (WORC) and Short- form health survey (SF-36)
      were the tools used to evaluate the quality of life. The WORC is specific to patients
      suffering from rotator cuff injury with five domains: physical symptoms (SF), sports and
      recreation (ER), work (T), state of vitality (EV) and emotion (E). The WORC scores can be set
      by calculation or by the general analysis of independent domains.

      The treatment plan will be held for 3 months, twice a week throughout the sample, through the
      practice of therapeutic exercises for the shoulder and scapula stabilizers using bat without
      charge, training and isometric exercises commuting to the cuff muscles, without subacromial
      generate impaction. In the experimental group, we associate the progressive resistance
      training of the biceps. The progression of resistance training biceps, based on calculations
      of maximum resistance (MR), being conducted in three sets of 10 repetitions with 50% of MRI
      in the first series of training and 75% of MRI in the second series, 2 minutes, between each.
      In the presence of pain greater than or equal to seven, based on the VAS, patients were
      instructed in the use of paracetamol 750mg every six hours and diclofenac sodium 50mg every
      eight hours.
    

Intervention name(s): therapeutic exercises; biceps resistance training and therapeutic exercises
Intervention type(s): Other; Other
Intervention description(s): therapeutic exercises for the shoulder and scapula stabilizers using bat without charge, training and isometric exercises commuting to the cuff muscles, without producing subacromial impaction.; The biceps resistance training based on calculations of maximum resistance (MR), being conduct in three series 10 reps with 50% of MR in the first series of training and 75% of MR in the second series, with 2 minutes between each and therapeutic exercises for the shoulder and scapula stabilizers.
Other intervention name(s): progressive resistance training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: biceps; resistance training; rehabilitation; impact syndrome