The Effects of Manual Therapy and Scapular Exercise for the Pectoralis Minor in Individuals With Shoulder Pain
Condition: Shoulder Pain; Shoulder Impingement; Scapular Dyskinesis
MeSH terms: Shoulder Pain; Shoulder Impingement Syndrome
Study type: Interventional

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.
    


Intervention name(s): pectoralis minor intervention group; shoulder strengthening group
Intervention type(s): Procedure; Procedure
Intervention description(s): 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.; 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: pectoralis minor length; pectoralis minor index; scapular kinematic