Effect of Extracorporeal Shock Wave Therapy in Impingement Syndrome
Condition: Shoulder Impingement Syndrome; Trigger Point Pain
MeSH terms: Shoulder Impingement Syndrome; Syndrome; Rotator Cuff Injuries
Study type: Interventional

Summary: 
      Purpose: This study aimed to investigate the effectiveness of ESWT applied to trigger points
      on pain, function, and effusion in individuals diagnosed with shoulder impingement syndrome.

      Material and methods: This was a randomized controlled clinical trial with a total of 32
      which were randomly divided into two equal groups (ESWT Group (EG), n = 16; Control Group
      (CG), n=16). The participants in the EG were given Extracorporeal Shock Wave Therapy to the
      trigger point of the patients with a trigger point in one of the supraspinatus, subscapularis
      and infraspinatus muscles for a total of 5 sessions in 3 weeks (2 sessions in the first week,
      2 sessions in the second week, 1 session in the third week) in addition to conventional
      treatment while CG received only conventional treatments for five days per week for 3
      consecutive weeks. The primary outcome was pain intensity Visual analog scale (VAS).
      Secondary measurements were Tendon thickness and effusion with Ultrasound, Range of motion
      (ROM), Manual muscle testing (MMT), Corbin posture analysis, Constant Murley Score (CMS), Arm
      Shoulder and Hand Problems Questionnaire (DASH). Supraspinatus tendon thickness and effusion
      of the cases included in the study were evaluated by ultrasonography before and after the
      treatment(3 weeks) by the same specialist physician who was blind to the groups. Normal joint
      range of motion by universal goniometer, muscle strength by manual muscle test, posture
      evaluation by Corbin posture analysis, pain evaluation by Visual Analogue Scale (VAS),
      functional evaluation by Constant Murley Score (CMS), Arm Shoulder and Hand Problems
      Questionnaire (DASH) by physiotherapist It was evaluated before and after the treatment (3
      weeks).
    

Detailed description: 
      This study aimed to investigate the effectiveness of ESWT applied to trigger points on pain,
      function, and effusion in individuals diagnosed with shoulder impingement syndrome.

      This was a randomized controlled clinical trial with a total of 32 which were randomly
      divided into two equal groups (ESWT Group (EG), n = 16; Control Group (CG), n=16). The
      participants in the EG were given Extracorporeal Shock Wave Therapy to the trigger point of
      the patients with a trigger point in one of the supraspinatus, subscapularis and
      infraspinatus muscles for a total of 5 sessions in 3 weeks (2 sessions in the first week, 2
      sessions in the second week, 1 session in the third week) in addition to conventional
      treatments , while CG received only conventional treatment for five days per week for 3
      consecutive weeks. Conventional treatment consist of Ultrasound treatment (Gymna Pulson200)
      (1 mHz. treatment dose average 1.5 w/cm², intermittent with a small head (50%), 5 minutes )
      around the glenohumeral joint of the cases in both groups participating in the study; at an
      intensity that the patient can tolerate, covering the painful area TENS (modified biphasic
      asymmetric pulse, and it was set to a pulse width of 100 μs and a frequency of 100 Hz, 20
      min,) (Hometech ht 66b) applied; hotpack and exercises (posterior capsule stretching, wand
      exercises, mobilization approximately 60 minutes of conventional treatment consisting of
      exercises and shoulder isometric exercises) was applied once a day, 5 times a week in both
      groups. In addition to conventional physiotherapy. additional to conventional treatment EG
      was applied 1000 pulses to the trigger point of the patients with a trigger point in one of
      the supraspinatus, subscapularis and infraspinatus muscles, 500 pulses to the surrounding
      area, 2 bars, ESWT (GYMNMA Shockmaster 500) was applied for a total of 5 sessions in 3 weeks
      (2 sessions in the first week, 2 sessions in the second week, 1 session in the third week) at
      10 Hz, medium energy level (<0.28 mJ/mm2).Supraspinatus tendon thickness and effusion of the
      cases included in the study were evaluated by ultrasonography before and after the
      treatment(3 weeks) by the same specialist physician who was blind to the groups. Normal joint
      range of motion by universal goniometer, muscle strength by manual muscle test, posture
      evaluation by Corbin posture analysis, pain evaluation by Visual Analogue Scale (VAS),
      functional evaluation by Constant Murley Score (CMS), Arm Shoulder and Hand Problems
      Questionnaire (DASH) by physiotherapist It was evaluated before and after the treatment (3
      weeks).
    

Intervention name(s): ESWT Group; Control Group
Intervention type(s): Other; Other
Intervention description(s): EG were given Extracorporeal Shock Wave Therapy to the trigger point of the patients with a trigger point in one of the supraspinatus, subscapularis and infraspinatus muscles for a total of 5 sessions in 3 weeks (2 sessions in the first week, 2 sessions in the second week, 1 session in the third week) in addition to conventional treatment. 1000 pulses to the trigger point of the patients with a trigger point in one of the supraspinatus, subscapularis and infraspinatus muscles, 500 pulses to the surrounding area, 2 bars, ESWT (GYMNMA Shockmaster 500) was applied for a total of 5 sessions in 3 weeks at 10 Hz, medium energy level (<0.28 mJ/mm2).; Both EG and CG were given conventional treatment.Conventional treatment is consist of Ultrasound therapy (Gymna Pulson200) (1 mHz. treatment dose average 1.5 w/cm², intermittent with a small head (50%), 5 minutes (45)) around the glenohumeral joint of the cases in both groups participating in the study; TENS applied at an intensity that the patient can tolerate, covering the painful area (modified biphasic asymmetric pulse, and it was set to a pulse width of 100 μs and a frequency of 100 Hz, 20 min,) (Hometech ht 66b); hotpack and exercises (posterior capsule stretching, wand exercises, mobilization approximately 60 minutes of conventional treatment consisting of exercises and shoulder isometric exercises) was applied once a day, 5 times a week in both groups.
Other intervention name(s): EG; CG
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The participants in the Experimental Group were given Extra Corporeal Shockwave therapy to the trigger point of the patients with a trigger point in one of the supraspinatus, subscapularis and infraspinatus muscles for a total of 5 sessions in 3 weeks (2 sessions in the first week, 2 sessions in the second week, 1 session in the third week) in addition to conventional treatments , while Control group received only conventional treatments for five days per week for 3 consecutive weeks
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: extracorporeal shock wave therapy; shoulder pain