Effectiveness of Supervised Exercise Program in 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 a pathology resulting from mechanical repetitive
      compression and inflammation of the supraspinatus tendon, subacromial bursa and biceps tendon
      under the acromion and the coracoacromial ligament. It is the most common cause of shoulder
      pain, with an incidence of 44-65%. Restriction of the range of motion, along with the pain in
      the anterior region of the shoulder, is the main reason for disability and decreased quality
      of life in patients with SIS. Physical exercises to improve the range of motion,
      strengthening, and flexibility is the main part of treatment. The subacromial-subdeltoid
      bursa corticosteroid injection is shown to decrease pain during the exercise program and
      increase participation in the treatment. This study aims to compare the effectiveness of a
      supervised exercise program and home-based exercise program after subacromial-subdeltoid
      bursa corticosteroid injection in patients with SIS.
    

Detailed description: 
      Subacromial Impingement Syndrome (SIS) is a pathology resulting from mechanical repetitive
      compression and inflammation of the supraspinatus tendon, subacromial bursa and biceps tendon
      under the acromion and the coracoacromial ligament. It was first described in 1972 by Neer.
      Neer described SIS as a progressive syndrome with three stages, beginning with chronic
      bursitis and proceeding to partial and complete tears of the supraspinatus tendon, which may
      extend to rupture of other parts of the rotator cuff and may also involve the long biceps
      tendon. SIS is one of the most common causes of shoulder pain and disability reasons in both
      primary and secondary care. It is characterized by functional impairment of shoulder resulted
      from the progressive limitation of both active and passive glenohumeral movements.
      Restriction of the range of motion (ROM) along with the pain in the anterior region of the
      shoulder that gets worse with arm elevation or overhead activities is the main reason for
      decreased quality of life in patients with SIS. Therapeutic exercise programs are commonly
      used treatment methods in relieving pain and improving ROM and muscle elasticity. It was
      shown that such programs are more effective in reducing pain and improving functional loss
      than placebo in both short- and long-term. However, the optimal exercise regimen with the
      variety, frequency, and intensity exercises is still unclear. It is also controversial if a
      supervised exercise program is superior to a prescribed home-based exercise program. An
      efficient exercise program should target all structures affected by subacromial impingement.
      Therefore, both supervised and home-based exercise programs must involve rotator cuff and
      scapular stabilizing muscle strengthening, stretching and active-assistive range of motion
      exercises and proprioceptive neuromuscular facilitation exercises. Corticosteroid injection
      into the subacromial-subdeltoid bursa is shown to increase participation, decrease pain
      during the exercise program, and found to be effective for symptomatic impingement. The
      analgesic effect provides significant improvement of functions mainly in the short-term.
      Therefore, some physicians prefer corticosteroid injections alone in the treatment of SIS.
      However, it was found that the combination of corticosteroid injection and exercise program
      is significantly superior to corticosteroid injections alone. Ultrasound-guided
      subacromial-subdeltoid bursa injections are shown to have better outcome results than blind
      injections for both pain and overall shoulder function. This study aims to compare the
      effectiveness of supervised exercise and home-based exercise programs after ultrasound-guided
      subacromial-subdeltoid bursa corticosteroid injection in patients with SIS.

      Patients diagnosed with SIS will be included and randomized into two groups. Both groups will
      receive subacromial-subdeltoid bursa 1 ml (7 mg/ml) betamethasone and 4 ml of 0.5%
      bupivacaine injection. The injection will be performed ultrasound-guided while the patient is
      in a sitting position with the lateral approach. The first group will perform their exercises
      under the supervision of the physiotherapist in the hospital. The second group will be taken
      to the home-based exercise program in a brochure format. Thus, both groups will receive the
      same exercises every day.

      The pain will be assessed with the Visual Analogue Scale (VAS), active and passive ROM will
      be measured with a goniometer before injection, immediately, first hour, third week, and
      third month after the injection. The quality of life will be evaluated by Short Form 36, and
      disability will be questioned by Shoulder Pain and Disability Index before injection and
      third week and third month after injection.
    

Intervention name(s): Subacromial-subdeltoid bursa corticosteroid injection
Intervention type(s): Drug
Intervention description(s): 1 ml (7 mg / ml) betamethasone and 4 ml of 0.5% bupivacaine will be given subacromial bursa-subdeltoid space. Injection will be performed ultrasound-guided while the patient is in sitting position with the lateral approach.
Other intervention name(s): Subacromial-subdeltoid bursa injection
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Intervention model description: This randomized controlled study is designed to have two groups with a single arm.
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Subacromial Impingement Syndrome; Subacromial-subdeltoid bursa corticosteroid injection; Exercise Therapy