Clinical Prediction Rule for Patients With Shoulder Impingement

To investigate if pain severity, scapular upward rotation angle and upper trapezius/serratus anterior isometric strength ratio can predict patient's response to scapular training in patients with subacromial impingement syndrome.

Shoulder impingement syndrome (SIS) is the most commonly diagnosed shoulder disorder. In literature shoulder impingement is reported between 48% and 65% of all painful shoulder conditions.

The coordinated coupled motion between the scapula and humerus, the so-called scapulohumeral rhythm (SHR), is needed for efficient arm movement. Reduced scapular mobility reduces the acromio-humeral distance during arm abduction and therefore increases the risk for shoulder impingement syndrome.

Clinical prediction rules (CPRs) are tools designed to improve decision making in clinical practice by assisting practitioners in making a particular diagnosis, establishing a prognosis, or matching patients to optimal interventions based on a parsimonious subset of predictor variables from the history and physical examination.

HYPOTHESES:

Pain severity will not be predictor for treatment success in patients suffering from subacromial impingement syndrome treated with scapular training.

Scapular upward rotation angle will not be predictor for treatment success in patients suffering from subacromial impingement syndrome treated with scapular training.

Ratio of upper trapezius /serratus anterior isometric strength will not be predictor for treatment success in patients suffering from subacromial impingement syndrome treated with scapular training.

RESEARCH QUESTION:

Does pain severity, scapular upward rotation angle and upper trapezius/serratus anterior isometric strength ratio predict patient's esponse to scapular training in patients with subacromial impingement syndrome?

Eligibility Criteria:
Inclusion Criteria:

* 1. Age 18-45 years old patients diagnosed as subacromial impingement syndrome.
* 2. Patients will be included in this study if they have at least 3 of the following 6 criteria:
* 2a. Positive "Neer sign": The examiner passively flexes the humerus with medial rotation to end-range with over pressure. The patient's facial expression and the reproduction of the pain confirm the presence of impingement.
* 2b. Positive "Hawkins sign": The shoulder is passively placed in approximately 90 degrees of flexion and is passively internally rotated to end-range with overpressure, reproducing the patient's pain.
* 2c. Pain with active shoulder elevation in the scapular plane.
* 2e. Pain with resisted isometric abduction.
* 2f. A history of pain in the superior part of lateral arm.
* 3. Demonstration of a painful arc of the arm from 60 to 120 of flexion

Exclusion Criteria:

* 1. Diagnosis of internal shoulder impingement.
* 2. A history of traumatic onset of shoulder pain.
* 3. Recent trauma of shoulder.
* 4. Torn tendons.
* 5. Ligamentous laxity based on a positive Sulcus and apprehension tests.
* 6. Numbness or tingling in the upper extremity
* 7. Cervical discogenic problems.
* 8. Previous shoulder or cervical spine surgery.
* 9. Systemic illness.
* 10. Corticosteroid injection on the shoulder within 1 year of the study.
* 11. Evidence of central nervous system involvement, or the inability to comply with treatment.