Teres Major Muscle and Subacromial Impingement Syndrome

Study Overview
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Brief Summary
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There is not a clear understanding of the origin of symptoms perceived by patients with impingement of the soft tissue structures of the subacromial space. Tendinopathy, tendon rupture or other pathologies, are present in asymptomatic subjects and subjects with symptoms and structural integrity can also be found. Patients diagnosed with subacromial impingement syndrome frequently have myofascial trigger points in the teres major muscle. Travell and Simons reported that the symptoms caused by trigger points in this muscle are similar to those experienced by patients diagnosed with impingement syndrome, but a literature search provides few results regarding relationship between subacromial impingement syndrome and presence of myofascial trigger points in the teres major muscle. This study aims to provide evidence of the results that can be obtained with a specific approach of teres mayor muscle by two manual techniques, Trigger Point Pressure Release and Diacutaneous Fibrolysis, in subjects with subacromial impingement syndrome, a condition that still representing both a diagnostic and therapeutic challenge. Secondary objective is to compare the outcomes between both techniques to select for each patient the most appropriate to their needs and characteristics.

Official Title
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Effectiveness of Teres Major Muscle Specific Treatment in Patients Diagnosed With Subacromial Impingement Syndrome

Conditions
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Trigger Points in Teres Major Muscle, Subacromial Impingement Syndrome

Intervention / Treatment
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* Device: Diacutaneous Fibrolysis
* Other: Trigger Point Pressure Release
* Other: Protocolized physiotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 years and over Clinical diagnosis of Subacromial Impingement Syndrome. Detectable trigger points in teres major muscle. Sign informed consent form. Exclusion Criteria: Diacutaneous Fibrolysis contraindications Previous shoulder surgery (<1year) Language barriers or cognitive issues that limit their ability to provide informed consent and participate in research. Patients with a pending litigation or court claim.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Fibrolysis Group<br>Actual Diacutaneous Fibrolysis and protocolized physiotherapy | Device: Diacutaneous Fibrolysis<br>* Applied only around teres major muscle.<br>Other: Protocolized physiotherapy<br>* Exercises, TENS and cryotherapy<br>|
| Experimental: Pressure Group<br>Trigger Point Pressure Release and protocolized physiotherapy | Other: Trigger Point Pressure Release<br>* Applied only in teres major muscle trigger points.<br>Other: Protocolized physiotherapy<br>* Exercises, TENS and cryotherapy<br>|
| Active Comparator: Control Group<br>Protocolized physiotherapy | Other: Protocolized physiotherapy<br>* Exercises, TENS and cryotherapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Pain intensity (Using a VAS) | Using a VAS | Change from baseline to 3 weeks. | 
| Change in Functional capacity (Abbreviated Constant-Murley score) | Abbreviated Constant-Murley score | Change from baseline to 3 weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Active Range of Motion | Flexion, extension, abduction, external rotation and internal rotation | Change from baseline to 3 weeks. | 
| Patient perception of change (Global Rating of Change scale) | Global Rating of Change scale | 3 weeks after recruitment |