Shoulder Eccentric External Rotator Training for Subacromial Pain Syndrome

Study Overview
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Brief Summary
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The purpose of this study is to examine the effects of eccentric exercise to the shoulder muscles for people with shoulder pain. Identifying specific exercise protocols for individuals with shoulder pain will provide evidence to help clinicians select the best interventions.

Detailed Description
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Prior investigations for eccentric training of the shoulder have primarily utilized a pain provocation model for exercise progression. This method of progressing resistance training load and volume assumes that pain must be increased during the exercise movement for clinical benefit to occur. When the individual reports a reduction in pain, load is increased so that the provoking pain level returns. The contrast to this approach would be a performance based progression as utilized in the Blume et al study for shoulder eccentric training. This method progresses a patient based on ability to perform a higher number of repetitions at a given load without increasing symptoms which could be favorable in many clinical settings. Further investigation on the role of eccentric training, specifically to the shoulder external rotators, in patients with SAPS is warranted. Thus, the aim of this investigation was to compare outcomes, for individuals diagnosed with SAPS, performing a six week protocol of eccentric training to the shoulder external rotators compared to a general exercise protocol.

Official Title
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Shoulder External Rotator Eccentric Training for Subacromial Impingement Syndrome

Conditions
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Subacromial Impingement Syndrome

Intervention / Treatment
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* Other: Eccentric Shoulder External Rotator Training
* Other: General Shoulder exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Presence of non-acute shoulder pain (greater than 3 months duration) 3 out of the 6 following tests positive, Neer impingement, Hawkins-Kennedy impingement, empty can test, resisted external rotation test, palpable tenderness at the insertion of the supraspinatus or infraspinatus, and painful arc from 60° to 120° during active abduction. Age over 18 years old Sufficient ability to read English as required for completing questionnaires Exclusion Criteria: Red flags noted in the patient's Medical Screening Questionnaire (MSQ) (ie. tumor, fracture, metabolic diseases, rheumatoid arthritis, osteoporosis, prolonged history of steroid use) Full thickness supraspinatus or infraspinatus tendon tear as determined by a positive drop arm test, lag sign or rent test. Shoulder adhesive capsulitis as evidenced by a limitation in passive motion for all shoulder planes of movement. Having an upper extremity amputation. Individuals having a history of surgery to the cervical spine or involved upper extremity for a musculoskeletal, neurological or dermatological condition for which they are at the time of data collection receiving post-operative care. Pending legal action regarding their shoulder pain Inability to comply with treatment and follow up schedule Insufficient English language skills to complete all questionnaires

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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Eccentric External rotator training<br>Eccentric Shoulder External Rotators along with scapular retraction and posterior shoulder stretching exercises. | Other: Eccentric Shoulder External Rotator Training<br>* Eccentric training exercise for the external rotators, 3 sets of 15 daily.<br>|
| Sham Comparator: General shoulder exercise<br>General shoulder exercise protocol of active flexion, abduction, scapular retraction and posterior shoulder stretching exercises. | Other: General Shoulder exercise<br>* general exercise consisting of active shoulder movements<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Western Ontario Rotator Cuff Index | shoulder functional self report measure is a disease specific self reported outcome measure for individuals experiencing rotator cuff pathology. A score of 0 is the minimum score and indicates low levels of shoulder function. A score of 100 is the maximum score and indicates full shoulder function. Scores are derived by summing all 5 subscales and dividing that number by the total available number of 2100. Units for each item are derived from a visual analog scale totaling 100cm. | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global Rating of Change | Global rating of change is a single item questionnaire asking about total change since beginning treatment. The scale ranges from -7 (a great deal worse) to +7 (a great deal better). The unit of measure is scores on a scale. | 6 months | 
| Numeric Pain Rating Scale | 0-10 pain scale with 0 meaning no pain and 10 being maximal pain. This is derived from a single item questionnaire. | 6 months | 
| Shoulder Active Range of Motion | Degrees of shoulder elevation with 0 being the least and 180 being the greatest. | 6 months | 
| Upper Quarter Y Balance Test | Measure of single arm reach with 0 being the least and higher numbers indicating greater distance reached. | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Shoulder, Eccentric Training, Subacromial Impingement Syndrome