Exercise Training Sequence for Subacromial Impingement Syndrome

Study Overview
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Brief Summary
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Randomized crossover trial evaluating the impact of exercise training sequence of axioscapular and rotator cuff exercises in patients diagnosed with subacromial impingement syndrome.

Detailed Description
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While physical therapy is an effective element in the rehabilitation of rotator cuff (RC) disease, the most effective sequence of training interventions has not been defined. The purpose of this study is to determine if there is a difference in pain or function in patients who are given RC strengthening prior to or after initiating scapular stabilization exercises. The study was a prospective randomized crossover design. 26 men and 14 women, mean age 51, diagnosed with subacromial impingement syndrome (SAIS) were randomly assigned to one of two groups for a comprehensive and standardized rehabilitation program over six visits at an orthopedic outpatient clinic. One group was prescribed a 4-week program of scapular stabilization exercises while the other group began with RC strengthening exercises. The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation.

Official Title
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The Effect of Axioscapular and Rotator Cuff Exercise Training Sequence in Patients With Subacromial Impingement Syndrome: A Randomized Crossover Trial

Conditions
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Subacromial Impingement Syndrome

Intervention / Treatment
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* Other: Rotator Cuff Training
* Other: Scapular Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-80 years of age diagnosis of Neer Stage I/II subacromial impingement with a primary pain complaint in the shoulder and/or upper arm presence of at least two of the following findings: painful arc, weakness in external rotation, positive impingement sign (Hawkins-Kennedy or Neer/Walsh tests), pain and/or weakness with resistance to internal rotation, external rotation, or scapular plane elevation. Exclusion Criteria: concurrent medical co-morbidities including pregnancy, diabetes, and rheumatoid arthritis - osteoarthritis greater than grade 2 on the Kellgren-Lawrence scale current diagnosis and/or previous history of glenohumeral instability or dislocation full-thickness rotator cuff tear adhesive capsulitis fractures of the scapula, clavicle or humerus scapulothoracic or rotator cuff paresis shoulder surgery in past year inability to speak the English language at a level sufficient to obtain informed consent.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 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: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Scapular Training<br>Initiated scapular training exercise for the first 4 weeks followed by addition of rotator cuff exercises the next four weeks | Other: Scapular Training<br>* four specific band-resisted strength training exercises for rotator cuff<br>* Other names: exercise;|
| Experimental: Rotator Cuff Training<br>initiated rotator cuff training exercise for the first 4 weeks followed by addition of scapular training exercises the next four weeks. | Other: Rotator Cuff Training<br>* four specific band-resisted strength training exercises for scapula<br>* Other names: exercise;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| American Shoulder Elbow Surgeon's Outcome Score | self-report of function | 16 weeks | 
| Numeric Pain Score | pain levels | 16 weeks | 
| Global Rating of Change | patient satisfaction | 16 weeks | 
| Global Percentage of Improvement | patient perception of status | 16 weeks |