Effects of Overload Progressive in the Treatment of Shoulder

Study Overview
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Brief Summary
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Seventy subjects with shoulder impingement syndrome associated with scapular dyskinesis will be recruited and randomized into two groups of treatment. The group a will receive a strenghtening protocol with progressive overload during 20 sessions and group b will receive the same protocol with minimal load, without change during the 20 sessions. The primary outcomes measures will be pain, function, quality of life, global impression of recovery. The change will be measure from baseline at 10 weeks (after 20 sessions), 3 and 6 months (follow-up). The secundary outcomes will be disability, quality of life measure by other instruments, shoulder muscle strength and scapular 3d kinematic variables. For these data, change will be measure from baseline at 10 weeks (after 20 sessions).

Official Title
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Effects of Overload Progressive in the Treatment of Shoulder Impingement Syndrome Associated With Scapular Dyskinesis: a Randomized Controlled Trial

Conditions
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Shoulder Impingement Syndrome

Intervention / Treatment
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* Other: Strengthening protocol with progressive load
* Other: Strengthening protocol without progressive load


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: People with diagnosis shoulder impingement syndrome or supraspinatus/rotator cuff tendinopathy or subacromial bursitis shoulder pain for more than 4 months, at least 4 points of pain in 0-10 NPRS at least 130° shoulder active elevation 3 or more positive of 5 physical examination tests (painful arc, external rotation resistence, Neer, empty can (Jobe) and Hawkins-Kennedy positive dynamic scapular dyskinesis in clinical observation Exclusion Criteria: Referred pain from vertebral spine previous shoulder, elbow or neck surgery complete rotator cuff tear (positive drop arm sign or substantial shoulder elevation or rotation weakness) neoplastic or neurological disorders previous fracture or dislocation injury (shoulder, humerus, clavicle) adhesive capsulitis signs inflammatory diseases specific treatment for the shoulder in the previous four months (injection, physiotherapy) using drugs in the previous week inability to understand portuguese language

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 70 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: Progressive overload strengthening group<br>Strengthening protocol with progressive load Strengthening muscle exercises for the shoulder and scapular with progressive increase of load during 10 weeks (20 sessions) | Other: Strengthening protocol with progressive load<br>* Strengthening protocol for scapular and shoulder muscles<br>|
| Active Comparator: Strengthening group<br>Strengthening protocol without progressive load Strengthening muscle exercises for the shoulder and scapular without increase of load (minimal load) during 10 weeks (20 sessions) | Other: Strengthening protocol without progressive load<br>* Strengthening protocol for scapular and shoulder muscles<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Numeric pain rating scale (0-10) |  | baseline, 10 weeks, 3 months and 6 months | 
| Change in SPADI (Shoulder Pain and Disability Index) Questionnaire (0-100) |  | baseline, 10 weeks, 3 months and 6 months | 
| Change in ASES (American Shoulder and Elbow Surgeons) Questionnaire (0-100) |  | baseline, 10 weeks, 3 months and 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disabilities | DASH (Disabilities of the Arm, Shoulder and Hand) Questionnaire (0-100) | Change from baseline at 10 weeks | 
| Quality of life | WORC (The Western Ontario Rotator Cuff Index) Questionnaire (0-100) | Change from baseline at 10 weeks | 
| Muscle Strength | Shoulder internal rotation, external rotation, adduction and abduction muscles measured by handheld dynamometer | Change from baseline at 10 weeks | 
| Scapular kinematic | 3D data of scapula at 30, 60, 90 and 120° of shoulder abduction | Change from baseline at 10 weeks | 
| Global impression of recovery | GPE (global perceived effect) scale (-5 to +5) | Change from baseline at 10 weeks, 3 months and 6 months |