Handgrip Strengthening Exercise in Treatment of the Patients With Primary Sub-Acromial Impingement Syndrome

Study Overview
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Brief Summary
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This study aims to investigate the relative effect of handgrip strengthening exercise in improving function, pain, strength, and active range of motion (AROM) of the shoulder among patients with primary sub-acromial impingement syndrome (SAIS).

Detailed Description
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The current study is a Single-Blind Randomized Clinical Trial to investigate the effectiveness of handgrip strengthening exercise in the treatment of patients with primary subacromial impingement syndrome. The randomization process will be based on concealed envelop picked up by participants.The patient will be conveniently recruited from the ministry of health hospitals in Jeddah.The patient who will meet the inclusion criteria; they will sign the consent form. The baseline data will be collected. The assessment will be carried out at the baseline, 4 weeks and 8 weeks; end of the treatment program; by the same blinded examiner for each patient and consist of the following instrument: Disabilities of Arm, Shoulder & Hand (DASH questionnaire), Visual analog scale (VAS), Hand-held dynamometer (HHD), and smartphone clinometer.

Official Title
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The Relative Effect of Handgrip Strengthening Exercise in Treatment of the Patients With Primary Sub-Acromial Impingement Syndrome

Conditions
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Impingement Syndrome, Shoulder

Intervention / Treatment
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* Behavioral: Hand grip strengthening
* Behavioral: Conventional treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Willing to comply with all study procedures and be available for the duration of the study Aged 18 to 45 Diagnosed by their referring physician with subacromial impingement syndrome and has a positive impingement & rotator cuff test Pain intensity between 3 to 8 in VAS Exclusion Criteria: History of shoulder fracture or dislocation, osteophytes, and labral tear. History of cardiac, neurological or musculoskeletal disease that precludes the ability to perform the exercise in the upper extremity. Treatment with another intervention. Hand or forearm dysfunction Rheumatoid disease Diabetic History of shoulder, cervical, and thoracic surgery Pregnancy Malignancy Symptoms for more than 1 year Bilateral SAIS

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: Hand grip strengthening<br>This group will receive handgrip strengthening exercises. | Behavioral: Hand grip strengthening<br>* Handgrip strengthening exercises will be added to the experimental group. This exercise is chosen based on literature review of EMG and biomechanical studies. Adjustable heavy grip hand gripper will be used as handgrip resistance at 10 repetitions maximum (RM). The exercise will be performed in standing position the patient's back will be rested in a wall, arm at 30º abduction, 60º abduction 90º abduction & with 90º ER. In this positions, the patient will be performed 3 sets of 10 squeezes each at a 1-minute interval.<br>|
| Active Comparator: Conventional treatment<br>This group will receive conventional exercises. | Behavioral: Conventional treatment<br>* Ultrasound therapy will be used to treat both groups. Ultrasound will be applied; while the patient will be seated in an adjustable chair with back support, feet on the floor. The chair will be positioned beside a table. The patient's shoulder will be rested on the table beside the body and elbow will be flexed at 90°. A round-headed probe will be used that is put in direct contact with the patient's skin over the shoulder joint. Ultrasound gel will be used on all surfaces of the head in order to reduce friction and assist in the transmission of the ultrasonic waves.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Function | It will be assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, which is a 30-item questionnaire that assess the ability of a patient to perform various upper extremity activities. it uses a 5-point Likert scale. A higher scores signify a greater level of disability, whereas, lower scores signify a lower level of disability. | Change from baseline functional score at 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Strength | It will be assessed using HHD | Change from baseline muscle strength at 8 weeks | 
| Range of motion | It will be assessed using smartphone clinometer | Change from baseline range of motion at 8 weeks | 
| Pain | Pain intensity will be assessed using visual analog scale (VAS) (0 - 10 cm with 0 indicates no pain and 10 indicates the worst pain). | Change from baseline pain intensity at 8 weeks |