Clinical trial NCT04813757: Scapular Upward Rotation Focused Treatment for Patient With Shoulder Impingement Syndrome and a Positive Scapular Assistance Test
Official title: Scapular Upward Rotation Focused Treatment for Patients With Shoulder Impingement Syndrome and a Positive Scapular Assistance Test
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Subacromial Pain Syndrome
Impingement Syndrome
Scapular Dyskinesis
Lead sponsor: Meuhedet. Healthcare Organization
Sponsor class: OTHER
Collaborators: name: Ariel University
First posted: 2021-03-24
Enrollment: 50
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Randomized controlled trial
Primary purpose: TREATMENT

Brief summary: Altered scapular movement is a common impairment among patients with subacromial impingement syndrome (SAIS). Nevertheless scapular focused interventions have resulted in conflicting findings among this population. One possible reason for this is the inability to identify patients with SAIS who will respond favorably to a scapular focused intervention.

The scapular assistance test (SAT) may be one possible indicator of patients most likely to benefit from a scapular focused intervention, particularly one that emphasizes scapular upward rotation. The purpose of this study is to examine targeted upward rotation intervention in patients demonstrating a positive Scapular Assistance test.

Detailed description: Background: Patients with SAIS are commonly referred to physical therapy. A common impairment among patients with SAIS is altered scapular movement, characterized by insufficient upward rotation and posterior tilt. These deficits are believed to decrease the subacromial space and diminish length -tension relationship among the deltoid and rotator cuff musculature. The scapular assistance test (SAT) is a physical examination manoeuvre aimed to detect patients in whom insufficient scapular upward rotation and posterior tilt contribute to the generation of shoulder symptoms. The SAT may, therefore, serve as an indication for the need of scapular focused intervention. Given the inconsistent results of scapular focused interventions among patients with SAIS, the purpose of this study is to assess the outcome of a scapular-focused intervention, particularly geared toward increasing scapular upward rotation, among patients with SAIS that exhibit a positive SAT as well.

Methods: Fifty patients with SAIS and a positive SAT referred to the "Meuhedet" outpatient physical therapy clinic in Ashdod will be recruited for this study. Following baseline assessment, patients will be randomized into 12 sessions over a 6-week period. The intervention group will receive manual therapy and an exercise program focused on increasing scapular upward rotation while the control group will receive manual therapy and an exercise program focused on scapular muscle an rotator cuff strengthening with no special emphasis on scapular upward rotation. Repeated measures analysis of covariance will be conducted to detect differences in pain intensity, shoulder -related disability and scapular upward rotation following the intervention

Eligibility criteria: Inclusion Criteria:

* Unilateral shoulder pain for ≥1 month
* A diagnosis of SAIS as determined by having 3 or ore positive tests out of: Neer test, Hawkins test, Painful arc, Jobe test, external rotation resistance test.
* A positive SAT

Exclusion criteria:

* Cervical spine involvement as evidenced by reproduction of symptoms with neck movement
* Massive rotator cuff tear as evidenced by pseudoparalysis
* Previous history of a fracture or surgery within the involved shoulder.
* Limited passive range of motion by ≥50% or more compared with uninvolved side in

  * 2 planes of motion (i.e. flexion, external rotation)
* A history of shoulder dislocation or subluxation
* A history of Rheumatoid arthritis, CVA, fibromyalgia
* Current pregnancy
* Population with special needs
* Pending disability claim / litigation procedure associated with shoulder complaint.

Primary outcomes:
measure: Disability of the Arm, Shoulder and Hand (DASH) questionnaire
timeFrame: pre intervention
measure: Numeric pain Rating Scale (NPRS), 0 - 10
timeFrame: pre intervention
Secondary outcomes:
measure: Active shoulder flexion
timeFrame: pre intervention
measure: active shoulder abduction
timeFrame: pre intervention
measure: scapular posterior tilt
timeFrame: pre intervention
Other outcomes:
Locations:
city: Ashdod
country: Israel
facility: Meuhedet
Study officials:
References: