Clinical trial NCT04660682: A Comparison of the Long Term Effects of the Traditional and Modified Posterior Shoulder Stretching Exercise in Subacromial Impingement Syndrome
Official title: A Comparison of the Long Term Effects of the Traditional and Modified Posterior Shoulder Stretching Exercise on Shoulder Mobility, Pain, Ultrasonographic Parameters, Proprioception, Strength, Functionality, and Disability Level in Subacromial Impingement Syndrome
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Subacromial Impingement Syndrome
Keywords: Glenohumeral Internal Rotation Deficit, Modified Cross-body Stretching
Lead sponsor: Dokuz Eylul University
Sponsor class: OTHER
First posted: 2020-12-09
Enrollment: 60
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: There are 3 groups. The first group will receive the modified static cross-body posterior shoulder stretching and the standard physiotherapy program. The second group will receive traditional static cross-body posterior shoulder stretching and the standard physiotherapy program. The Control group will receive sham stretching and the standard physiotherapy program. In standard physiotherapy program, there are TENS, hot-pack, posture, proprioceptive, and strengthening training. The treatment program will last for eight weeks. Patients will receive the treatment program 5 days a week under the physiotherapist's supervision and 2 days a week as a home program.
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to investigate and compare the long term effects of traditional and modified static cross-body posterior shoulder stretching training in individuals with subacromial impingement syndrome (SIS) having glenohumeral internal rotation deficit (GIRD). Modified cross body posterior shoulder stretching group will receive static stretching in the modified cross-body stretching position and standard physiotherapy program. The traditional cross body posterior shoulder stretching group will receive static stretching and standard physiotherapy program. The Control group will receive only sham stretching and standard physiotherapy program.

Detailed description: SIS is the most common cause of pain and shoulder dysfunction. The etiology of SIS depends on many factors including tightness of the posterior shoulder structures. Posterior shoulder tightness (PST) narrows the subacromial space and forces anterior-superior migration of the humeral head over the glenoid fossa and, it could cause limitation of the internal rotation (IR) and horizontal adduction range of motion (ROM). GIRD is known as loss of IR ROM in the glenohumeral joint. In the SIS, limitation IR ROM has been reported. Supraspinatus tendon thickness can change, subacromial space may become narrower and joint position sense (JPS) could be decreased in SIS patients. The effectiveness of traditional static cross body posterior shoulder stretching on various parameters such as shoulder rotational ROM or pain was studied and proved in the literature. Traditional static cross body posterior shoulder stretching could reduce subacromial symptoms and improve shoulder ROM with some disadvantages such as inadequate control of the scapula and glenohumeral rotation. To prevent accessory abduction of the scapula, restrict the external rotation ROM of the humerus and provide isolated posterior capsule stretching, Wilk et al. (2013) recommend the use of modified cross-body stretching for IR ROM increase. In the modified cross-body position, the patient is positioned in a more advantageous way. In the literature, although modified cross-body posterior stretching seems effective on SIS symptoms there is no research about the comparison of the long-term effects of the traditional and modified static cross-body posterior shoulder stretching exercises in individuals with SIS having GIRD. Therefore, whether modified stretching is superior to traditional stretching is not known. Our study aims to investigate and compare the long term effects of the traditional static cross-body posterior shoulder stretching exercise and modified static cross-body posterior shoulder stretching exercise in individuals with SIS having GIRD on shoulder IR ROM, GIRD, PST, pain, external rotation ROM, JPS, subacromial space, supraspinatus tendon thickness, posterior capsule thickness, the occupational ratio of the supraspinatus tendon in the subacromial space, muscle strength and shoulder function and disability level. Stretching groups will receive either traditional or modified static cross-body posterior shoulder stretching exercise and standard physiotherapy program. The Control group will receive only sham stretching and standard physiotherapy program. Standard physiotherapy program consists of electrotherapy, posture, proprioceptive, and strengthening exercises. The treatment program will be performed 5 days a week under the physiotherapist's supervision and 2 days a week as a home program for 8 weeks.

Eligibility criteria: Inclusion Criteria:

* Diagnosis of subacromial impingement syndrome
* Glenohumeral internal rotation range of motion of the affected shoulder should be less than other shoulder and bilateral shoulder internal rotation range of motion difference should be ≥15 º
* Pain with resisted arm elevation or external rotation as well as a minimum of 3 of 5 positive subacromial impingement syndrome tests, painful arc, pain or weakness with resisted external rotation, Neer, Hawkins and Jobe tests .
* Ability to complete the entire study procedure

Exclusion Criteria:

* A 50% limitation of passive shoulder range of motion in \>2 planes of motion
* Pain \>7/10
* A history of fracture to the shoulder girdle
* Systemic musculoskeletal disease
* History of shoulder surgery,
* Glenohumeral instability (positive apprehension, relocation or positive sulcus test) or positive findings for a full thickness rotator cuff tear (positive lag sign, positive drop arm test, or marked weakness with shoulder external rotation)

Primary outcomes:
measure: Shoulder internal rotation range of motion
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Glenohumeral internal rotation deficit
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
Secondary outcomes:
measure: Posterior shoulder tightness
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Pain intensity
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Joint position sense
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Isometric strength
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Subacromial space
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Supraspinatus tendon thickness
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Shoulder external rotation range of motion
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Posterior capsule thickness
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Occupational ratio of the supraspinatus tendon in the acromial-humeral space
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Shoulder Function
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
measure: Upper extremity function
timeFrame: Baseline, 8 weeks, 12 weeks, 24 weeks
Other outcomes:
Locations:
city: İzmir
country: Turkey
facility: Dokuz Eylül University Physical Therapy and Rehabilitation Department
state: Balçova
Study officials:
affiliation: Dokuz Eylul University Physical Therapy and Rehabilitation Department
name: Sevgi Sevi YESILYAPRAK, PhD, PT
role: STUDY_DIRECTOR
affiliation: Dokuz Eylul University
name: Mehmet ERDURAN, MD
role: STUDY_DIRECTOR
affiliation: Dokuz Eylul University
name: Onur BAŞÇI, MD
role: STUDY_DIRECTOR
References: