Clinical outcomes following motor control rehabilitation for shoulder impingement

Worsley, Peter, Mottram, Sarah, Warner, Martin, Morrissey, Dylan, Gadola, Stephan D., Carr, Andrew and Cooper, Cyrus (2012) Clinical outcomes following motor control rehabilitation for shoulder impingement. Rheumatology, 51, supplement 3, 95.

Abstract

Background: shoulder impingement is the most common pathology of all shoulder pain referrals. Impingement syndrome can cause functional disability and reduce quality of life and may contribute to the development of rotator cuff disease. The aim of the present study was to examine the effects of a motor control based exercise intervention for shoulder impingement patients.

Methods: sixteen young adults with shoulder pain (mean age 24.61.6, range 18-34 years, 11 males) were recruited from the local community. Inclusion criteria were: current shoulder pain severe enough to limit activity for more than one week and impingement signs. Diagnostic ultrasound imaging was used to exclude participants with complete rotator cuff tears. Mean duration of shoulder symptoms was 16 months (range 4-36 months).Physical screening of pain participants was conducted in order to derive a clinical presentation of shoulder impingement using three clinical tests; Hawkins-Kennedy, Neer’s and Painful Arc. A 10 week motor control retraining package was targeted at correcting movement impairments of the scapula by re-educating muscle recruitment. There were two components to the package: 1) Motor control exercises to correct alignment and coordination, which involve a) controlling scapular orientation during active arm movements; b) muscle-specific exercises for trapezius and serratus anterior; 2) Commonly used manual therapy techniques to reduce joint and muscle restrictions. Participants underwent three data collection sessions; pre-intervention, immediately post-intervention and six months post-intervention (13 participants completed post). The and Disability Index (SPADI); other questionnaires included the Disabilities of Arm Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), Short-Form 36 (SF-36), visual analogue scale (VAS) of pain.

Results: the SPADI scores improved on average by 10(7) and 13(6) points at the 10 week and 6 months assessments respectively. These changes were statistically significant (p<0.001) and reachedthe Minimal Clinically Important Difference (MCID). Pain scores on the 10-point VAS also reduced immediately after and 6 months postintervention with a mean reduction of 3.4(1.5) and 4.3(2) respectively. DASH improved by 9.2(10.3) at 10 weeks and 11.8 (6.3) at 6 months, whilst small improvements were also seen in the OSS (4.74) and SF-36 physical scores (3.84.9). Immediately postintervention the physical tests for impingement syndrome were negative for 15/16 participants.

Conclusions: the present findings suggest that a 10 week programme of specific motor control exercises can improve function and pain in young adults with shoulder impingement. Improvements persisted at 6 months but effectiveness in the longer-term needs to be examined and compared with other exercise interventions in a randomized controlled trial involving a wider age range of shoulder impingement patients.

Disclosure statement: ll authors have declared no conflicts of interest

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Contributors

Author: Peter Worsley

Author: Martin Warner

Author: Cyrus Cooper

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