Integrating High-Intensity Laser Therapy with Exercise Regimen for Impingement Syndrome: A Case Report

To compare the effects of High-Intensity Laser Therapy (HILT) versus Low-Level Laser Therapy (LLLT) on shoulder pain and disability, shoulder Range of Motion (ROM), Pain Pressure Threshold (PPT), and sleep quality of patients having Subacromial Impingement Syndrome (SAIS). Forty-two patients with SAIS were randomly assigned into three groups, the HILT group (n = 14), the LLLT group (n = 14), and control group (n = 14). All groups received an exercise program consisted of shoulder muscles stretching and strengthening exercises. Along with the exercise program, the HILT group received HILT at 810nm /980 nm, and LLLT group received LLLT at 904nm, three times weekly for three weeks. The primary outcome was the change in shoulder pain and disability measured by Shoulder Pain and Disability Index (SPADI). Secondary outcomes included shoulder ROM using a standard goniometer, PPT measured by pressure algometer, and sleep quality by Pittsburgh Sleep Quality Index (PSQI). Measurements were taken both before and after a 3-week intervention to assess the outcomes. After 3-wk intervention, both the HILT and LLLT groups exhibited significant improvements in all parameters when compared to the control group (p < 0.05). Additionally, there were clinically significant differences between groups supported by a large ES favoring the HILT group for SPADI pain (ηp2 = 0.71), SPADI disability (ηp2 = 0.54), SPADI total (ηp2 = 0.82), PPT (ηp2 = 0.63), and PSQI (ηp2 = 0.42). The combination of HILT with exercises proved to be more beneficial in enhancing pain and function, PPT, and sleep quality compared to LLLT combined with exercises in treating patients with SAIS.

This study primary aimed to evaluate the effect of high-intensity laser therapy (HILT) on the elasticity of the supraspinatus tendon in participants with subacromial impingement syndrome (SIS) and secondary aimed to evaluate the effect of HILT on pain and function. This randomized controlled double-blind study included 66 participants diagnosed with SIS and were randomly assigned into HILT group (HILT and physical therapy) and control group (sham HILT and physical therapy) and received 10 sessions (five days a week during two weeks). Supraspinatus tendon elasticity was measured by shear wave elastography (SWE). Pain and function were assessed by visual analog scale (VAS) and shoulder pain and disability index (SPADI), respectively. Measurements were made at baseline and after treatment. The minimal clinically important difference (MCID) was accepted as 1.37 for VAS and 13.2 for SPADI. There was no difference in SWE measurements before and after treatment in both groups (p > 0.05). VAS and SPADI showed clinically and statistically significant improvement in the HILT and control groups (p < 0.001). The r value for VAS and SPADI in the HILT group was calculated as 0.97; and 0.97 for VAS and 0.96 for SPADI in the control group. A statistically significant difference was found in VAS and SPADI in the HILT group compared to the control group (p = 0.010, p < 0.001, respectively). However, the differences were not clinically significant (mean differences 0.5 and 6.41, respectively). This study concluded that HILT applied together with physical therapy had no effect on tendon elasticity in the short term. Besides, HILT combined with physical therapy is statistically more effective in reducing pain and improving function than physical therapy alone.

THU0621-HPR The Effectiveness of Scapular Stabilization Exercises in Patients with Subacromial Impingement Syndrome and Scapular Dyskinesis

Local steroid injections are common for treatment of impingement syndrome. Corticosteroid injections methods are basically in two formats, blind or with image guidance. The aim of this study is to compare the effect of ultrasound-guided in comparison with blind corticosteroid injections in patients with impingement syndrome. This study is a randomized clinical trial study undertaken in patients with diagnosis of impingement syndrome done in Isfahan University of Medical Science clinics from February 2014 to February 2015. The number of all patients registered in the study is 48; and then 40 patients were allocated to either control group randomly which received blind steroid injection or case group that underwent ultrasound-guided steroid injection. The clinical symptoms were assessed using Shoulder Pain and Disability Index (SPADI) questionnaire, Visual Analogue Scale (VAS) and shoulder range of motion (ROM) using goniometer at baseline and six weeks after the injection. Data analysis revealed a significant difference in the mean of the VAS, SPADI and shoulder ROM in both groups 6 weeks after intervention (P < 0.05). Patients with ultrasound guided corticosteroid injection had statistically significant improvements in function and shoulder ROM (abduction, flexion) compared to blind injection group after 6 weeks (P<0.05). There was not significant differences in pain (VAS) and internal and external rotation between these two groups (p>0.05). Our findings suggest that US image guided can improve the shoulder function of patients with impingement syndrome, and thus can be considered in comprehensive care programs of these patients for fast speed of rehabilitation.

Background: Sub-acromial impingement syndrome (SAIS) is the most common disorder of shoulder. Conservative treatment is the first choice, often with corticosteroid injection or different physiotherapy interventions, or both. So we aimed to assess the mean reduction in shoulder pain and disability index (SPADI) score after administration of sub-acromial corticosteroid injections for management of SAIS.Objectives: To determine the mean reduction in SPADI score after administration of Sub-acromial corticosteroid injections for management of sub-acromial impingement syndrome.Material and Methods: The Quasi – experimental study was conducted in Department of Orthopedic Surgery, Mayo Hospital Lahore from November 2013 to august 2014. 150 cases were enrolled in this study. Then baseline SPADI score was noted. Patients were injected with sub-acromial injections of 40 mg triamcinolone acetonide mixed with 4.5 ml of 2% lignocaine under aseptic measures. All patients did exercises, consisting of pendulum and range of motion under care of physiotherapist. Each patient was followed-up in OPD for assessment of shoulder function according to SPADI score at 1, 3 and 6 weeks after administration of injection. The result was analyzed by using SPSS version 16.Results: The mean age of the patients was 44.58 ± 11.48 years. There were 46.67% males and 53.33% females in this study. The mean SPADI score of the patients at baseline was noted as 75.94 ± 7.73 which was reduced to 46.25 ± 5.62 after 6 weeks.Conclusion: Our study results concluded that Sub-acromial corticosteroid injection is effective in treatment of shoulder impingement syndrome.

Purpose To investigate the effects of Mulligan thoracic sustained natural apophyseal glides (SNAGS) techniques and traditional exercises on pain, shoulder function, size of sub-acromial space, and shoulder joint range in patients with sub-acromial impingement syndrome. Methods Seventy-four patients with sub-acromial impingement syndrome (25 to 40 years) joined this research and were allocated randomly into two equal groups; experimental group A (Mulligan SNAGS and exercise) and control group B (exercise only). All patients were assessed by visual analogue scale (VAS) for pain intensity, Shoulder Pain and Disability Index (SPADI) for shoulder function, plain x-ray for the size of sub-acromial space, and goniometer for shoulder range of motion (ROM). The measurements were performed at two intervals (baseline and after four weeks of intervention). Results After 4 weeks of intervention, there were statistically significant differences between groups, in favor of Mulligan SNAGS, on sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion (p < 0.05). In within-group analysis, there were also statistically significant differences between pre- and post-treatment in all measured variables (p < 0.05). Conclusion Mulligan thoracic spine (SNAGS) mobilization into extension and traditional exercises improve sub acromial space size, pain intensity, shoulder function, and shoulder joint range of motion in patients with sub acromial impingement syndrome. It is recommended to mobilize the thoracic spine by mulligan SNAGS in the treatment of sub-acromial impingement syndrome.

To evaluate clinical and ultrasonographic efficacy of high-intensity laser therapy (HILT) in patients with hemiplegic shoulder pain (HSP) accompanied by partial thickness rotator cuff tear (PTRCT). The study was designed as a prospective, randomized, controlled trial. Patients with HSP accompanied by PTRCT (n = 44) were randomly assigned to HILT and control groups. Both groups were treated with a multidisciplinary stroke rehabilitation and a therapeutic exercise program to the affected shoulder supervised by physiotherapists. In addition, HILT group received 3 sessions of the intervention per week for 3 weeks. Primary outcome measure was visual analogue scale (VAS) for pain. Secondary outcome measures were range of motion (ROM) of the shoulder joint, Shoulder Pain and Disability Index (SPADI), Brunnstrom Recovery Stage (BRS), Modified Ashworth Scale (MAS), Nottingham Health Profile (NHP), Functional Independence Measure (FIM), and ultrasonographic PTRCT size. Participants were assessed at pre- and post-treatment. A total of 41 patients completed the study. A statistically significant improvement was observed in VAS, ROM, FIM, SPADI, NHP, and PTRCT parameters in HILT group at post-treatment compared to pre-treatment (all P < 0.05). However, control group indicated significant improvement only in VAS, ROM, and SPADI parameters (all P < 0.05). When differences in clinical parameters at pre- and post-treatment assessment were compared between two groups, change in VAS, FIM, BRS, SPADI, NHP, and PTRCT in HILT group was significantly better than control group (all P < 0.05). HILT combined with therapeutic exercise seems to be clinically and ultrasonographically more effective in the treatment of patients with HSP accompanied by PTRCT than therapeutic exercise alone in the short term. Further studies are needed with long-term follow-up. CinicalTrials.gov Identifier: NCT04669405.

Subacromial impingement syndrome (SAIS) is a major contributing factor of shoulder pain; and treatment approaches (Kinesio® taping [KT], Exercise [EX], manual therapy [MT], and high-intensity laser therapy [HILT]) have been developed to treat the pain. The key objective of this study was to compare the effects of KT, MT, and HILT on the pain, the range of motion (ROM), and the functioning in patients with SAIS. Seventy patients with SAIS were randomly divided into four groups based on the treatment(s) each group received [EX (n = 15), KT + EX (n = 20), MT + KT + EX (n = 16), and MT + KT + HILT + EX (n = 19)]. All the patients were assessed before and at the end of the treatment (15th day). The main outcome assessments included the evaluation of severity of pain by visual analogue scale (VAS) and shoulder flexion, abduction, and external rotation ROM measurements by a universal goniometry. Shoulder pain and disability index (SPADI) was used to measure pain and disability associated with shoulder pathology. Statistically significant differences were found in the treatment results of all parameters in MT + KT + EX and HILT + MT + KT + EX groups (p < 0.05). When the means of ROM and SPADI results of three groups were compared, statistically significant differences were found between all the groups (p < 0.05). These differences were significant especially between the groups MT + KT + EX and KT + EX (p < 0.05) and HILT + MT + KT + EX and KT + EX (p < 0.05). HILT and MT were found to be more effective in minimizing pain and disability and increasing ROM in patients with SAIS. Further studies with follow-up periods are required to determine the advantages of these treatments conclusively.

Immediate Effects of Mobilization With Movement vs Sham Technique on Range of Motion, Strength, and Function in Patients With Shoulder Impingement Syndrome: Randomized Clinical Trial

BackgroundSubacromial impingement syndrome is the most frequent cause of shoulder problems which themselves affect 1 in 3 adults. Management commonly includes exercise and corticosteroid injection. However, the few existing trials of exercise or corticosteroid injection for subacromial impingement syndrome are mostly small, of poor quality, and focus only on short-term results. Exercise packages tend to be standardised rather than individualised and progressed. There has been much recent interest in improving outcome from corticosteroid injections by using musculoskeletal ultrasound to guide injections. However, there are no high-quality trials comparing ultrasound-guided and blind corticosteroid injection in subacromial impingement syndrome. This trial will investigate how to optimise the outcome of subacromial impingement syndrome from exercise (standardised advice and information leaflet versus physiotherapist-led exercise) and from subacromial corticosteroid injection (blind versus ultrasound-guided), and provide long-term follow-up data on clinical and cost-effectiveness.Methods/DesignThe study design is a 2x2 factorial randomised controlled trial. 252 adults with subacromial impingement syndrome will be recruited from two musculoskeletal Clinical Assessment and Treatment Services at the primary-secondary care interface in Staffordshire, UK. Participants will be randomised on a 1:1:1:1 basis to one of four treatment groups: (1) ultrasound-guided subacromial corticosteroid injection and a physiotherapist-led exercise programme, (2) ultrasound-guided subacromial corticosteroid injection and an advice and exercise leaflet, (3) blind subacromial corticosteroid injection and a physiotherapist-led exercise programme, or (4) blind subacromial corticosteroid injection and an advice and exercise leaflet. The primary intention-to-treat analysis will be the mean differences in Shoulder Pain and Disability Index (SPADI) scores at 6 weeks for the comparison between injection interventions and at 6 months for the comparison between exercise interventions. Although independence of treatment effects is assumed, the magnitude of any interaction effect will be examined (but is not intended for the main analyses). Secondary outcomes will include comparison of long-term outcomes (12 months) and cost-effectiveness. A secondary per protocol analysis will also be performed.DiscussionThis protocol paper presents detail of the rationale, design, methods and operational aspects of the SUPPORT trial.Trial registrationCurrent controlled trials ISRCTN42399123.

This case report describes the long-term effect of the high-intensity laser therapy (HILT) in a patient with chronic shoulder pain refractory in comparison to other treatments. Ten sessions of HILT were applied in a thirty-one-year-old woman diagnosed with subacromial syndrome. Assessment was carried out through different tests: Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Scale (NPRS) and pressure pain threshold (PPT). All measurements were taken at four different points: at the end of the 10 sessions, after one month, three months after the intervention and nine months after the initial intervention. There was a clinically significant improvement in NPRS (decrease of 5 points), PPT (increase of 1.5kg/cm2) and SPADI (decrease of 24 points) one month after the intervention. After three months, the increase of NPRS and SPADI required a 5-session intervention to support the clinical improvement. Six months after these booster sessions an increase in PPT and a decrease in NPRS and SPADI were observed. Results indicate the suitability of developing new research lines which will optimize the use of HILT.

The effectiveness of extracorporeal shockwave treatment in subacromial impingement syndrome and its relation with acromion morphology

The aim of the study was to determine the effectiveness of the lateral approach to subacromial injection, compared with the posterior approach, for the treatment of subacromial impingement syndrome. A pragmatic randomized controlled trial was carried out in an outpatient community musculoskeletal service. The sample comprised 80 adults, aged 18 years or over, with subacromial impingement syndrome. The intervention group received a single subacromial injection, using a 21-gauge green needle, of 40 mg/ml triamcinolone acetonide (Kenalog) and 4 ml 1% lignocaine using a lateral approach. The control group received identical treatment, with the exception that the injection was given using a posterior approach. The outcome measures were pain measured using 0-10 numerical pain scale and shoulder pain and disability index (SPADI) scores at 8 and 12 weeks' follow-up. A moderate but statistically and clinically significant difference in improvement in daytime pain (mean change in score) occurred in favour of the lateral group (mean = 4.0) compared with the posterior group (mean = 2.0) between weeks 0 and 8 (1.4 points [95% confidence interval 0.3, 2.6; p = 0.018]). However, there were no statistically significant differences between the groups in night-time pain, shoulder function and SPADI scores. There was a statistically and clinically significant difference (p = 0.001) within the groups for all clinical outcomes between weeks 0 and 8, and between weeks 0 and 12. There were no significant differences in the treatments; however, both forms of treatment were associated with a significant improvement in shoulder pain, function and disability.

BackgroundThe Shoulder Pain and Disability Index (SPADI) is a self-administered questionnaire that aims to measure pain and disability associated with shoulder disease. The aim of the present study was to investigate the construct validity and factor structure of the SPADI in a population-based study of patients with self-reported chronic shoulder symptoms.MethodsThe North West Adelaide Health Study is a representative longitudinal cohort study of people aged 18 years and over. The original sample was randomly selected and recruited by telephone interview. Overall, 3 206 participants returned to the clinic during the second stage (2004-2006) and were asked to report whether they had pain, aching or stiffness on most days in either of their shoulders. Data was also collected on body mass index and shoulder range of motion (ROM) and demographic factors. The SPADI (numeric rating scale) was administered to participants with shoulder symptoms. Principal components factor analysis, with varimax rotation of factor loadings, was used to assess subscale structure of SPADI. Correlations between the SPADI, shoulder ROM and SF-36 were performed.ResultsOverall, 22.3% of participants indicated that they had pain, aching or stiffness in either of their shoulders. SPADI results were available for 588 of participants with current shoulder symptoms. The internal consistency of the SPADI subscales were high (Cronbach's alpha > 0.92). Two factors, explaining 61.4% of the total variance were extracted by factor analysis. These were interpreted as disability and pain respectively. There was a strong negative correlation between SPADI disability subscale scores and shoulder range of motion. SPADI disability, but not pain, subscale scores were correlated with age.ConclusionsThe SPADI is a valid measure to assess pain and disability in people with shoulder pain in a population-based study. In this setting, the SPADI had a bidimensional structure with both pain and disability subscales.

The short-term effectiveness of high-intensity laser therapy (HILT) was investigated as a retrospective case series for the treatment of the pain and disability associated with subacromial impingement syndrome (SAIS). A total of 42 patients, who were diagnosed with subacromial impingement syndrome, underwent a total of nine sessions (three sessions per week) of high-intensity laser therapy. The patients were evaluated before therapy and 8 weeks after therapy using the pain and disability subscales and the total scores of the Shoulder Pain and Disability Index (SPADI), as well as scores for the University of California at Los Angeles (UCLA) shoulder rating scale. Significant differences were observed between SPADI pain, disability, and total scores and UCLA scores of the patients. HILT was found to be effective in the short term in the treatment of pain and disability in patients with SAIS.