Treatment Of Subacromial Impingement Syndrome Research Articles

Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial

ABSTRACT 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.

Subacromial Impingement Syndrome. A Retrospective Analysis of Long-Term Outcomes of Surgical and Conservative Treatment

INTRODUCTION. Subacromial impingement syndrome (SAIS) is one of the most common reasons that makes patients seek treatment for shoulder pain.&#x0D; PURPOSE. To assess the effectiveness of surgical and conservative treatment of patients with subacromial impingement syndrome.&#x0D; MATERIALS AND METHODS. The clinical results of 48 patients with SAIS stage 1, 2 according to Neer, divided into 3 groups, were analyzed: 1) conservative group without rotator cuff tears (16 patients), 2) conservative group with partial rotator cuff tears (16 patients); 3) surgical group (16 patients). The patients of the conservative groups were treated according to the rehabilitation protocol including myofascial release techniques, physiotherapy, manual therapy, exercises. The patients of the surgical group underwent an arthroscopic subacromial decompression. The follow-up period was at least 24 months. The clinical condition of the patients was assessed using ASES, VAS scales and SANE questionnaire.&#x0D; RESULTS. The study did not reveal a statistically significant difference of the surgical and conservative treatment groups according to VAS and ASES. There was a statistically significant difference in the results of the SANE questionnaire (p = 0.008) with better results in the conservative groups. Longer rehabilitation was noted in patients of the surgical group.&#x0D; DISCUSSION. Ketola et al. compared clinical results of surgical group of patients who underwent the subacromial decompression and the conservative group who performed the exercises. There was no statistically significant difference found in VAS level results, subjective shoulder function assessment. Paavola et al. have not found statistically significant difference in VAS scale results between surgical group, group of diagnostic arthroscopy and conservative group of patients with rotator cuff tendinopathy.&#x0D; CONCLUSION. The conservative treatment of subacromial impingement syndrome with physiotherapy and manual therapy let achieve good and excellent results.

Diacutaneous Fibrolysis: An Update on Research into Musculoskeletal and Neural Clinical Entities.

Diacutaneous Fibrolysis (DF) is an instrumentally assisted manual therapy technique defined as "a specific instrumental intervention for normalizing the musculoskeletal system function after a precise diagnosis and preserving the skin's integrity". The aim of this technique is soft tissue mobilization with the assistance of specially designed, hook-shaped steel instruments in different musculoskeletal structures, such as the myofascia, aponeurosis, tendons, ligaments and scar tissues. Due to discrepant results between previous reviews and the quite abundant new evidence provided by recently published randomized clinical trials, we propound this narrative review to provide an update on the scientific evidence related to the fundamentals and clinical efficacy of DF. Current evidence primarily supports the mechanical effect of DF on connective soft tissues. Diminished deep tendon reflex and rigidity have been registered after the implementation of DF in healthy subjects. Though there is still much to uncover, scientific evidence supports the use of the technique for the clinical treatment of subacromial impingement syndrome, chronic lateral epicondylalgia, chronic patellofemoral pain syndrome, mild to moderate carpal tunnel syndrome, hamstring shortening, temporomandibular disorders, tension-type headache and chronic low back pain. Additional data are essential for better recommendations in the clinical practice of DF.

Effectiveness of Pulse Electromagnetic Field Therapy in Patients With Subacromial Impingement Syndrome: A Double-Blind Randomized Sham Controlled Study

ObjectivesTo evaluate the 3-month effects of pulsed electromagnetic field therapy (PEMF) in the treatment of subacromial impingement syndrome (SIS). DesignPlanned analysis of a randomized controlled trial with 4- and 12-week follow-ups. SettingPhysical medicine and rehabilitation clinic, treatment unit. ParticipantsOf the 250 individuals screened for eligibility, participants with a diagnosis of SIS (N=80) were randomized to intervention or control groups. InterventionThe first group received PEMF + exercise and the second group received sham PEMF + exercise 5 days a week for a total of 20 sessions. Main Outcome MeasuresVisual Analog Scale (VAS), Constant Murley Score (CMS), Shoulder Pain and Disability Index (SPADI), Short Form-36 (SF-36) Quality of Life Questionnaire, and shoulder muscle strength measurement with an isokinetic dynamometer. Evaluations were performed before treatment (T0), after treatment (T1), and 12th week (T2). ResultsEvaluation at T1 and T2 showed improvement in most parameters in both groups compared with baseline. In the comparison between the 2 groups at T1 and T2, more improvement was found in the PEMF group in most parameters. ConclusionsIn our study, PEMF was found to be superior to sham PEMF in terms of pain, ROM, functionality, and quality of life at the first and third months.

Comparison of the effects of manual therapy and scapular stabilization exercises on pain, functional status, and quality of life in subacromial impingement syndrome

Aims: This study aimed to determine the effects of manual therapy and scapular stabilization exercises combined with conventional physiotherapy on pain, functional status, and quality of life, and whether they are superior in individuals with subacromial impingement.&#x0D; Methods: 30 patients between the ages of 25-65 who were diagnosed with subacromial impingement syndrome were included in the study. Individuals were randomized 1:1 to "conventional physiotherapy+scapular stabilization" and "conventional physiotherapy+manual therapy" groups. Individuals' age, gender, medication use, and presence of chronic disease were recorded. The presence of pain was measured by the Visual Analogue Scale, shoulder range of motion was measured by a goniometer, quality of life was measured by Short Form-12 Quality of Life Survey, and functional status was evaluated with the Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems. The conventional physiotherapy program applied to both groups included electrotherapy, passive and active assisted range of motion exercises, and rotator cuff strengthening exercises. Both groups received a total of 12 sessions of physiotherapy, 3 days per week, for 4 weeks.&#x0D; Results: 19 females and 11 males, participated in the study. There were no statistically significant differences between the groups at baseline assessment for pain at rest, activity, and night (p=0,37; 0,39; 0,17, respectively), range of motion of shoulder flexion, abduction, internal rotation, and, external rotation (p=0,5; 0,1; 0,91; 0,9, respectively), Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems score (p: 0,09) and Short Form-12 Quality of Life Survey scores physical and mental component (p=0,23; 0,98, respectively). After treatment, both groups observed positive improvements in pain at rest, activity, and night (p=0,001), range of motion of shoulder flexion, abduction, internal rotation, and, external rotation (p=0,001), Questionnaire Quick Disability of the Arm, Shoulder, and Hand Problems score (p=0,001) and Short Form-12 Quality of Life Survey scores physical and mental component (Group1; p=0,001; 0,001, Group 2; p=0,001; 0,005, respectively). There was no statistically significant advantage among the treatment methods except for shoulder abduction and internal rotation range of motion parameters (p=0,04; 0,009, respectively).&#x0D; Conclusion: When applied with traditional physiotherapy, both treatment methods provided significant improvements in pain, functional condition, quality of life, and joint motion clarity compared to before treatment. However, the methods applied are not superior to each other. It is important to choose the appropriate technique for the patient in the treatment of subacromial impingement syndrome, and it is useful to prepare personalized, combined programs. It is envisaged that researching more effective exercise methods for patients with subacromial impingement syndrome in the future will increase the usefulness of the treatment.

Phonophoresis treatment of subacromial impingement syndrome: Pulsed or continuous: A randomized-controlled clinical trial.

Objectives: This study aims to compare the effectiveness of pulsed and continuous modes of therapeutic ultrasound (US) for phonophoresis in the treatment of subacromial impingement syndrome (SAIS). Patients and methods: Between April 2019 and January 2021, a total of 66 patients with SAIS (17 males, 49 females; mean age: 48.2±8.6 years; range, 19 to 64 years) were included. The patients were randomized to the phonophoresis with continuous mode group (n=22), phonophoresis with pulsed mode group (n=22), and phonophoresis with sham US group (n=22). Five grams of ibuprofen phonophoresis was applied in five sessions per week for three weeks for all groups. Primary outcomes were pain intensity as assessed by the Visual Analog Scale (VAS) and shoulder functions by the short version of Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). The secondary outcome was the quality of life as assessed by the Nottingham Health Profile (NHP). All patients were evaluated at pre-treatment, post-treatment, and at three months after the end of the treatment. Results: There was a significant improvement in pain during activity, shoulder function, and quality of life after treatment in phonophoresis with continuous and pulsed modes compared to phonophoresis with sham US (p <0.05). Phonophoresis with continuous mode was superior to other groups in reducing pain at rest (p <0.05). Changes between pre-treatment and the three-month follow-up showed a significant improvement in pain during activity and shoulder functions in phonophoresis with continuous and pulsed modes, compared to phonophoresis with sham US (p <0.05). Phonophoresis with pulsed mode was more effective than the other interventions in improving quality of life during the same period (p<0.05). Conclusion: Despite a significant change in phonophoresis with continuous and pulsed modes, it is more pronounced for rest pain in the early period in continuous mode and for quality of life during follow-up in pulsed mode.

Surgery for subacromial impingement syndrome and occupational biomechanical risk factors in a 16-year prospective study among male construction workers.

The aim of this study was to assess the association between occupational biomechanical exposures and the occurrence of surgical treatment for subacromial impingement syndrome (SIS). A cohort of 220 295 male constructions workers who participated in a national occupational health surveillance program (1971-1993) were examined prospectively over a 16-year follow-up period (2001-2016) for surgically treated SIS. Worker job title, smoking status, height, weight, and age were registered on health examination. Job titles were mapped to 21 occupational groups based on tasks and training. A job exposure matrix (JEM) was developed with exposure estimates for each occupational group. Surgical cases were determined through linkage with the Swedish national in- and outpatient registers. Poisson regression was used to assess the relative risks (RR) for each biomechanical exposure. The total incidence rate of surgically treated SIS over the 16-year observation period was 201.1 cases per 100 000 person-years. Increased risk was evident for workers exposed to upper-extremity loading (push/pull/lift) (RR 1.45-2.30), high hand grip force (RR 1.47-2.23), using handheld tools (RR 1.52-2.09), frequent work with hands above shoulders (RR 1.62-2.11), static work (RR 1.77-2.26), and hand-arm vibration (RR 1.78-2.13). There was an increased risk for SIS surgery for all occupational groups (construction trades) compared with white-collar workers (RR 1.56-2.61). Occupational upper-extremity load and posture exposures were associated with increased risk for surgical treatment of SIS, which underlines the need for reducing workplace exposures and early symptom detection in highly exposed occupational groups.

The Effect of Scapular Proprioceptive Neuromuscular Facilitation Techniques on Pain and Functionality in Patients with Subacromial Impingement Syndrome: A Randomized Controlled Trial

Abstract Objective To determine the effectiveness of scapular proprioceptive neuromuscular facilitation (PNF) techniques in patients with subacromial impingement syndrome (SIS). Methods 36 patients were randomized and a 6-week exercise program was applied to both groups 2 days a week. PNF group also received rhythmic initiation and repeated stretch PNF techniques in 2 scapula diagonals. Pain and function were primary outcomes. Active range of motion (ROM), pain pressure threshold (PPT), active myofascial trigger points (MTrPs), scapular dyskinesis, anxiety and depression status were secondary outcomes. Results The improvement in function, internal rotation ROM, PPT, active MTrPs and patient satisfaction was significantly greater in PNF group than exercise group (p&lt;0.05). Scapular dyskinesis improved only in PNF group (p&lt;0.05). Significant improvement in pain, function, ROM, PPT, active MTrPs, anxiety and depression was found in both groups (p&lt;0.05). Conclusions Both scapular PNF techniques and standard exercise program are effective in the treatment of SIS. However, scapular PNF techniques can be added to the exercise program to further improve function, ROM, PPT, active MTrPs, scapular dyskinesis, and patient satisfaction.

Impingement Syndrome: A Review of the Literature

Rotator Cuff tendinopathy (RCT) is a common disorder that poses challenges for effective treatment. Evidence suggests that extrinsic, intrinsic, and combinations of biomechanical mechanisms play a role. There are no significant differences in outcome between conservatively and surgically treated patients with subacromial impingement syndrome (SAIS). For most patients with subacromial impingement syndrome (SAIS), nonsurgical treatment is successful. Surgical intervention is successful in patients who fail nonsurgical treatment. Surgeon experience and intraoperative assessment may guide the method of surgical treatment. Studies have shown that many surgical interventions, including debridement and open and arthroscopic acromioplasty, have been successful. However, there remains a need for high-quality clinical research on the diagnosis and treatment of SAIS. In this review, there are not figures and outcomes.

Short Term Effectiveness of Intraarticular Injection of Methylprednisolone Acetate in Subacromial Impingement Syndrome in A Tertiary Care Hospital

Objective: To determine the effectiveness of intraarticular injection of methylprednisolone acetate in subacromial impingement syndrome. Study Design: Descriptive Case Series Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and MTI, Hayatabad Medical Complex Peshawar for one year duration from February 2020 to February 2021. Methods: Total 100 patients of newly diagnosed subacromial impingement syndrome were enrolled in this study. Patients were aged between 20-60 years. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients did not receive any treatment before were included. Effectiveness of intraarticular injection of methyl prednisolone acetate was measured by using visual analogue scale (VAS) for pain intensity from 0 to 10 by VAS score after 4 weeks.Completedata was analyzed by SPSS 22.0 version. Results: Mean age of the patients was 38.14±7.44 years with mean BMI 25.64±18.9kg/m2. Among 100 cases, 75 (75%) patients were males and 25 (25%) were females. Diabetic patients were 25 (25%) and 14 (14%) patients were gout among all cases. Mean VAS score before treatment was 6.14±4.84 and after treatment VAS score was reduced to 4.41± 3.64. After follow up of 4 weeks VAS score was decreased to 1.11±3.65. Satisfaction among patients were 90 (90%). Conclusion: We concluded in this study that for the treatment of subacromial impingement syndrome, intraarticularinjection of methylprednisolone acetate was effective and useful. It was also observed that VAS score among patients were reduced significantly with should pain. Keywords: Intra articular methylprednisolone injection, Subacromial impingement syndrome, Effectiveness, Visual analogue scale

The effectiveness of high-intensity laser therapy on pain, range of motion, functional capacity, quality of life, and muscle strength in subacromial impingement syndrome: a 3-month follow-up, double-blinded, randomized, placebo-controlled trial.

The aim of this study was to perform a placebo-controlled assessment of the short- and long-term efficiency of high-intensity laser therapy (HILT) in treatment of subacromial impingement syndrome (SAIS). Sixty-three patients (32 in HILT + exercise and 31 in sham HILT + exercise group) who were diagnosed with SAIS were included. The assessments were performed before (baseline, 0) and after treatment (3rd week/12th week). Active range of motion (ROM) with goniometric measurement, pain with visual analog scale (VAS), shoulder function with Constant-Murley score (CMS), quality of life with SF-36 (short-form 36) health survey, muscle strength using isokinetic device (including peak torque level measurements at shoulder internal rotation (IR) and external rotation (ER) at 120, 180, and 210 degrees) were assessed. Significant improvements were determined in the assessments at the 3rd and 12th week controls in both HILT and control groups. In the comparison of the values of the groups (3rd/12th week), the HILT group had a statistically significant improvement compared with the placebo group; in the active shoulder flexion, IR, and ER ROM measurements; in VAS scores; in CMS activities of daily living, ROM, strength and total scores; in all the sub-parameters of SF-36; and in IR 120,180, 210 and ER 120,180 degree/s peak torque values of isokinetic measurements. In the comparison of both groups, HILT + exercise treatment is more effective in reducing pain and increasing the ROM, functioning, quality of life, and the muscular strength assessed with isokinetic in the short and long term.

Short Term Effectiveness of Intraatricular Injection of Methylprednisolone Acetate in Subacromial Impingement Syndrome in a tertiary care hospital.

Objective: To determine mean decrease in VAS pain score of intraarticular injection of methyl prednisolone acetate in patients of subacromial impingement syndrome. Methods: Its Descriptive Case Series/ Quasi experimental study. Study was conducted in department of Orthopedics Unit- I, Jinnah hospital Lahore. Study completed in Six months i.e. from June 2014 to December 2014.After taking an informed consent, 70 newly diagnosed cases of Subacromial impingement syndrome by history and examination (described by the patient as pain in subacromial space when the humerus was elevated or internally rotated and tested by having the patient place his hand on the unaffected shoulder and gradually forward flexing the shoulder (positive impingement sign)which have not received any kind of treatment were included. Results: Effectiveness of intraarticular injection of methyl prednisolone acetate was measured on visual analogue scale (VAS) from 0 to 10 by VAS score after 6 weeks. 70 patients with mean age of 36.2 ± 10.6 years were included. 61 patients (75.7%) were male, 10 patients (14.3%) had gout and 20% were diabetic. Mean pretreatment VAS score was 5.03 ± 1.58 while mean post-treatment VAS score was 3.86 ± 0.839. Mean reduction was 1.17 ± 1.57 ranged from 2 to 6. There was non-significant association of age and diabetes with mean reduction in VAS score while female gender and gout were significantly and negatively associated with treatment outcome. It is concluded that mean reduction in VAS score after 6 weeks of treatment of subacromial impingement syndrome after intra articular methylprednisolone injection is 1.17 ± 1.57 and acceptable. Conclusion: It is concluded that intraatricular injection of methyl prednisolone injection is efficacious and effective for treatment of Subacromial impingement syndrome in Pakistani population. Keyword: subacromial impingement syndrome, intra articular methylprednisolone injection, visual analogue scale, effectiveness.

Evidence-based recommendations for the treatment of mechanical outlet impingement

Abstract Background The benefits of the various therapeutic options for the treatment of subacromial impingement syndrome are a topic of ongoing debate. Several studies on the subject are insufficiently evidence-based, with many other studies being considered controversial by members of the field. Nevertheless, a general opinion against surgical interventions is developing in the media in reference to these systematic reviews and meta-analyses based on insufficiently differentiated literature. Aim of the study This article provides an overview of the literature and examines the outcome after arthroscopic subacromial decompression compared with conservative therapy or diagnostic arthroscopy and bursectomy. Conclusion The outcome for patients treated with conservative therapy or subacromial decompression who explicitly suffered from mechanical outlet impingement (MOI) or mechanical non-outlet impingement (MNOI) has not yet been studied. The main problem concerning almost all published studies is that they are based on a mixture of pathologies. It seems likely that especially patients with a mechanical, and therefore structural, narrowing of the subacromial space can profit more from surgical management than patients with unspecific subacromial pain. Differentiation between the pathologies is crucial for the correct treatment decision, not only for the reduction of symptoms, but most importantly for the preservation of the supraspinatus tendon.

Outcomes of ketorolac versus depomedrol infiltrations for subacromial impingement syndrome: a randomized controlled trial.

Local subacromial infiltration with steroids is a common method of treatment of subacromial impingement syndrome. However, the use of steroids has concerns like tendon rupture, articular cartilage changes and infections. Local NSAIDs infiltration has recently been tried in literature. This study compares the effect of subacromial injections of ketorolac with steroids. A randomized controlled study was planned with 35 patients in each group. Patients in group-1 were infiltrated with subacromial ketorolac (60mg with 2% lignocaine) and in group-2 with a steroid (methylprednisolone-40mg with 2% lignocaine). A similar rehabilitation protocol was followed, and clinical outcomes were analyzed using visual analog scale (VAS) for pain and shoulder pain and disability score (SPADI) and range of motion at one-month and three-months follow-up. Total data of 67 patients were analyzed, as three patients were lost to follow-up. In group 1, mean VAS improved from 7.9 [Formula: see text] 0.95 to 3.19 [Formula: see text] 0.81 (p < 0.001) and SPADI improved from 61.41 [Formula: see text] 11.86 to 28.91 [Formula: see text] 9.06 (p < 0.001) at three months, respectively. In group 2, mean VAS improved from 8.05 [Formula: see text] 0.94 to 2.9 [Formula: see text] 0.64 (p < 0.001) and SPADI improved from 63.45 [Formula: see text] 9.64 to 25.32 [Formula: see text] 6.87 (p < 0.001) at three months, respectively. However, there were no differences in functional outcomes between the groups (p = 0.21 for VAS, p = 0.16 for SPADI). Subacromial ketorolac infiltration has an equivalent outcome as that of steroid infiltration. Ketorolac could be considered as a reasonable alternative to steroids in cases where it is contraindicated.

Ultrasound-guided versus blind subacromial corticosteroid and local anesthetic injection in the treatment of subacromial impingement syndrome: A randomized study of efficacy.

Objectives This study aims to compare the effects of ultrasound (US)-guided and blind subacromial corticosteroid and local anesthetic (LA) injection in the treatment of subacromial impingement syndrome (SIS) on shoulder pain, range of motion (ROM), and functionality.Patients and methods The prospective study was conducted between 01 February 2017 and 31 May 2017. A total of 29 patients with clinical findings and magnetic resonance imaging (MRI) consistent with SIS were randomized into two groups: 14 patients received US-guided subacromial corticosteroid and LA injection and 15 patients received a blind subacromial corticosteroid and LA injection. Patients were evaluated before and one month after treatment. One patient was lost to follow up. The primary outcome measure was a visual analog scale (VAS) for shoulder pain. Secondary outcomes were active shoulder ROM in flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the modified Constant-Murley Score (CMS).Results Twenty eight patients (11 males, 17 females; mean age 39.5 in the US guided group and 42.5 in the blind group; range 20 to 64 years in both groups) completed the study. There was a significant improvement in VAS for shoulder pain, active ROM, DASH questionnaire score and modified CMS in both groups four weeks after treatment (p<0.05). There was no between-group difference in VAS, ROM or DASH questionnaire scores. Following treatment, the modified CMS in the US-guided injection group was higher than in the blind injection group (p=0.02). However, when the mean change in modified CMS in the US-guided injection group was compared to that of the blind injection group, the difference was insignificant (p=0.23).ConclusionBoth US-guided and blind subacromial steroid injection improve shoulder pain, ROM, and functionality in SIS; one treatment option was not found to be superior to the other. Therefore, blind injection can be performed in clinical settings where US is not available. Equally, blind injection can also be performed in patients who have a definite diagnosis of SIS based on clinical and MRI findings.

Morphometric analysis of the acromion process of the scapula

Context: This study was done to analyze the morphometric parameters of the acromion process of human scapulae. The knowledge of morphometry of acromion process is vital for orthopedic surgeons while performing surgeries like acromioplasty for the treatment of subacromial impingement syndrome and repair of rotator cuff tears. Aims: The aim was to study the morphometry of the acromion process of the scapula. Settings and Design: The study was conducted on 105 adult dry human scapulae of unknown age and sex. All damaged human scapulae were excluded from the present study. Subjects and Methods: Length, breadth, thickness of acromion process, coraco-acromial distance, and acromioglenoid distance were measured in millimeter using digital Vernier caliper. Statistical Analysis Used: Data were tabulated. Mean and standard deviation for each parameter were calculated using SPSS version 16.0. Results: The mean acromial length was 41.65 ± 7.57 mm, acromial width was 24.50 ± 2.91 mm, acromial thickness was 7.62 ± 1.34 mm, coracoacromial distance was 33.35 ± 6.12 mm, and acromioglenoid distance was 29.41 ± 4.65 mm. Conclusions: The data obtained in the current study can add to the knowledge that can aid in surgical procedures around the shoulder joint.

Comparison of the Effectiveness of Platelet-Rich Plasma, Corticosteroid, and Physical Therapy in Subacromial Impingement Syndrome.

This study aims to investigate and compare the efficacy of platelet-rich plasma (PRP) injection, corticosteroid injection, and physical therapy in addition to exercise treatment on pain, shoulder functions, and quality of life in patients with subacromial impingement syndrome (SAIS). Ninety patients (37 males, 53 females; mean age 48.99 years; range, 33 to 60 years) who were diagnosed as Stage 2 SAIS were included in the study. Patients were randomized into three groups. PRP injection was administered into the subacromial space of the affected shoulder in group 1, corticosteroid injection was administered in the subacromial joint space in group 2, and 10 sessions of physical therapy were given in group 3 five times weekly including transcutaneous electrical nerve stimulation, ultrasound, and hot packs. Moreover, an exercise program was administered in all groups. Visual Analog Scale (VAS) was used to determine the resting and moving shoulder pain; while the Shoulder Disability Questionnaire, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, and the University of California, Los Angeles Shoulder Rating Scale (UCLA SRS) were used to evaluate the functionality of patients. Quality of life was analyzed using a generic Short Form 36 (SF-36). All scores improved in all three groups compared with the period before treatment. Comparison of the groups showed higher scores in group 1 compared to groups 2 and 3 at week eight on QuickDASH, UCLA SRS, VAS at rest and during activity, and SF-36 pain subgroup scores. All three treatment modalities were effective in the treatment of SAIS. However, we suggest that the inexpensive and noninvasive methods of physical therapy and exercise should be the first preferred treatment in SAIS owing to causing no adverse events.

Clinical and functional outcome comparison for platelet rich plasma with steroid injection in patients with isolated subacromial impingement syndrome

Background: To compare the 6-weeks, 3 and 6 months outcome in 80 patients who received an injection of platelet-rich plasma (PRP) or steroid for sub-acromial impingement syndrome (SIS).Methods: There were 42 males and 38 females received a single-dose injection of PRP (n=40) or steroid (n=40) for SIS that had not responded to conservative treatment for more than 6 months. Both groups were put on physiotherapy protocol followed in our institution. The use of non-steroid anti-inflammatory drugs was prohibited. Patients were evaluated before and 6 weeks, 3 and 6 months after treatment using the constant score, visual analogue scale (VAS) for pain, and range of motion (ROM) of the shoulder.Results: No local or systemic complication occurred. Improvement in the constant score and VAS for pain at week 6, 3 and month 6 was clinically better following steroid than PRP injection. However, this difference was statistically insignificant. The 2 groups were comparable for improvement in ROM of the shoulder.Conclusions: PRP injection was not more effective than steroid injection for treatment of SIS in terms of at the end of 6 months. However, long term studies should be indicated to substantiate the findings.

Clinical and functional outcome comparison for platelet-rich plasma with steroid injection in patients with isolated subacromial impingement syndrome

Objective: The objective of this study is to compare the 6-weeks, 3-, and 6-month outcome in 80 patients who received an injection of platelet-rich plasma (PRP) or steroid for subacromial impingement syndrome (SIS). Materials and Methods: Forty-two males and 38 females received a single-dose injection of PRP (n = 40) or steroid (n = 40) for SIS that had not responded to conservative treatment for more than 6 months. Both groups were put on physiotherapy protocol followed in our institution. The use of nonsteroid anti-inflammatory drugs was prohibited. Patients were evaluated before and 6 weeks, 3 and 6 months after treatment using the constant score, visual analog scale (VAS) for pain, and range of motion (ROM) of the shoulder. Results: No local or systemic complication occurred. Improvement in the Constant score and VAS for pain at 6 weeks, 3-, and 6-months was clinically better following steroid than PRP injection. However, this difference was statistically insignificant. The two groups were comparable for improvement in ROM of the shoulder. Conclusion: PRP injection was not more effective than steroid injection for the treatment of SIS in terms of at the end of 6 months. However, long-term studies should be indicated to substantiate the findings.

Efficacy of Corticosteroid Injection in the Conservative Treatment of Subacromial Impingement Syndrome

Amaç: Çalışmamızın amacı omuz subakromial sıkışma sendromunun (SSS) tedavisinde tek başına fizik tedavi ile fizik tedavi ile kombine subakromial kortikosteroid enjeksiyonu uygulamasının etkinliğinin karşılaştırılmasıdır. Materyal ve Metot: 30‐65 yaş arası, rotator kılıf yırtığı olmayan 56 SSS tanısı alan hasta çalışmaya dahil edildi. Yalnızca fizik tedavi alan hastaların oluşturduğu Grup 1(n=26) ile fizik tedavi ile birlikte subakromial kortikosteroid enjeksiyonu yapılan hastaların oluşturduğu Grup 2(n=30), işlem öncesi döneme kıyasla 3., 6. ve 12. ayda ölçülen Visual Analog Scale (VAS) ve American Shoulder and Elbow Surgeons (ASES) skorlamaları kullanılarak karşılaştırıldı. Bulgular: Her iki grup arasında anlamlı farklılık 3. ve 6. ay VAS ve ASES skorlarında Grup 2(fizik tedavi ile birlikte enjeksiyon uygulaması) lehine bulunmuştur (p<0,001) 12. ay takiplerinde VAS(p=0,539) ve ASES(p=0,117) ölçümlerindeki değişim, gruplar açısından istatistiksel olarak anlamlı değildir. Her iki grupta da işlem öncesi döneme göre 3. ve 6. ay takiplerinde istatistik olarak anlamlı bir artış saptanmıştır. Sonuç: Kortikosteroid enjeksiyonu ile birlikte fizik tedavi uygulaması sadece fizik tedavi uygulaması ile kıyaslandığında kısa dönemde daha etkili olduğu ancak her iki yöntemin de ağrıyı azalttığı ve fonksiyonlarda iyileşme sağladığı düşünülmektedir.