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PURPOSE: To investigate whether scapular movement training (SMT) is superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain. METHODS AND METHODS: A total of 64 individuals with chronic shoulder pain were randomly assigned to receive 16 sessions of SMT or SE over 8 weeks. Outcome measures included three-dimensional scapular kinematics, muscle activity of scapulothoracic muscles, pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes. Kinematics and muscle activity were assessed at baseline and after treatment, and self-reported measurements at baseline, 4, 8, and 12 weeks. RESULTS: SMT significantly (p < 0.05) decreased scapular internal rotation during arm elevation and lowering at sagittal and scapular planes (mean difference [MD]: ranged from 2.8 to 4.1°), and at lower angles of arm elevation and lowering at the frontal plane (MD: 3.4° and 2.4°, respectively), increased upper trapezius (UT) activity (MD: 10.3%) and decreased middle trapezius (MT) (MD: 60.4%) and serratus anterior (MD: 9.9%) activity during arm lowering compared to SE. Both groups significantly improved pain, disability, fear-avoidance, kinesiophobia, and self-perceived changes over 4 weeks, which was sustained over the remaining 8 weeks. CONCLUSIONS: SMT is not superior to standardized exercises in improving scapular biomechanics, behavioral, and clinical aspects of individuals with shoulder pain. CLINICAL TRIAL REGISTRATION NUMBER: NCT03528499Implications for rehabilitationScapular movement training (SMT) showed small and likely not clinically relevant changes in scapular kinematics and muscle activity compared to standardized exercises.SMT and standardized exercises presented similar improvements in pain, disability, fear-avoidance beliefs, kinesiophobia, and self-perceived change in health condition immediately following 4-weeks of treatment, which was sustained over the following 8 weeks.The changes in patient-reported outcome measures are unlikely to be associated with changes in scapular kinematics and electromyographic activity.Clinicians should consider other factors than scapular movement during the treatment of patients with shoulder pain.

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BACKGROUND: Deficits in movement and muscle activation of scapulohumeral joint are related to Subacromial Pain Syndrome. Electromyography biofeedback during exercise may enhance muscle activation and coordination, and consequently improve pain and shoulder function. METHODS: This study compared the effects of an exercise protocol with and without using electromyographic biofeedback on pain, function and movement of the shoulder complex in subjects with Subacromial Pain Syndrome. A total of 24 patients with subacromial pain (mean age = 46.2 + 8.1;18 women) were randomized to either therapeutic exercise or exercise plus biofeedback to the trapezius and serratus muscles. Pain and shoulder function were evaluated as the primary outcome and range of motion, muscle strength, electromyographic activity and scapulohumeral kinematics as secondary outcomes. The subjects underwent eight weeks of intervention and comparisons were made between groups in baseline, at 4 weeks, 8 weeks, and at 4 weeks post intervention. FINDINGS: There were differences between groups for pain [mean difference = 1.5 (CI 0.3, 3.2) p = 0.01] at 8 weeks in the Exercise group and scapular upward rotation at 60° of arm elevation [mean difference = 13.9 (CI 0.9, 9.3), p = 0.006] in the Biofeedback group. There was no difference for the other variables of scapular kinematics as well as for shoulder function (DASH), muscle strength, range of motion and electromyographic variables. INTERPRETATION: The addition of Biofeedback to the exercise protocol increased upward rotation of the scapula. However, the volunteers who performed only the Exercises had a better response in reducing pain.

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OBJECTIVE: To determine the effectiveness of kinesiotaping (KT) with or without co-interventions for clinical outcomes in patients with subacromial impingement syndrome (SIS). DESIGN: Systematic review with meta-analysis of randomized clinical trials. DATA SOURCES: Eight databases (MEDLINE, CENTRAL, EMBASE, PEDro, LILACS, CINAHL, SPORTDiscus, and Web of Science) were searched from inception until March 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Clinical trials that determine the effectiveness of KT with or without co-interventions for clinical outcomes in patients with SIS who are older than 18 years of age. RESULTS: Ten trials for the quantitative analysis were included. For pain intensity at 1-3 weeks, the overall pooled MD was -0.73 cm, 95% CI = -1.50 to 0.04 (p = 0.06), and at 3-6 weeks, it was -0.13 cm, 95% CI = -1.37 to 0.36 (p = 0.25). For shoulder function, the MD was -0.02, 95%CI = -0.30 to 0.26 (p = 0.89). For shoulder Range of Motion (ROM) flexion, the MD was -16.70, 95% CI = -0.52 to 33.92 (p = 0.06). Additionally, there was a low to moderate quality of evidence according to the GRADE rating. CONCLUSION: Kinesiotaping with or without co-interventions was not superior to other interventions for improving shoulder pain intensity, function and ROM flexion in patients with SIS.

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RESUMEN: El pinzamiento de hombro es la principal causa del hombro doloroso. Dentro de las estrategias terapéuticas propuestas se encuentra la terapia manual. En este contexto, la maniobra de Mulligan, implica una rotación axial en sentido anterior de la clavícula, emulando la acción del músculo subclavio, lo cual hipotéticamente aumentaría el espacio subacromial. Sin embargo, no existen antecedentes que proporcionen sustento experimental a dicha hipótesis. El objetivo del presente estudio fue explorar si la rotación axial de la clavícula, producida por la maniobra de Mulligan, tiene efecto sobre la presión registrada en el espacio subacromial, con el propósito disponer de antecedentes metodológicos que puedan contribuir al diseño de futuros estudios que aborde la problemática expuesta y consideren un mayor tamaño de muestra. Mediante un estudio exploratorio ex-vivo, se evaluaron dos preparados anatómicos que comprendían la escapula, la clavícula y los dos tercios proximales del humero, ambos con indemnidad de la articulación glenohumeral y acromioclavicular. En estos se registraron la presión en el espacio subacromial y la rotación axial de la clavícula, todo durante la realización de una maniobra de rotación axial clavicular en sentido anterior. Se analizaron las diferencias de presión entre una condición basal y durante la maniobra, como también la máxima rotación axial de clavícula. Dichas variables fueron registradas mediante un sensor de presión y un sistema de análisis de movimiento. La presión en el espacio subacromial durante la maniobra, disminuyó en todas las repeticiones en un rango comprendido entre el 21-51 % de la presión basal. La máxima rotación axial registrada estuvo entre los 3.9-10°. Los resultados de este estudio exploratorio, dan pie para hipotetizar que la maniobra de rotación axial anterior de la clavícula produce una disminución de la presión subacromial, en el área comprendida inmediatamente bajo el acromion.

SUMMARY: Shoulder impingement is the main cause of shoulder pain. Manual therapy is one of the proposed therapeutic strategies. In this context, the Mulligan maneuver implies anterior axial rotation of the clavicle, emulating the action of the subclavius muscle, which hypothetically would increase the subacromial space. However, there are no antecedents that provide experimental support for this hypothesis. The objective of the present study was to explore whether the axial rotation of the clavicle, produced by the Mulligan maneuver, has an effect on the pressure registered in the subacromial space, with the purpose of having methodological antecedents that can contribute to the design of future studies that address the problem exposed and consider a larger sample size. Through an ex-vivo exploratory study, two anatomical preparations comprising the scapula, clavicle, and proximal two-thirds of the humerus, both with glenohumeral and acromioclavicular joint sparing, were evaluated. In these, the pressure in the subacromial space and the axial rotation of the clavicle were recorded, all during the performance of an anterior clavicular axial rotation maneuver. Pressure differences between a basal condition and during the maneuver were analyzed, as well as the maximum axial rotation of the clavicle. These variables were recorded using a pressure sensor and a movement analysis system. The pressure in the subacromial space during the maneuver decreased in all repetitions in a range between 21-51% of the basal pressure. The maximum axial rotation recorded was between 3.9-10°. The results of this exploratory study give rise to the hypothesis that the anterior axial rotation maneuver of the clavicle produces a decrease in subacromial pressure, in the area immediately below the acromion.

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RESUMEN Introducción: el síndrome subacromial es una afección caracterizada por el pinzamiento tendinoso intraarticular por osteofitos o estrechamiento del espacio. Objetivos: evaluar la técnica de Neer en el tratamiento de pacientes con síndrome subacromial y los factores y actividades que favorecen esta afección. Materiales y métodos: se realizó un estudio observacional, descriptivo, prospectivo a pacientes con síndrome subacromial tratados con acromioplastia por la técnica de Neer. El universo lo conformaron 66 pacientes mayores de 20 años, que presentaron síndrome subacromial con síntomas por más de seis meses, y que fueron tratados con la técnica de Neer. Resultados: el sexo más afectado fue el femenino, con 65,2 %. Predominó el grupo etario de 41 a 50 años. El dolor en etapa prequirúrgica fue de moderado a severo en un 77,2 %, y nulo o leve después de la operación. La función en etapa prequirúrgica estuvo afectada de moderada a severa en un 68,1 %, y nula o leve después del tratamiento quirúrgico. La flexión anterior activa estuvo por debajo de 90º en un 83,1 % antes de ser operados, y por encima de 90º en un 80,3 % en el posquirúrgico. La fuerza muscular era mala o regular en etapa prequirúrgica en un 77,2 %, resultando ser excelente o buena después de la operación. Conclusiones: una vez aplicada la técnica de Neer, el dolor fue leve o nulo en la mayoría del universo, la función del hombro fue buena, la flexión anterior adecuada, y buena la fuerza muscular. Se recomienda emplear esta técnica quirúrgica en esta afección (AU).

ABSTRACT Introduction: subacromial syndrome is a condition characterized by intra-articular tendinous impingement by osteophytes or narrowing of space. Objective: to evaluate Neer's technique in the treatment of patients with subacromial syndrome and the factors and activities favoring this condition. Materials end methods: an observational, descriptive, prospective study was performed in patients with subacromial syndrome treated with acromioplasty using Neer's technique. The universe was formed by 66 patients aged over 20 years, who presented subacromial syndrome with symptoms for more than 6 months, and were treated with Neer's technique. Results: the most affected sex was the female one, with 65.2 %. The age group aged 41 to 50 years predominated. In pre-surgical stage, pain ranged from moderate to severe in 77.2 %, and from null to mild after surgery. Preoperative function was moderate to severe in 68.1 % and null or mild after surgical treatment. The previous active flexion was below 90° in 83.1 % before being operated, and above 90° in 80.3 % after surgery. Muscle strength was poor or regular in pre-surgical stage in 77.2 %, being excellent or good after surgery. Conclusions: once Neer's technique was applied, the pain was mild or null in most of the universe, the shoulder function was good, the anterior flexion adequate, and the muscle strength good (AU).

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BACKGROUND: Interventions focused on the scapula should be considered in treating subacromial pain syndrome (SAPS). However, the effect of adding scapular stabilization exercises to protocols of progressive strengthening of the shoulder complex muscles on a non-multimodal approach remains unclear. OBJECTIVE: To investigate the effect of adding scapular stabilization exercises, emphasizing retraction, and depression of the scapula, to a progressive periscapular strengthening protocol on disability, pain, muscle strength, and ROM in patients with SAPS. DESIGN: Randomized, controlled, superiority trial, prospectively registered, two-arms, parallel, blind assessor, blind patient, and allocation concealment. METHODS: Sixty patients with SAPS were randomly allocated into two groups: Periscapular Strengthening (PSG) or Scapular Stabilization (SSG) exercises. The interventions were performed three times a week for eight weeks. The primary outcome function and secondary outcomes (Pain, kinesiophobia, global perceived effect, satisfaction with treatment, the range of motion, scapula position and muscle strength) were measured in the baseline, four weeks, eight weeks (end of intervention) and 16 weeks after baseline. Shoulder pain and function were assessed by the Brazilian version of the Shoulder Pain and Disability Index (SPADI-Br). RESULTS: A total of 60 patients were included and randomized to PSG (n = 30) or SSG (n = 30) from March 2016 to June 2017. There were no between group differences in primary and secondary outcomes at any time point. CONCLUSION: The inclusion of the isolated scapular stabilization exercises, emphasizing retraction and depression of the scapula, to a progressive general periscapular strengthening protocol did not add benefits to self-reported shoulder pain and disability, muscle strength, and ROM in patients with SAPS. TRIAL REGISTRATION: ClinicalTrials.gov.

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BACKGROUND: The most common cause of injury is shoulder impingement syndrome. Management includes physical therapy, analgesics, steroids and surgery. The aim of the study was to determine the cost-effectiveness of using steroids combined with therapeutic exercise at home in the chronic impingement syndrome. METHODS: Clinical trial randomized in 30 people with subacromial impingement syndrome underwent two treatments: steroid and at home rehabilitation booklet evaluated at the first and fourth week through UCLA Shoulder rating scale. RESULTS: We studied 17 men (56.7 %) and 13 women (43.3 %), mean age was 42.87 years. Group 2 earned greater improvement in UCLA Shoulder rating scale 18.87 at baseline and 27.60 at the end. With 30.27 accumulated disability days for group 1, and 14.80 for group 2. CONCLUSIONS: The combination of local steroids with therapeutic exercise is more effective clinically and declining disability compared to conventional physical therapy.

INTRODUCCIÓN: la causa de lesión de hombro más frecuente es el síndrome de pinzamiento subacromial. Su manejo incluye fisioterapia, analgésicos, esteroides y cirugía. El objetivo de este trabajo fue determinar el costo-efectividad del uso de esteroides combinado con ejercicio terapéutico en casa en el síndrome de pinzamiento subacromial (SIS). MÉTODOS: ensayo clínico aleatorizado en 30 trabajadores con síndrome de pinzamiento subacromial sometidos a dos tratamientos: esteroide con folleto de rehabilitación en casa y terapia de rehabilitación convencional, ambos grupos evaluados a la primera y cuarta semana mediante la escala de hombro de UCLA. RESULTADOS: estudiamos a 17 hombres (56.7%) y 13 mujeres (43.3%), con edad media de 42.87 años (9.133 DE). El grupo 2 obtuvo mayor mejoría en la escala de evaluación del hombro de la UCLA con una puntuación de 18.87 al inicio y 27.60 al final. Con 30.27 días acumulados de incapacidad para el grupo 1 y 14.80 para el grupo 2. CONCLUSIONES: la combinación de esteroides locales con ejercicio terapéutico es más efectivo clínicamente y reporta una disminución en el número de incapacidades en comparación con la terapia física convencional.

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OBJECTIVE: The purpose of this study was to compare the immediate effects of mobilization with movement (MWM) with sham technique on range of motion (ROM), muscle strength, and function in patients with shoulder impingement syndrome. METHODS: A randomized clinical study was performed. Participants (mean age ± standard deviation, 31 ± 8 years; 56% women) were divided into 2 groups: group 1 (n = 14), which received the MWM technique in the first 4 sessions and the sham technique in the last 4 sessions; and group 2 (n = 13), which was treated with the opposite order of treatment conditions described for group 1. Shoulder ROM, isometric peak force assessed with a handheld dynamometer, and function as determined through the Disabilities of the Arm, Shoulder and Hand and Shoulder Pain and Disability Index (SPADI) questionnaires were collected at preintervention, interchange, and postintervention moments. RESULTS: Two-way analysis of variance revealed no significant group-by-time interaction for any outcome but did reveal a main time effect for shoulder external rotation (P = .04) and abduction (P = .01) ROM, Disabilities of the Arm, Shoulder and Hand (P < .01), SPADI Pain (P < .01), SPADI Function (P < .01), and SPADI Total (P < .01). Only abduction movement and SPADI Pain overcame the clinical relevance threshold. The isometric peak force tests revealed no effects. CONCLUSION: The MWM technique was no more effective than a sham intervention in improving shoulder ROM during external rotation and abduction, pain, and function in patients with shoulder impingement syndrome.

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Introducción: la capsulitis adhesiva del hombro es una enfermedad que anatómicamente se caracteriza por una retracción fibrosa de la cápsula articular; lo que produce una gran limitación de la movilidad de la articulación glenohumeral, tanto activa como pasiva, en todos los movimientos. Objetivos: evaluar la efectividad de la técnica de acupuntura y kinesioterapia en pacientes con capsulitis adhesiva del hombro, así como determinar grado de dolor y la limitación funcional en los pacientes antes y después del tratamiento. Métodos: ensayo clínico terapéutico controlado para evaluar la efectividad de la acupuntura y kinesioterapia en 62 pacientes con capsulitis adhesiva del hombro, atendidos en el Policlínico Docente "Dr. Tomás Romay" del municipio Artemisa, desde enero del año 2014 hasta enero del 2015. Se conformaron 2 grupos (de estudio y control) de 31 integrantes en cada uno: los primeros recibieron acupuntura y kinesioterapia; los segundos: tratamiento de electroterapia y kinesioterapia. Resultados: a las 20 sesiones terapéuticas, el dolor se alivió considerablemente en los integrantes del grupo de estudio, lo cual tuvo diferencias significativas entre ambos grupos con respecto a la intensidad del mismo (p< 0,05). A los 3 meses la mejoría en el grupo estudio fue notable, con respecto al grupo control, tanto en el alivio del dolor como en la función habilidad del hombro. Conclusiones: se consideró de buena efectividad el tratamiento aplicado con acupuntura y kinesioterapia en la capsulitis adhesiva del hombro. Tanto el alivio del dolor como la limitación funcional de la articulación del hombro desde las primeras 20 sesiones de tratamiento, mejoraron notablemente(AU)

Introduction: Adhesive capsulitis of shoulder is a diseases anatomically characterized by a fibrous retraction of the articular capsule, which produces great limitation in all both active and passive glenohumeral motions. Objective: To evaluate the acupuncture and kinesiotherapy technique effectiveness in patients with adhesive capsulitis of shoulder, as well as to determine pain degree and functional limitation in patients before and after treatment. Methods: Controlled clinical therapeutic essay for assessing acupuncture and kinesiotherapy effectiveness in 62 patients with adhesive capsulitis of shoulder, attended in "Dr. Tomás Romay" Teaching Polyclinic of Artemisa Municipality, from January 2014 to January 2015. Two groups were made up (control group and study group) by 31 members each: the first ones received acupuncture and kinesiotherapy; the second ones, electrotherapy treatments and kinesiotherapy. Results: After 20 therapeutic sessions, the pain let up considerably in the study group members, which were significantly different between both groups regarding pain intensity (p< 0.05). After three months, the study group improvement was noticeable as compared with the control group regarding both pain relief and shoulder function-ability. Conclusions: The acupuncture and kinesiotherapy treatment was assumed as fairly affective in adhesive capsulitis of shoulder. Both pain relief and functional limitation of the shoulder as of the first 2o sessions of treatment improved noticeably(AU)

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BACKGROUND: Painful shoulder impingement syndrome is one of the first reasons for care in rehabilitation centres. As the evidence regarding the effectiveness of physical measures as adjuvant treatment is limited, the aim of this study was to determine the effectiveness of physiotherapy on shoulder pain. MATERIAL AND METHODS: A retrospective and analytical study was conducted using the medical records of patients with shoulder pain who attended in a rehabilitation centre from October 2010 to September 2011. The demographic and clinical data were collected, and the clinical improvement was determined as: complete, incomplete, or no improvement. STATISTICAL ANALYSIS: Chi squared was used to determine whether there were differences between the different modalities of physiotherapy, as well as the level of improvement. RESULTS: The study included a total of 181 patients, with a mean age of 54.3 years, and a mean of 4.6 months of onset of pain. The physiotherapy treatments included: warm compresses plus interferential current (60.2%), and warm compresses plus ultrasound (17.1%). Just over half (53.6%) obtained a moderate recovery, 36.4% slight improvement, and 9.9% no improvement. No significant differences were found between the different forms of therapy. CONCLUSIONS: The supervised rehabilitation program consists of 9 sessions of physiotherapy. A functional improvement of 90% was obtained, without finding any statistical differences between the therapies used.

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