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OBJECTIVE: To investigate the effect of low-level laser therapy (LLLT) combined with exercise on shoulder pain and disability in patients with subacromial impingement syndrome (SIS). DESIGN: Randomised controlled trial. SETTING: Pontifical Catholic University. SUBJECTS: We enrolled 120 subacromial impingement syndrome patients. INTERVENTION: Groups I (n = 42), II (n = 42) and III (n = 36) were treated with Low-level laser therapy and exercise, exercise only and Low-level laser therapy only, respectively. Interventions were conducted three times a week for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome was the change in shoulder pain and disability index (SPADI). Secondary outcomes included changes in the numeric pain rating scale and medication intake. RESULTS: Average ages of patients in groups I, II and III were 51.9 ± 8.7 years, 56.0 ± 10.4 years and 54.2 ± 7.1 years, respectively. Pain scores at baseline (P = 0.829), 2 months (P = 0.057) and 3 months follow-ups (p = 0.004) were 6.8 (4.7-7.7), 0.2 (0.0-0.5) and 0.3 (0.0-1.0) for group I; 6.6 (5.7-8.0), 0.5 (0.2-2.0) and 0.2 (0.0-3.3) for group II; and 6.5 (5.1-7.4), 2.4 (0.1-6.7) and 4.0 (2.0-5.0) for group III, respectively. SPADI scores at baseline (P = 0.029), 2 months (P < 0.001) and 3 months follow-ups (P = 0.001) were 60.8 (37.7-70.8), 3.8 (0.0-10.8) and 2.3 (0.8-10.8) for group I; 61.5 (41.5-71.5), 9.2 (3.8-29.2) and 14.2 (1.5-38.0) for the group II; and 73.3 (59.2-80.8), 34.2 (16.9-54.6) and 33.1 (22.3-49.2) for the group III, respectively. CONCLUSION: Low-level laser therapy combined with exercises reduce pain intensity, improve shoulder function and reduces pain intensity and medication intake over 3 months. CLINICAL TRIAL REGISTRATION NUMBER: NCT02725749.

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OBJECTIVE: To determine whether supervised physiotherapy is more effective for functional improvement and pain relief than a home exercise program in subjects with subacromial impingement syndrome. DESIGN: Systematic review and meta-analysis of randomized clinical trials. METHODS: An electronic search was performed in Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared supervised physiotherapy versus home exercise program, in the shoulder function, pain, and range of motion in subjects older than 18 years of age with a medical diagnosis of subacromial impingement syndrome treated conservatively. RESULTS: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, four studies were included. The standardized mean difference for shoulder function was -0.14 points (95% CI: -1.04 to 0.76; p = 0.760), mean difference 0.21 cm (95% CI: -1.36 to 1.78; p = 0.790) for pain, and mean difference 0.62° (95% CI: -7.15 to 8.38; p = 0.880) for range of motion of flexion. CONCLUSION: Supervised physical therapy and home-based progressive shoulder strengthening and stretching exercises for the rotator cuff and scapular muscles are equally effective in patients with subacromial impingement syndrome treated conservatively. TRIAL REGISTRATION NUMBER: CRD42018086348.

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Se efectuó un estudio descriptivo y transversal de 17 pacientes con síndrome doloroso regional complejo, que recibieron rehabilitación en el Departamento de Fisioterapia del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero 2016 hasta febrero 2017, con vistas a caracterizarles según aspectos clínicos y radiográficos. Entre los principales resultados predominaron el tipo 1 de la enfermedad (64,7 por ciento), la etapa precoz (25,0 por ciento), la localización en el miembro superior (82,4 por ciento) y el sexo femenino (58,8 por ciento), entre otros. La corrección postural y la cinesiterapia fueron necesarias independientemente del estadio clínico de la enfermedad. Se concluye que resulta importante efectuar un diagnóstico clínico y radiográfico oportuno, así como ejecutar medidas rehabilitadoras tempranas para evitar la discapacidad y lograr una recuperación funcional óptima

A descriptive and cross-sectional study of 17 patients with complex painful regional syndrome who received rehabilitation in the Physiotherapy Department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital was carried out in Santiago de Cuba, from January, 2016 to February, 2017, aimed at characterizing them according to clinical and radiographical aspects. Among the main results there was a prevalence of the type 1 of the disease (64.7 percent), early stage (25.0 percent), localization in the upper member (82.4 percent) and the female sex (58.8 percent), among others. The postural correction and kinesiotherapy were necessary independently of the clinical stage of the disease. It was concluded that it is important to make an appropriate clinical and radiographic diagnosis, as well as to implement early rehabilitative measures to avoid disability and achieve a good functional recovery

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OBJECTIVE: To investigate the short-term effects of thoracic spine manipulation (TSM) on pain, function, scapular kinematics, and scapular muscle activity in individuals with shoulder impingement syndrome. DESIGN: Randomized controlled trial with blinded assessor and patient. SETTING: Laboratory. PARTICIPANTS: Patients with shoulder impingement syndrome (N=61). INTERVENTIONS: Participants were randomly allocated to TSM group (n=30) or sham-TSM group (n=31) and attended 2 intervention sessions over a 1-week period. MAIN OUTCOME MEASURES: Scapular kinematics and muscle activity were measured at day 1 (baseline, before the first intervention), day 2 preintervention (before second intervention), day 2 postintervention (after the second intervention), and day 3 (follow-up). Shoulder pain and function were assessed by the Disability of the Arm, Shoulder and Hand questionnaire and Western Ontario Rotator Cuff Index at baseline, day 2 preintervention, and follow-up. An assessor blinded to group assignment measured all outcomes. RESULTS: Pain decreased by 0.7 points (95% confidence interval, 1.3-0.1 points) at day 2 preintervention and 0.9 points (95% confidence interval, 1.5-0.3 points) at day 2 postintervention in the TSM group. The Disability of the Arm, Shoulder and Hand questionnaire (P=.01) and Western Ontario Rotator Cuff Index (P=.02) scores improved in both groups. Scapular upward rotation increased during arm lowering (P<.01) at day 2 postintervention (5.3°) and follow-up (3.5°) in the TSM group. Upper trapezius activity increased (P<.05) in the sham-TSM group. Middle trapezius, lower trapezius, and serratus anterior decreased activities in both groups during elevation and lowering of the arm. CONCLUSIONS: TSM may increase scapular upward rotation during arm lowering. TSM does not seem to influence activity of the scapular muscles. The results concerning shoulder pain, function, scapular tilt, and internal rotation are not conclusive.

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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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BACKGROUND: Rotator cuff tears are the leading cause of pain and functional disability of the shoulder. Conservative treatment is an essential part of their management. Despite the limited evidence, rehabilitation is the mainstay of the treatment for rotator cuff tears associated to impingement syndrome. There are current reports on the utility of strengthening with resistance, particularly by eccentric exercise. OBJECTIVE: This report aims to present an overview of the efficacy of eccentric exercises in tendinopathies and current evidence of its benefit in rotator cuff tears. METHODS AND RESULTS: We describe the information available in tendinopathy and analyzed four studies published on eccentric strengthening for rotator cuff tears. There is theoretical evidence about its usefulness in this pathology, but only a controlled clinical trial has been published with data on improvement in strength but not in pain or functionality. CONCLUSIONS: More studies are needed with better methodological designs in order to generate evidence of their utility and recommendation.

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OBJECTIVE: To evaluate the effects of pulsed electromagnetic field (PEMF) and exercises in reducing pain and improving function and muscle strength in patients with shoulder impingement syndrome (SIS). DESIGN: Double-blind, randomized controlled trial with a 3-month posttreatment follow-up. SETTING: Outpatient rehabilitation of a public hospital. PARTICIPANTS: Patients (N=56) between 40 and 60 years of age, with a diagnosis of SIS, were randomly assigned to receive active PEMF (n=26; mean age, 50.1y) or placebo PEMF (n=30; mean age, 50.8y). INTERVENTIONS: After 3 weeks of active or placebo PEMF, both groups performed the same program of exercises that focused on shoulder strengthening. MAIN OUTCOME MEASURES: A visual analog scale, the University of California/Los Angeles shoulder rating scale, the Constant-Murley shoulder score, and handheld dynamometry for muscle strength were used as outcome measures at baseline (pretreatment), at 3 weeks (after active or placebo PEMF), at 9 weeks (postexercise), and at 3 months posttreatment. RESULTS: Patients in the active PEMF group had a higher level of function and less pain at all follow-up time frames compared with baseline (P<.05). However, the placebo PEMF group had increased function and reduced pain only at the 9-week and 3-month follow-ups (P<.05)-that is, after performing the associated exercises. For the shoulder dynamometry, the active PEMF group had increased strength for lateral rotation at 9 weeks (P<.05), and increased strength for medial rotation at 9 weeks and 3 months (both P<.05) when compared with baseline. There was no significant difference for shoulder strength in the placebo PEMF group (P>.05), as well as no significant differences (P>.05) for all outcome measures. CONCLUSIONS: The combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SIS. However, these results should be carefully interpreted because of the lack of differences between groups.

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Objetivo: Evaluar la efectividad en la disminución del dolor aplicando el protocolo propuesto para hombro doloroso por tendinitis del manguito rotador. Diseño: Estudio cuantitativo, prospectivo, longitudinal, comparativo y de orientación clínica. Lugar: Servicio de Medicina Física del Hospital Nacional Dos de Mayo. Participantes: Pacientes entre 35 a 65 años de edad, diagnosticados con hombro doloroso por tendinitis del manguito rotador. Intervenciones: Previo consentimiento informado (anexo 01) a 40 pacientes, se les dividió arbitrariamente en dos grupos: Grupo abordado con el protocolo fisioterapéutico propuesto (casos) y grupo abordado con el protocolo fisioterapéutico estandarizado del Servicio de Medicina Física (control). En el grupo abordado con el protocolo propuesto se aplicó: Compresas Húmedas Calientes (CHC), TENS, aplicación de ultrasonido, técnicas manuales (masoterapia, masaje de fricción transversal, estiramiento palpable y movilizaciones pasivas por el método Kalterborn), estiramientos terapéuticos y ejercicios terapéuticos de fortalecimiento. En el grupo abordado con el protocolo estándar del servicio: Compresas Húmedas Calientes (CHC), aplicación de terapia combinada, masoterapia y ejercicios terapéuticos. Principales medidas de resúltados: Escala Análogo Visual. Resultados: Los pacientes investigados en el presente trabajo fueron sometidos a diferentes tratamientos mencionados anteriormente al cual llamamos grupo B al que se le aplica el tratamiento tradicional y el grupo A al que se le aplica protocolo propuesto, los cuales tienen las siguientes característica, un paciente al cual se aplicó el tratamiento A tiene en promedio de edad de 52.9±4.67, del sexo femenino (85 por ciento), con ocupación de ama de casa, más del 50 por ciento, por otro lado un paciente al cual se aplicó el tratamiento B tiene en promedio de edad de 56.5±3.79, del sexo femenino (85 por ciento), con ocupación de ama de casa más del 50 por ciento, Dolor: Se observa que en el tratamiento A, la diferencia promedio es mayor que el resultado presentado en el tratamiento B; 7.25 Y 5.45 puntos de dolor respectivamente. Se encontró diferencia significativa de la intensidad del dolor inicial con la intensidad de dolor final en ambos grupos (p<0,005). Funcionalidad: Se observa mediante la Escala de Constant que el tratamiento Ala diferencia promedio es mayor que el resultado presentado en el tratamiento B; 40,1 y 38,05 puntos de funcionalidad respectivamente. Conclusiones: En ambos grupos se logra disminuir el dolor, sin embargo, en el grupo abordado con el protocolo fisioterapéutico propuesto el porcentaje de disminución de' dolor alcanzó más del 90 por ciento sin dolor y en el grupo con el protocolo estándar del Servicio de Medicina Física y Rehabilitación sólo alcanzó el 30 por ciento, evidenciando una mayor efectividad en un menor tiempo en el grupo abordado con el protocolo propuesto

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Shoulder impingement syndrome and tendonitis of the rotator cuff are the most common intrinsic causes of shoulder pain and disability. The present literature review addresses general concepts on shoulder impingement syndrome as well as progressive resistance training and different physiotherapy interventions for this condition. The aim was to review what exists in the literature regarding progressive resistance training as a therapeutic approach to shoulder impingement syndrome. The review was carried out using the Lilacs, Medline, Pubmed and Web of Knowledge databases searching for studies published between 2000 and 2008. The following keywords were used: resistance exercises, exercises with weight, resistance training, strength training, painful shoulder, shoulder impingement syndrome, exercise and the translations of these terms in Portuguese. Controlled, randomized clinical trials that assessed the use of resistance training for shoulder impingement syndrome were selected. Articles written in English and Portuguese were included. Only one article on the subject was encountered. The authors stress the need for further studies on this topic, as the method has been widely used on a number of other musculoskeletal disorders.

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OBJECTIVE: To offer a three-dimensional description of the scapular kinematics and scapulohumeral rhythm (SHR) in healthy subjects during quasi-static shoulder abduction. To analyze and compare the influence of loaded and unloaded conditions on scapula kinematics and SHR. DESIGN: Eleven subjects were analyzed using videogrammetry and the application of mathematical modelling during quasi-static shoulder abduction positions (intervals of approximately 30 degrees). MAIN OUTCOME MEASUREMENTS: Scapular kinematic data under unloaded and loaded conditions. RESULTS: The scapula presented external rotation, upward rotation and posterior tilting during the studied movement. Analyzing the scapulohumeral rhythm, different behaviours were observed in the scapular movement planes. Loading condition increased scapular upward rotation and posterior tilt at 60 degrees and 90 degrees of abduction (p>0.01). CONCLUSIONS: Analyzed scapular kinematics and scapulohumeral rhythm showed differences between adopted loading conditions. The clinical applications of these findings are discussed.

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OBJECTIVE: To assess pain, function, quality of life, and muscle strength in patients with shoulder impingement syndrome who participated in muscle strengthening exercises. METHODS: A total of 60 patients diagnosed with shoulder impingement syndrome were selected from the clinics of the Federal University of São Paulo and randomly distributed into experimental and control groups. Patients were evaluated regarding pain, function, quality of life, muscle strength, and the number of antiinflammatory drugs and analgesics taken. Patients then participated in the progressive resistance training program for the musculature of the shoulder, which was held twice a week for 2 months, while the control group remained on a waiting list. RESULTS: Sixty patients were randomly allocated to the experimental group (21 women and 9 men, mean age 56.3 years) and control group (25 women and 5 men, mean age 54.8 years). Patients from the experimental group showed an improvement from 4.2 cm to 2.4 cm on a 10-cm visual analog scale (P < 0.001) regarding pain at rest and from 7.4 cm to 5.2 cm (P < 0.001) regarding pain during movement. Function went from 44.0 to 33.2 (P < 0.007) using the Disabilities of the Arm, Shoulder, and Hand assessment and domains from the Short Form 36. There was a statistically significant difference in improvement in pain and function between patients in the experimental group and those in the control group (P < 0.05). CONCLUSION: The progressive resistance training program for the musculature of the shoulder in patients with shoulder impingement syndrome was effective in reducing pain and improving function and quality of life.

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Este estudo visou verificar se existe diferença, na força gerada durante a abdução do ombro e a atividade eletromiográfica da porção clavidular, acromial e espinhal do músculo deltóide, entre indivíduos saudáveis e portadores da síndrome do impacto do ombro...

This staudy aimed at comparing electromyographic activity of the pars clavicularis, acromialis, and spinalis of the deltoideus muscle, as well as the force exercet during abduction, in helath individuals snd in thodr wilth shoulder impigemen...

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Analizamos el resultado de la descompresión subacromial en pacientes con rupturas totales del manguito rotador reparadas con técnica "mini open" basadas en principios biomecánicos...La edad promedio fue de 60 años, con un rango entre 37 y 63 años. El seguimiento promedio fue de 21 meses. El diagnóstico se basó en el examen clínico y las imágenes, outlet view y RMN

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Analizamos el resultado de la descompresión subacromial en pacientes con rupturas totales del manguito rotador reparadas con técnica "mini open" basadas en principios biomecánicos...La edad promedio fue de 60 años, con un rango entre 37 y 63 años. El seguimiento promedio fue de 21 meses. El diagnóstico se basó en el examen clínico y las imágenes, outlet view y RMN

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