Kromer TO, Tautenhahn UG, De Bie RA, et al. Effects of physiotherapy in patients with shoulder impingement syndrome: a systematic review of the literature
To critically summarize the effectiveness of physio-therapy in patients presenting clinical signs of shoulder impingement syndrome.
Randomized controlled trials were searched electronically and manually from 1966 to December 2007. Study quality was independently assessed by 2 reviewers using the Physiotherapy Evidence Database (PEDro) scale. If possible, relative risks and weighted mean differences were calculated for individual studies, and relative risks or standardized mean differences for pooled data, otherwise results were summarized in a best evidence synthesis.
Sixteen studies were included, with a mean quality score of 6.8 points out of 10. Many different diagnostic criteria for shoulder impingement syndrome were applied. Physio-therapist-led exercises and surgery were equally effective treatments for shoulder impingement syndrome in the long term. Also, home-based exercises were as effective as combined physiotherapy interventions. Adding manual therapy to exercise programmes may have an additional benefit on pain at 3 weeks follow-up. Moderate evidence exists that passive treatments are not effective and cannot be justified.
This review shows an equal effectiveness of physiotherapist-led exercises compared with surgery in the long term and of home-based exercises compared with combined physiotherapy interventions in patients with shoulder impingement syndrome in the short and long term; passive treatments cannot be recommended for shoulder impingement syndrome. However, in general, the samples were small, and different diagnostic criteria were applied, which makes a firm conclusion difficult. More high-quality trials with longer follow-ups are recommended.
Available from: Liv Heide Magnussen
- "At present, no systematic review focusing solely on the treatment effect of LLLT for shoulder tendinopathy has been published. Previous reviews covering the effect of physiotherapy interventions in general have not advocated LLLT as a potential option for treating shoulder tendinopathy (Green et al., 2003; Kromer et al., 2009), primarily because of conflicting findings across an insufficient number of published trials. However , none of these reviews assessed the validity of the LLLT treatment variables and procedures. "
- "We used EndNote X6 to create a bibliographic database to manage the search results. As a supplemental search, we hand-searched the reference lists of previous systematic reviews for any additional relevant studies (Desmeules et al., 2003; Kromer et al., 2009; Kuhn, 2009; Braun and Hanchard, 2010; Kelly et al., 2010; Hanratty et al., 2012; Littlewood et al., 2012; Verhagen et al., 2013). "
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ABSTRACT: Exercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear.
Determine the effectiveness of exercise for shoulder pain.
We searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology.
We retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care.
The evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care.
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Available from: Ferdi Yavuz
- "The goals of management in patients with SAIS are to relieve pain, improve joint stiffness, restore muscle strength, and maximize dynamic shoulder function . Conservative treatment methods include analgesic drugs, modification of daily activities, physical treatment modalities such as ultrasound (US) therapy, low-level laser therapy (LLLT), extracorporal shock wave therapy, interferential current therapy, transcutaneus electrical nerve stimulation (TENS) and acupuncture , range of motion and strengthening exercises, and subacromial steroid injections  . Low-level laser therapy is widely used in various rheumatologic and musculoskeletal disorders. "
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ABSTRACT: The aim of this study was to compare the effectiveness of low-level laser therapy and ultrasound therapy in the treatment of subacromial impingement syndrome.
Thirty one patients with subacromial impingement syndrome were randomly assigned to low-level laser therapy group (n=16) and ultrasound therapy group (n=15). Study participants received 10 treatment sessions of low-level laser therapy or ultrasound therapy over a period of two-consecutive weeks (five days per week). Outcome measures (visual analogue pain scale, Shoulder Pain and Disability Index -SPADI-, patient's satisfactory level and sleep interference score) were assessed before treatment and at the 1st and 3rd months after treatment. All patients were analyzed by the intent-to-treat principle.
Mean reduction in VAS pain, SPADI disability and sleep interference scores from baseline to after 1 month, and 3 months of treatment was statistically significant in both groups (P< 0.05). However, there was no significant difference in the mean change in VAS pain, SPADI disability and sleep interference scores between the two groups (P > 0.05). The mean level of patient satisfaction in group 1 at the first and third months after treatment was 72.45 ± 23.45 mm and 71.50 ± 16.54 mm, respectively. The mean level of patient satisfaction in group 2 at the first and third months after treatment was 70.38 ± 21.52 mm and 72.09 ± 13.42 mm, respectively. There was no significant difference in the mean level of patient satisfaction between the two groups (p > 0.05).
The results suggest that efficacy of both treatments were comparable to each other in regarding reducing pain severity and functional disability in patients with subacromial impingement syndrome. Based on our findings, we conclude that low-level laser therapy may be considered as an effective alternative to ultrasound based therapy in patients with subacromial impingement syndrome especially ultrasound based therapy is contraindicated.
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