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Shoulder Function and 3-Dimensional Kinematics in People With Shoulder Impingement Syndrome Before and After a 6-Week Exercise Program

PW McClure, PT, PhD, is Associate Professor, Department of Physical Therapy, Arcadia University, 450 S Easton Rd, Glenside, PA 19038 (USA) (mcclure{at}arcadia.edu)
J Bialker, PT, MPT, is Physical Therapist, Penn Therapy and Fitness: University of Pennsylvania Medical Center
N Neff, PT, MPT, is Research Physical Therapist, Department of Physical Therapy, Arcadia University
G Williams, MD, is Orthopaedic Surgeon, Shoulder and Elbow Service, Department of Orthopaedic Surgery, University of Pennsylvania Medical Center
A Karduna, PhD, is Assistant Professor, Department of Exercise and Movement Science, University of Oregon, Eugene, Ore

Address all correspondence to Dr McClure

Background and Purpose. Shoulder impingement syndrome is a common condition and is often managed with an exercise program. The purpose of this study was to examine an exercise program in patients with shoulder impingement syndrome. Specifically, the purpose was to identify changes that might occur in 3-dimensional scapular kinematics, physical impairments, and functional limitations. Subjects. Fifty-nine patients with impingement syndrome were recruited, and 39 patients successfully completed the 6-week rehabilitation program and follow-up testing. Impingement was defined as having at least 3 of 6 predefined clinical signs or symptoms. Methods. Subjects were assessed before and after a 6-week rehabilitation program and again at 6 months. Pain, satisfaction, and function were measured using the University of Pennsylvania Shoulder Scale. Range of motion, isometric muscle force, and 3-dimensional scapular kinematic data also were collected. Subjects were given a progressive exercise program that included resistive strengthening, stretching, and postural exercises that were done daily at home. Subjects also were given shoulder education related to anatomy, the basic mechanics of impingement, and strategies for reducing load on the shoulder. Each subject attended one physical therapy session per week for a 6-week period, primarily for monitoring and upgrading the exercise program. Pretest and posttest scores were compared using paired t tests and repeated-measures analysis of variance. Results. Passive range of motion increased for both external and internal rotation but not for elevation. Abduction external and internal rotation force all increased. There were no differences in scapular kinematics. Improvements were found for pain, satisfaction, and shoulder function and for Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) scores related to physical function. At 6-month follow-up, improvements made in pain, satisfaction, and function were maintained. Discussion and Conclusion. The use of this exercise protocol in the management of shoulder impingement syndrome may have a positive impact on patients' impairments and functional limitations. Our findings suggest a relatively simple exercise program combined with patient education may be effective and, therefore, merits study in a larger trial using a control group. Changes in scapular kinematics did not appear to be a primary mechanism underlying improvement in symptoms and function.

Key Words: Biomechanics • Exercise • Shoulder impingement • Shoulder kinematics

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