Deya ÇELİK, GÜLSEREN DERYA AKYÜZ, İpek YELDAN

Subakromiyal sıkışma sendromunda iki farklı egzersiz programının ağrı üzerine etkilerinin karşılaştırılması

Amaç: Akut veya subakut subakromiyal sıkışma sendromunda (SSS) 90° altında ve üstünde yapılan iki farklı egzersiz programının ağrı üzerine etkinliği karşılaştırıldı. Çalışma planı: Çalışmada, akut veya subakut SSS tanısı konan 30 hasta (23 kadın, 7 erkek; ort. yaş 52; dağılım 34-70) rastlantısal yöntemle eşit sayıda iki gruba ayrıldı. Grup 1’e 90 derecenin altında, grup 2’ye ise 90° ve üstünde egzersiz programı uygulandı. Standard egzersiz programına ek olarak, iki gruba da transkutanöz elektrik sinir uyarımı, kesikli ultrason ve buz uygulandı; steroid olmayan antienflamatuvar ilaç verildi. Tedavi süresi iki hafta (10 seans) idi. Ağrının değerlendirilmesinde Constant ağrı skoru, görsel analog skala (GAS) ve yüz skalası kullanıldı. Hastaların psikolojik durumları Beck Depresyon Ölçeği ile değerlendirildi. Hasta/terapist memnuniyeti ölçüldü. Değerlendirmeler başlangıç, 2. ve 16. haftalarda yapıldı. Sonuçlar: Constant ağrı skoru, GAS skoru ve yüz skalasında 2. hafta ve 16. hafta sonunda iki grupta da anlamlı iyileşme görüldü. Yüz skalasında grup 2’de 2-16. haftalar arasındaki değişim anlamlı bulunmadı. Beck Depresyon Ölçeği’ndeki düzelme iki grupta da anlamlıydı. Hasta memnuniyetindeki değişimler iki grupta da anlamlıyken, ﬁzyoterapist memnuniyetinde 2-16. haftalar arasındaki artış sadece grup 1’de anlamlıydı. Gruplararası karşılaştırmalarda, Constant ağrı skorundaki değişimler anlamlı fark göstermedi. Grup 1’de 2. haftada GAS skoru, 16. haftada yüz skalası skoru anlamlı olarak daha iyi bulundu. Beck depresyon değerlendirmesi ve hasta/ﬁzyoterapist memnuniyeti iki grupta benzer bulundu. Çıkarımlar: Subakromiyal sıkışma sendromunda egzersizlerin 90 derecenin altında uygulanması (ağrısız hareket açıklığ) GAS ve yüz skorlarında ek düşüşlere yol açmıştır.

Anahtar Kelimeler:

Ağrı ölçümü, Egzersiz tedavisi, Fizik tedavi yöntemleri, Omuz sıkışma sendromu, Omuz ağrısı

Comparison of the effects of two different exercise programs on pain in subacromial impingement syndrome

Objectives: We compared the effects of two different exercise programs below or above 90 degrees on pain in subacromial impingement syndrome (SIS). Methods: Thirty patients (23 females, 7 males; mean age 52 years; range 34-70) with acute or subacute SIS were randomly assigned to two groups, equal in number, to receive an exercise program below (group 1) or above (group 2) 90°, respectively. In addition to the standard exercise program, transcutaneous electrical nerve stimulation, intermittent ultrasound, and cold pack were applied, and a nonsteroidal anti-inﬂammatory drug was given. Treatment lasted two weeks (10 sessions). Pain was assessed using the Constant score, a visual analog scale (VAS), and face score, and psychologic state was assessed with the Beck Depression Inventory. Satisfaction levels of the patients and the therapist were measured. Assessments were made before, and 2 and 16 weeks after treatment. Results: Both groups had signiﬁcant improvements in the Constant score, VAS score, and face score at 2 and 16 weeks. Change in the face score between 2 and 16 weeks was not signiﬁcant in group 2. Improvements in the Beck Depression Inventory were signiﬁcant in both groups. While patient satisfaction signiﬁcantly increased in both groups, increase in the therapist’s satisfaction between 2 and 16 weeks was signiﬁcant only in group 1. The two groups did not differ with respect to changes in the Constant score, whereas VAS score at 2 weeks and face score at 16 weeks were signiﬁcantly better in group 1. The two groups were similar with respect to improvements in the Beck Depression Inventory and patient/ therapist satisfaction. Conclusion: The exercise program below 90 degrees (painfree range of motion) resulted in additional improvements in VAS and face scores in SIS.

Keywords:

Pain Measurement, Exercise Therapy, Physical Therapy Modalities, Shoulder Impingement Syndrome, Shoulder Pain,

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1. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg [Am] 1972;54:41-50.
2. Giannakopoulos K, Beneka A, Malliou P, Godolias G. Isolated vs. complex exercise in strengthening the rotator cuff muscle group. J Strength Cond Res 2004;18:144-8.
3. Werner A, Walther M, Ilg A, Stahlschmidt T, Gohlke F. Self-training versus conventional physiotherapy in subacromial impingement syndrome. Z Orthop Ihre Grenzgeb 2002;140:375-80. [Abstract]
4. Morrison DS, Frogameni AD, Woodworth P. Non-operative treatment of subacromial impingement syndrome. J Bone Joint Surg [Am] 1997;79:732-7.
5. Walther M, Werner A, Stahlschmidt T, Woelfel R, Gohlke F. The subacromial impingement syndrome of the shoulder treated by conventional physiotherapy, self-training, and a shoulder brace: results of a prospective, randomized study. J Shoulder Elbow Surg 2004;13:417-23.
6. Conroy DE, Hayes KW. The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome. J Orthop Sports Phys Ther 1998;28:3-14.
7. Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther 2004;17:152-64.
8. Conboy VB, Morris RW, Kiss J, Carr AJ. An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg [Br] 1996;78:229-32.
9. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983;16:87-101.
10. Lorish CD, Maisiak R. The Face Scale: a brief, nonverbal method for assessing patient mood. Arthritis Rheum 1986;29:906-9.
11. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
12. Evangelou E, Tsianos G, Ioannidis JP. Doctors’ versus patients’ global assessments of treatment effectiveness: empirical survey of diverse treatments in clinical trials. BMJ 2008;336:1287-90.
13. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidencebased rehabilitation protocol. J Shoulder Elbow Surg 2009; 18:138-60.
14. Kamkar A, Irrgang JJ, Whitney SL. Nonoperative management of secondary shoulder impingement syndrome. J Orthop Sports Phys Ther 1993;17:212-24.
15. Lombardi I Jr, Magri AG, Fleury AM, Da Silva AC, Natour J. Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum 2008;59:615-22.
16. Ludewig PM, Borstad JD. Effects of a home exercise programme on shoulder pain and functional status in construction workers. Occup Environ Med 2003;60:841-9.
17. McClure PW, Bialker J, Neff N, Williams G, Karduna A. Shoulder function and 3-dimensional kinematics in people with shoulder impingement syndrome before and after a 6-week exercise program. Phys Ther 2004;84:832-48.
18. Roy JS, Moffet H, Hébert LJ, Lirette R. Effect of motor control and strengthening exercises on shoulder function in persons with impingement syndrome: a single-subject study design. Man Ther 2009;14:180-8.
19. Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moiré topographic analysis. Clin Orthop Relat Res 1992;(285):191-9.
20. Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop Surg 2003;11:142-51.
21. Yeldan I, Cetin E, Özdincler AR. The effectiveness of lowlevel laser therapy on shoulder function in subacromial impingement syndrome. Disabil Rehabil 2009;31:935-40.
22. Skolimowski J, Winiarski S, Demczuk-Włodarczyk E, Barczyk K, Skolimowska B, Dudek K. Principles of physiotherapeutic management of shoulder impingement syndrome. Ortop Traumatol Rehabil 2008;10:508-19. [Abstract]