DERYA ÇELİK, Bilsen SİRMEN, MEHMET SELAHATTİN DEMİRHAN

The relationship of muscle strength and pain in subacromial impingement syndrome

Amaç: Subakromiyal sıkışma sendromunda ağrı ile kas gücü arasındaki ilişkiyi incelemeyi amaçladık. Çalışma planı: Çalışmaya Evre I ve Evre II subakromiyal sıkışma sendromu (SSS) tanısı koyulan 18 kadın ve 2 erkek (ort. yaş48.15±5.9 yıl; dağılım 32-60) 20 hasta dahil edildi. Hastaların sıkışma bulgusu pozitif ve negatif olan omuzlarının üst, orta, alt trapez, serratus anterior, supraspinatus ve ön deltoid kas kuvveti el dinamometresi ile değerlendirildi Test kasların en spesifik çalıştığı pozisyonlarda yapıldı. Her kas 3 kere testlenerek ortalaması alındı. Ağrı görsel analog skala (GAS), fonksiyonel durum ise Constant skorları ile değerlendirildi. Modifiye Constant skoru ağrı parametrelerinden bağımsız olarak hesaplandı. Bulgular: Sıkışma bulgusu pozitif olan omuzlarda orta trapez, serratus anterior, supraspinatus ve deltoid ön lişerinde kas gücü sıkışma bulgusu negatif olan omuzlara göre istatistiksel olarak anlamlı derecede düşük bulundu (p=0.01, p=0.04, p=0.001, p=0.003). Ortalama Constant skoru 57.46, ortalama GAS 6.85 bulundu. Modifiye Constant skoru ile GAS arasında istatistiksel olarak anlamlı bir ilişki bulundu (p= 0.016, rs= -0.44). Çıkarımlar: Bu çalışmada orta trapez, serratus anterior, supraspinatus ve deltoid ön lişeri kas zayışığı ve ağrı arasında istatistiksel anlamlı bir ilişki bulunmuştur. Bu sonuç bize SSS’de bu kasların değerlendirilmesinin ve gerekirse kuvvetlendirilmesinin önemini vurgulamaktadır.

Subakromiyal sıkışma sendromunda ağrı ile kas gücü arasındaki ilişkinin değerlendirilmesi

Objective: We evaluated the relationship between muscle strength and pain in subacromial impingement syndrome (SIS). Methods: 18 female, 2 male twenty patients (mean age 48.15±5.9 years; range 32 to 60 years) with Stage I and II SIS were enrolled in the study. Upper, middle and lower trapezius, serratus anterior, supraspinatus and anterior deltoid muscle strengths were assessed bilaterally by a handheld dynamometer. Each muscle was assessed 3 times and the mean value of strength was calculated. Pain and functional results were assessed with visual analog scale (VAS), and Constant scores. Modified Constant score was calculated, with the exclusion of pain parameters. Results: Middle trapezius, serratus anterior, supraspinatus and anterior deltoid muscle strengths of the shoulder with positive impingement signs were significantly lower than healthy opposite side (p=0.01, p=0.04, p=0.01, p=0.003). The mean Constant score was 57.46 and the mean VAS 6.85, in shoulders with SIS. There was a significant correlation between VAS and Constant score, without pain assessment (p=0.016, rs= -0.44). Conclusion: In this study we found a relationship between the middle trapezius, serratus anterior, supraspinatus and anterior deltoid muscle weaknesses and pain in SIS. This result indicates that these muscles should be evaluated and strengthened in required cases during the rehabilitation.

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1. Neer CS 2nd. Impingement lesions. Clin Orthop 1983; (173):70-7.
2. Walter M, Werner A, Stahlschmdt 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.
3. 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.
4. Bang MD, Deyle GD. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement syndrome. J Orthop Sports Phys Ther 2000;30:126-37.
5. Morrison DS, Fragomeni AD, Wodworth P. Non-operative treatment of subacromial impingement syndrome. J Bone Joint Surg Am 1997;79:732-7.
6. Cools AM, Witvrouw EE, Mahieu NN, Danneels LA. Isokinetic scapular muscle performance in overhead athletes with and without impingement symptoms. J Athl Train 2005;40:104-10.
7. Roy JS, Moffet H, Hebert LJ, Lirette R. Effects 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.
8. Hayes K, Walton JR, Szomor ZL, Murrell GA. Reliability of 3 methods for assessing shoulder strength. J Shoulder Elbow Surg 2002;11:33-9.
9. Kibler WB, Sciascia A, Dome D. Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med 2006;34:1643-7.
10. Smith J, Kotajarvi BR, Padgett DJ, Eischen JJ. The effect of scapular protraction on isometric shoulder rotation strength in normal subjects Arch Phys Med Rehabil 2002;83:367-70.
11. Yen D. Limitations of isokinetic testing to determine shoulder strength after rotator cuff repair. Iowa Orthop J 2005;25:141-4.
12. Plotnikoff NA, MacIntyre DL. Test-retest reliability of glenohumeral internal and external rotator strength. Clin J Sport Med 2002;12:367-72.
13. MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elbow Surg 2004;13:593-8.
14. Erol O, Özçakar L, Çeliker R. Shoulder rotator strength in patients with stage I-II subacromial impingement: relationship to pain, disability, and quality of life. J Shoulder Elbow Surg 2008;17:893-7.
15. Moraes GF, Faria CD, Teixeira-Salmela LF. Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. J Shoulder Elbow Surg 2008;17:48-53.
16. Park JY, Lee WS, Lee ST. The strength of the rotator cuff before and after subacromial injection of lidocaine. J Shoulder Elbow Surg 2008;17:8-11.
17. Tyler TF, Nahow RC, Nicholas SJ, McHugh MP. Quantifying shoulder rotation weakness in patients with shoulder impingement. J Shoulder Elbow Surg 2005;14: 570-4.
18. Falla DL, Hess S, Richardson C. Evaluation of shoulder internal rotator muscle strength in baseball players with physical signs of glenohumeral joint instability. Br J Sports Med 2003;37:430-2.
19. Shaklar A, Dvir Z. Isokinetic strength relationships in shoulder muscles. Clin Biomech (Bristol, Avon) 1995;10: 369-73.
20. Hislop HJ, Montgomery J. Daniels and Worthington’s Manuel de¤erlendirme teknikleri. Çeviri Ed. Özdinçler AR, Yeldan ‹, Demirbafl B. 2008. p. 1-11.
21. Michener LA, Boardman ND, Pidcoe PE, Frith AM. Scapular muscle tests in subjects with shoulder pain and functional loss: reliability and construct validity. Phys Ther 2005;85:1128-38.
22. Moseley JB, Jobe FW, Pink M. EMG analysis of scapular muscles during a shoulder rehabilitation program. Am J sports Med1992; 20:128-34.
23. Decker MJ, Hintermeister HA, Faber KJ, Hawkins RJ. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med 1999;27:784-98.
24. Kelly BT, Kadrmas WR, Speer KP. The manual muscle examination for rotator cuff strength. An electromyographic investigation. Am J Sports Med 1996;24:581-8.
25. Chester R, Smith TO, Hooper L, Dixon J. The impact of subacromial impingement syndrome on muscle activity patterns of the shoulder complex: a systematic review of electromyographic studies. BMC Musculoskelet Disord 2010;11:45.
26. Ludewig PM, Cook TM Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther 2000;80:276-91.
27. Cools AM, Witvrouw EE, Declercq GA, et al. Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. Am J Sports Med 2003;31:542-9.
28. Cools AM, Declercq GA, Cambier DC, et al. Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms. Scand J Med Sci Sports 2007;17:25-33.
29. Cools AM, Witvrouw EE, Declercq GA, et al. Evaluation of isokinetic force production and associated muscle activity in the scapular rotators during a protraction-retraction movement in overhead athletes with impingement symptoms. Br J Sports Med 2004;38:64-8.
30. Cools AM, Witvrouw EE, Mahieu NN, Danneels LA. Isokinetic scapular muscle performance in overhead athletes with and without impingement symptoms. J Athl Train 2005;40:104-10.
31. Moraes GF, Faria CD, Teixeira-Salmela LF. Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. J Shoulder Elbow Surg 2008;17:48-53.
32. Wadsworth DJ, Bullock-Saxton JE. Recruitment patterns of the scapular rotator muscles in freestyle swimmers with subacromial impingement. Int J Sports Med 1997;18:618-24.
33. Reddy AS, Mohr KJ, Pink MM, Jobe FW. Electromyographic analysis of the deltoid and rotator cuff muscles in persons with subacromial impingement. J Shoulder Elbow Surg 2000;9:519-23.
34. Othman A, Taylor G. Is the Constant score reliable in assessing patients with frozen shoulder? 60 shoulders scored 3 years after manipulation under anaesthesia. Acta Orthop Scand 2004;75:114-6.
35. Turner Turner N, Ferguson K, Mobley BW, Riemann B, Davies G. Establishing normative data on scapulothoracic musculature using handheld dynamometry. J Sport Rehabil 2009;18:502-20.
36. Kibler WB, Sciascia Aaron. Current concepts: scapular dyskinesis. Br J Sports Med 2010;44:300-5.
37. Merolla G, Santis E, Sperling JW, Campi F, Paladini P, Paladini P, Porcellini G. Infraspinatus strength assessment before and after scapular muscles rehabilitation in professional volleyball players with scapular dyskinesis. J Shoulder Elbow Surg 2010;24:1-9.
38. Leroux JL, Hebert P, Mouilleron P, Thomas E, Bonnel F, Blotman F. Postoperative shoulder rotators strength in stages II and III impingement syndrome. Clin Orthop Relat Res 1995;(320):46-5.