Sunday, June 13, 2010

Scapular mobilization an effective manual therapy in painful limitations of shoulder



2 misconceptions about subacromial impingement & adhesive capsulitis

Subacromial impingement (SI) syndrome is a painful condition that occurs during overhead activities as the rotator cuff is compressed in the subacromial space. Unrecognized secondary causes of subacromial impingement may lead to treatment failure. Posterior capsular tightness, believed to alter glenohumeral joint kinematics, is often cited as a secondary cause of SI.

Karduna et al examined the effects of scapular orientation on clearance in the subacromial space in a cadaver study. Results from this study demonstrated no significant effect of posterior tilting and external rotation of the scapula but subacromial clearance was found to decrease with an increase in upward rotation, which is contrary to what was expected. These results suggest that changes in upward rotation observed in patients with impingement syndrome may serve to open the subacromial space.

In adhesive capsulitis there is tightening of posterior capsule. Poitras et al tried to test the conventional hypothesis that tightening of the posterior capsule would lead to increased subacromial pressure and increased superior translation during active abduction in the scapular plane. However contrary to their belief they found in their study tightening of the posterior capsule did not increase subacromial pressure, or increase superior or anterior translation during abduction in the scapular plane.

Scapular mobilization in shoulder painful limitations

Manual therapy is an important treatment in impingement syndrome: Senbursa et al compared the effectiveness of two physical therapy treatment approaches for impingement syndrome, either by joint and soft tissue mobilization techniques or by a self-training program. This study though a brief clinical trial showed patients treated with manual therapy combined with supervised exercise lead to improvement of symptoms including increasing strength, decreasing pain and improving function earlier than with exercise program only.

Scapular upward rotation is usually manifested in subacromial impingement cases or stiff shoulders secondary to subacromial impingement leading to adhesive capsulitis.

Surenkok et al evaluated the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function.

After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS (Constant shoulder score) between pretreatment and post-treatment compared with the sham and control groups. So this study found SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.

References:

1. Karduna AR et al; J Shoulder Elbow Surg. 2005 Jul-Aug; 14 (4):393-9. (Contact forces in the subacromial space: effects of scapular orientation.)
2. Poitras P et al; J Shoulder Elbow Surg. 2010 Apr; 19 (3):406-13. Epub 2009 Dec 11. (The effect of posterior capsular tightening on peak subacromial contact pressure during simulated active abduction in the scapular plane.)
3. Senbursa G et al; Knee Surg Sports Traumatol Arthrosc. 2007 Jul; 15 (7):915-21. Epub 2007 Feb 28. (Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clinical trial.)
4. Surenkok O, et al; J Sport Rehabil. 2009 Nov; 18 (4):493-501. (Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial.)



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