McClure Philip W, Bialker Jason, Neff Nancy, Williams Gerald, Karduna Andrew
Department of Physical Therapy, Arcadia University, 450 S Easton Rd, Glenside, PA 19038, USA.
Phys Ther. 2004 Sep;84(9):832-48.
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.
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.
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.
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.
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.
肩部撞击综合征是一种常见病症，通常采用运动疗法进行治疗。本研究旨在探讨针对肩部撞击综合征患者的运动疗法。具体而言，目的是确定三维肩胛运动学、身体功能障碍及功能受限方面可能出现的变化。
招募了59例撞击综合征患者，其中39例成功完成了为期6周的康复计划及随访测试。撞击被定义为具备6项预定义临床体征或症状中的至少3项。
在为期6周的康复计划前后以及6个月时对受试者进行评估。使用宾夕法尼亚大学肩部量表测量疼痛、满意度及功能。还收集了活动范围、等长肌力及三维肩胛运动学数据。为受试者制定了渐进性运动计划，包括阻力增强、拉伸及姿势练习，要求在家中每日进行。还向受试者提供了与解剖学、撞击基本力学及减轻肩部负荷策略相关的肩部知识教育。每位受试者在为期6周的时间里每周参加一次物理治疗，主要用于监测和调整运动计划。使用配对t检验和重复测量方差分析比较测试前和测试后的分数。
外旋和内旋的被动活动范围均增加，但抬高活动范围未增加。外展外旋和内旋力量均增加。肩胛运动学方面无差异。疼痛、满意度、肩部功能以及与身体功能相关的医学结局研究简明健康调查问卷（SF - 36）分数均有改善。在6个月随访时，疼痛方面的改善、满意度及功能得以维持。
在肩部撞击综合征的治疗中使用该运动方案可能对患者的功能障碍和功能受限产生积极影响。我们的研究结果表明，一个相对简单的运动计划结合患者教育可能是有效的，因此值得在使用对照组的更大规模试验中进行研究。肩胛运动学的变化似乎并非症状和功能改善的主要潜在机制。
