Ceballos Angel, Zeppieri Giorgio, Bialosky Joel
Department of Rehabilitation, University of Toledo Medical Center.
Department of Rehabilitation, University of Florida.
Int J Sports Phys Ther. 2022 Aug 1;17(5):931-940. doi: 10.26603/001c.36526. eCollection 2022.
Evidence informed management of individuals presenting with subacromial impingement syndrome (SAIS) includes strengthening exercises directed at the shoulder musculature. Patients with subacromial impingement syndrome (SAIS) can present with pain during and after completion of heavy resistance training limiting the applicability of this recommended treatment approach. Blood flow restriction (BFR) training is indicated for patients who have pain while completing heavy resistance training and may represent an important treatment modification for patients with SAIS unable to fully participate in a strengthening exercise program. The purpose of this case series is to describe the inclusion of BFR in the treatment of two patients with SAIS.
Two middle aged, non-operative patients with signs and symptoms consistent with SAIS and high levels of irritability were included. Treatment over one month consisted of three commonly used exercises in the treatment of SAIS in conjunction with a standard BFR protocol: 75 reps broken up into sets of 30,15,15,15 with the BFR cuff placed over proximal humerus.
Immediate within session improvements beyond measurement error were observed in resting pain and pain pressure thresholds at three sites. At the end of the course of treatment, clinically meaningful improvements were observed in patient reported outcomes including the PENN Score, ASES score, and the patient-specific functional scale. Clinically meaningful improvements and change beyond measurement error were also observed in range of motion and strength which (assessed via a handheld dynamometer).
The incorporation of low load resistance training with BFR may be a useful adjunct for treating patients with SAIS to promote exercise-induced hypoalgesia, decrease pain, and increase function in the upper extremity.
循证管理肩峰下撞击综合征（SAIS）患者包括针对肩部肌肉组织的强化训练。肩峰下撞击综合征（SAIS）患者在进行重负荷抗阻训练期间及训练结束后可能会出现疼痛，这限制了这种推荐治疗方法的适用性。血流限制（BFR）训练适用于在完成重负荷抗阻训练时出现疼痛的患者，对于无法充分参与强化训练计划的SAIS患者而言，可能是一种重要的治疗调整方式。本病例系列的目的是描述在两名SAIS患者的治疗中纳入BFR的情况。
纳入了两名中年非手术患者，他们的体征和症状与SAIS相符且疼痛敏感性较高。为期一个月的治疗包括SAIS治疗中常用的三项锻炼，并结合标准的BFR方案：75次重复动作，分为30次、15次、15次、15次几组，将BFR袖带置于肱骨近端。
在三个部位的静息疼痛和疼痛压力阈值方面，观察到在每次训练期间立即出现了超出测量误差的改善。在治疗过程结束时，在患者报告的结局指标中观察到了具有临床意义的改善，包括宾夕法尼亚评分、ASES评分和患者特定功能量表。在活动范围和力量方面（通过手持测力计评估）也观察到了具有临床意义的改善以及超出测量误差的变化。
将低负荷抗阻训练与BFR相结合，可能是治疗SAIS患者的一种有用辅助手段，以促进运动诱发的痛觉减退、减轻疼痛并增加上肢功能。
5级
