Guo Rui, Luo Yujun, Xu Yang, Lan Kang, Zhao Yan
College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, China.
Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.
Medicine (Baltimore). 2025 Jan 10;104(2):e41117. doi: 10.1097/MD.0000000000041117.
Subacromial impingement syndrome (SIS) is a common cause of shoulder pain and dysfunction. Modified posterior shoulder stretching exercises have been proposed as a treatment method aimed at improving shoulder function and reducing pain in patients with SIS. However, the efficacy of these exercises remains controversial, necessitating a systematic meta-analysis to comprehensively evaluate their effectiveness.
A systematic search was conducted across PubMed, Cochrane Library, Embase, and Web of Science databases to identify randomized controlled trials (RCTs) and observational studies evaluating the efficacy of modified posterior shoulder stretching exercises in patients with SIS. Inclusion criteria required that participants be diagnosed with SIS, the intervention be modified posterior shoulder stretching exercises, and key outcomes such as shoulder function improvement and pain relief be reported. Meta-analysis was performed using RevMan 5.3 software, calculating standardized mean differences (SMD) with 95% confidence intervals (CI), and heterogeneity and bias risk were assessed.
A total of 10 RCTs with 628 patients were included. The modified posterior shoulder stretching exercises demonstrated significant effects in reducing pain at rest (SMD = -1.00, 95% CI: -1.85 to -0.15, P = .02) and during activity (SMD = -1.45, 95% CI: -2.49 to -0.41, P = .006). Additionally, the exercises showed positive effects in improving internal rotation (SMD = 0.49, 95% CI: 0.22-0.75, P = .0003) and external rotation range of motion (SMD = 0.29, 95% CI: 0.00-0.58, P = .05), as well as enhancing shoulder function (CMS score: SMD = 0.95, 95% CI: 0.64-1.25, P < .00001) and reducing disability (quick DASH score: SMD = -0.85, 95% CI: -1.12 to -0.58, P < .00001). Sensitivity analysis indicated high robustness of the results, and Egger test did not reveal significant publication bias (P > .05).
Modified posterior shoulder stretching exercises are significantly effective in improving shoulder function and reducing pain in patients with SIS, with the study results showing high robustness and low risk of bias. However, further high-quality research is needed to validate these findings.
肩峰下撞击综合征（SIS）是肩部疼痛和功能障碍的常见原因。改良的肩部后伸拉伸运动已被提议作为一种治疗方法，旨在改善SIS患者的肩部功能并减轻疼痛。然而，这些运动的疗效仍存在争议，因此需要进行系统的荟萃分析以全面评估其有效性。
在PubMed、Cochrane图书馆、Embase和Web of Science数据库中进行系统检索，以识别评估改良的肩部后伸拉伸运动对SIS患者疗效的随机对照试验（RCT）和观察性研究。纳入标准要求参与者被诊断为SIS，干预措施为改良的肩部后伸拉伸运动，并报告诸如肩部功能改善和疼痛缓解等关键结果。使用RevMan 5.3软件进行荟萃分析，计算标准化平均差（SMD）及其95%置信区间（CI），并评估异质性和偏倚风险。
共纳入10项RCT，涉及628例患者。改良的肩部后伸拉伸运动在减轻静息时疼痛（SMD = -1.00，95%CI：-1.85至-0.15，P = 0.02）和活动时疼痛（SMD = -1.45，95%CI：-2.49至-0.41，P = 0.006）方面显示出显著效果。此外，这些运动在改善内旋（SMD = 0.49，95%CI：0.22 - 0.75，P = 0.0003）和外旋活动范围（SMD = 0.29，95%CI：0.00 - 0.58，P = 0.05）、增强肩部功能（CMS评分：SMD = 0.95，95%CI：0.64 - 1.25，P < 0.00001）以及减少残疾（快速DASH评分：SMD = -0.85，95%CI：-1.12至-0.58，P < 0.00001）方面也显示出积极效果。敏感性分析表明结果具有高度稳健性，Egger检验未显示出显著的发表偏倚（P > 0.05）。
改良的肩部后伸拉伸运动在改善SIS患者的肩部功能和减轻疼痛方面具有显著效果，研究结果显示出高度稳健性和低偏倚风险。然而，需要进一步的高质量研究来验证这些发现。
