Conroy D E, Hayes K W
Northwestern University Medical School, Programs in Physical Therapy, Chicago, IL, USA.
J Orthop Sports Phys Ther. 1998 Jul;28(1):3-14. doi: 10.2519/jospt.1998.28.1.3.
Primary shoulder impingement syndrome is a common shoulder problem which, if treated ineffectively, can lead to more serious pathology and expensive treatment. This study examined whether subjects receiving joint mobilization and comprehensive treatment (hot packs, active range of motion, physiologic stretching, muscle strengthening, soft tissue mobilization, and patient education) would have improved pain, mobility, and function compared with similar patients receiving comprehensive treatment alone. Subjects were eight men and six women (mean age = 52.9 years) with primary shoulder impingement syndrome (superolateral shoulder pain, decreased active humeral elevation, limited overhead function). Following random assignment to experimental (N = 7) and control groups (N = 7), three blinded evaluators tested 24-hour pain (visual analog scale), pain with subacromial compression test (visual analog scale), active range of motion (goniometry), and function (reaching forward, behind the head, and across the body in an overhead position) before and after nine treatments. One-tailed analyses of covariance (baseline values as covariates) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function (Mann-Whitney U) compared with controls. The experimental group improved on all variables, while the control group improved only on mobility and function (one-tailed, paired t tests; Wilcoxon matched pairs). Age, side of dominance, duration of symptoms, treatment attendance, exercise quality, and adherence had no effect on the outcomes. Results may be affected by inadequate sample size, minimal capsular tightness, insensitive functional scale, nonspecific motion measurements, position at which mobilization treatment was given, or a strong effect of comprehensive treatment. Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome, but larger replication studies are needed to assess more clearly mobilization's influence on motion and function.
原发性肩部撞击综合征是一种常见的肩部问题，如果治疗不当，可能会导致更严重的病变和昂贵的治疗费用。本研究旨在探讨与仅接受综合治疗的类似患者相比，接受关节松动术和综合治疗（热敷、主动活动范围训练、生理拉伸、肌肉强化、软组织松动术和患者教育）的受试者在疼痛、活动度和功能方面是否会有所改善。受试者为8名男性和6名女性（平均年龄=52.9岁），患有原发性肩部撞击综合征（肩部上外侧疼痛、主动肱骨抬高减少、头顶功能受限）。在随机分为实验组（N=7）和对照组（N=7）后，三名盲法评估者在九次治疗前后测试了24小时疼痛（视觉模拟评分）、肩峰下挤压试验时的疼痛（视觉模拟评分）、主动活动范围（角度测量）和功能（向前伸展、头后伸展和头顶位身体交叉伸展）。单因素协方差分析（以基线值作为协变量）显示，与对照组相比，实验组的24小时疼痛和肩峰下挤压试验时的疼痛较轻，但在活动范围和功能方面无差异（曼-惠特尼U检验）。实验组在所有变量上均有改善，而对照组仅在活动度和功能上有改善（单因素、配对t检验；威尔科克森配对检验）。年龄、优势侧、症状持续时间、治疗出勤率、运动质量和依从性对结果无影响。结果可能受到样本量不足、关节囊紧张度最小、功能量表不敏感、运动测量不特异、松动术治疗的位置或综合治疗的强烈影响。关节松动术可减轻原发性肩部撞击综合征患者的24小时疼痛和肩峰下挤压试验时的疼痛，但需要更大规模的重复研究来更清楚地评估关节松动术对运动和功能的影响。
