Used evidence based literature to compare laser therapy treatment versus corticosteroid injections, ultrasound, rehab exercises, and Kinesio taping to treat shoulder impingement.
5. ABOUT THE ATHLETE
19 year old female
Freshman starter
Outside hitter
Has never had previous shoulder injuries
6. PHYSICAL EXAMINATION
Mechanism: Insidious. Reports sharp ache pain. Reports trouble
with ADL’s such as taking off sports bra. Ranks pain 3/10 after px.
No pain during practice
No pervious history
No pain with palpation
AROM: Full ROM but pain at 90 degrees of flexion, 95degrees of
abduction and worst pain with horizontal adduction
Special Tests: Empty can (+), Neers (+), Hawkins Kennedy (+),
Speeds(+), Apprehension (-), Clunk (-),
MMT: Supraspinatus (4/5 with pain), Internal/External (5/5), Pec
minor/major (5/5), Biceps (5/5 with pain)
Diagnosis: Supraspinatus impingement
7. EPIDEMIOLOGY
NCAA injury surveillance system
Ligament sprains and muscle strains are the most common types of injury in
NCAA women’s volleyball.
More than 51 percent of the injuries occur to the lower extremity
Upper extremity, primarily the shoulder region, is at risk of overuse injuries
because of the amount of overhead motion required in the sport.
Accounts for 21.3% of injuries
8. CLINICALLY RELEVANT QUESTION
Among athletes with shoulder impingement, does treatment with
laser therapy result in significant improvements in symptoms and
reductions in complications, as compared to other treatment?
What will we be looking at:
Laser therapy vs. Corticosteroid
Ultrasound vs. Laser therapy
Kinesio taping
Exercises with Laser therapy
10. LOW-LEVEL LASER AND LOCAL CORTICOSTEROID INJECTION IN THE
TREATMENT OF SUBACROMIAL IMPINGEMENT SYNDROME: A
CONTROLLED CLINICAL TRIAL
PEDRO SCALE: 5/11
135 patients with subacromial impingement syndrome
Three groups
Group 1: Corticosteroid
Ground II: Sham Laser treatment
Group III: Laser therapy treatment
Patients were evaluated four times during the study period: pre-treatment,
post-treatment and three and six months after the first
visit
The outcome measurements of our study were pain during
activity and pain at rest
13. SHORT-TERM EFFECTS OF HIGH-INTENSITY LASER THERAPY VERSUS
ULTRASOUND
THERAPY IN THE TREATMENT OF PEOPLE WITH SUBACROMIAL IMPINGEMENT
SYNDROME: A RANDOMIZED CLINICAL TRIAL
PEDRO SCALE: 10/11
70 total patients with SAIS
Total of 10 treatments for a total of 2 consecutive weeks
Randomly assigned to 2 groups
a group of 35 participants received HILT
a group of 35 participants received US therapy
15. STUDY LOOKING AT LASER THERAPY
COMBINED WITH REHABILITATION
EXERCISES
16. THE EFFECTIVENESS OF LOW-LEVEL LASER THERAPY ON
SHOULDER FUNCTION IN SUBACROMIAL IMPINGEMENT SYNDROME
PEDRO: 7/11
67 total patients randomly assigned
Two groups:
received laser
received placebo laser
Both groups were assigned progressive rehabilitation exercises
Assess before and after 3 weeks
18. WHY I USED LASER THERAPY
According to evidence:
Quicker reduction of pain
Improved ROM
Improved overall functionally
Evidence proved little to no value in treating patients with
ultrasound for shoulder pain
Future studies: Need evidence for standard parameters of laser
therapy
20. CLINICAL EFFECTIVENESS OF KINESIOLOGICAL TAPING ON PAIN AND
PAIN FREE SHOULDER RANGE OF MOTION IN PATIENTS WITH SHOULDER
IMPINGEMENT SYNDROME: A RANDOMIZED, DOUBLE BLINDED, PLACEBO
CONTROLLED TRIAL
PEDRO SCALE: 11/11
Methods and Subjects:
A randomized, double blinded, placebo controlled study was conducted
in order to assess the effectiveness of KT in patients with SIS.
Thirty patients
Control Trial received placebo KT with no tension
Experimental trial received a standardized therapeutic KT
24. ROM EXERCISES
Glenohumeral Progression
Condmans Pendulum
Active Assistive motion with cane or contralateral arm
Active motion as comfort dictates
Active motion without elevating scapula
Postural Progression
Shrugs
Shoulder retraction
26. STRENGTHENING EXERCISES
Theraband exercise:
External rotation (humerus adducted to the body)
Internal rotation (humerus adducted to the body)
Rows (seated or standing)
Low trapezius rows
Chair press
Scaption
Press-up (subscapula)
Upright row
27. MANAGEMENT AND OUTCOMES
The patient continued to start and play ever game of the season
Limit hitting/serving
No overhead lifting activities
Patient satisfaction increased at the end of the season
None complaint athlete
28. MANAGEMENT AND OUTCOMES
Patient developed other complications along the way:
Reported tingling and numbing sensation down all her fingertips
Positive Adson’s and Allen's test
Thoracic Outlet syndrome
29. DOCTOR APPOINTMENT
MRI diagnosis
Right shoulder pain
Os Acromial
Subscapular nerve impingement
Infraspanatus atrophy
R Shoulder impingement
EMG Testing
30. DISCUSSION
To answer my clinical question
According to the literature laser therapy is an effective treatment for shoulder
impingement but the combination of rehab exercises and laser therapy
provides no beneficial effect.
31. WHAT WORKED
Graston most effective treatment
Provided therapeutic effect to upper traps, lats, and posterior capsule of
shoulder
Joint Mobs another effective treatment
Began with Grade 1 to II oscillations to alleviate joint pain
Started Grade III to stretch posterior capsule
Active Release Therapy
32. WHAT DIDN’T WORK
Rehab exercises
Patient was not consistent and was difficult to motivate
Educate patient
Laser therapy
Patient was not consistent with coming in for treatments
Alternative method for patient because she was not coming in for
exercises
Stretching before practices or games
Patient did not like to be stretched-believed it made her “shoulder
to lose”
33. WHAT COULD I CHANGE
Rest the patient for a couple of weeks
Begin conservative rehab program within those weeks
Evaluate progression with Patient Reported Outcomes such as
the the DASH questionnair, Shoulder Pain and Disability Index
Eccentric Exercises
34. ECCENTRIC TRAINING IN CHRONIC PAINFUL IMPINGEMENT SYNDROME OF
THE SHOULDER: RESULTS OF A PILOT STUDY
PEDRO SCALE: 4/11
9 patients: All patients had tried different treatment regimens like
rest,
cortisone injections, NSAID, and different types of shoulder
rehabilitation exercises.
The patients estimated the amount of pain in the shoulder during
horizontal shoulder activity on a 100-mm long visual analogue
scale (VAS) before treatment, and 12 weeks and 52 weeks after
treatment
37. REFERENCES
Kelle B, Kozanoglu E. Low-level laser and local corticosteroid injection in the
treatment of subacromial impingement syndrome: a controlled clinical trial.
Clin Rehabil. 2014;28(8):762-771.
Santamato A, Solfrizzi V, Panza F, et al. Short-term effects of high-intensity
laser therapy versus ultrasound therapy in the treatment of people with
subacromial impingement syndrome: a randomized clinical trial. Phys Ther.
2009;89(7):643-52.
Yeldan I, Cetin E, Ozdincler AR. The effectiveness of low-level laser therapy
on shoulder function in subacromial impingement syndrome. Disabil Rehabil.
2009;31(11):935-40.
Shakeri H, Keshavarz R, Arab AM, Ebrahimi I. CLINICAL EFFECTIVENESS
OF KINESIOLOGICAL TAPING ON PAIN AND PAIN‐FREE SHOULDER
RANGE OF MOTION IN PATIENTS WITH SHOULDER IMPINGEMENT
SYNDROME: A RANDOMIZED, DOUBLE BLINDED,
PLACEBO‐CONTROLLED TRIAL. International Journal of Sports Physical
Therapy2013;8(6):800-810.
38. REFERENCES CONTINUED
Jonsson P, Wahlström P, Ohberg L, Alfredson H. Eccentric
training in chronic painful impingement syndrome of the shoulder:
results of a pilot study. Knee Surg Sports Traumatol Arthrosc.
2006;14(1):76-81.
Kuhn JE. Exercise in the treatment of rotator cuff impingement: a
systematic review and a synthesized evidence-based
rehabilitation protocol. J Shoulder Elbow Surg. 2009;18(1):138–
160.
Borstad JD, Ludewig PM. Comparison of three stretches for the
pectoralis minor muscle. J Shoulder Elbow Surg. 2006;15(3):324–
330.
http://datalyscenter.org/programs/ncaa-injury-surveillance-program/.
Accessed November 30, 2014.
This treatment is known to produce analgesic, anti-inflammatory and biostimulating effects.
-The photons of light from laser penetrate deeply into the tissue an accelerate cellular reproduction and growth. The laser light increases the energy available to the cell so that the cell can take on nutrients faster and get rid of waste products
.
Photons are a bundle of light
No randomized, controlled trials have been found in the literature regarding the comparison of corticosteroid injections versus lowlevel laser treatment application in the treatment of subacromial impingement syndrome
-Both pain during activity and pain at rest scores were significantly different in group I and group III compared to group II at three months and six months after the first visit.
-In conclusion, this study demonstrated the positive effects of both low-level laser treatment and local corticosteroid injection in patients with subacromial impingement syndrome. Both methods are
practical, as well as potentially applicable, and they can be used alternatively in localized shoulder disorders, including subacromial impingement syndrome.
Evaluated with VAS
The subjects treated with HILT showed a greater reduction in pain and more improvement in articular movement, functionality, and muscle strength of the affected shoulder than the subjects treated with US therapy
After 3 weeks of combined exercise/LLLT and exercise/placebo LLLT, both groups had improved with their range of motion, pain and shoulder and hand disability scores but there was no between group difference in the scores. This result indicates that the addition of LLLT to exercise therapy confers no additional benefit to patient outcomes in the treatment of SAIS.
R-rest
A-Activity
N-Night
DISCUSSION
The results of this study showed a significant improvement in pain intensity during movement,nocturnal pain, and pain-free shoulder abduction, flexion and scaption ROM immediately after taping as compared to the pre-test values.
The results also revealed no significant difference in pain intensity during movement and shoulder flexion ROM immediately, after three days, and at the one week after placebo taping assessment.
hypothesized to provide positional stimulus through the skin, allow for “more space” by lifting fascia and soft tissue, provide sensory stimulation to assist or limit motion, and aid in removal of edema.
No theraputic effect.
Patient was satisfied for the first couple of minutes into the game.
KT produced an immediate improvement in pain intensity during movement and in the measure of nocturnal pain. However, no longer term effects of KT existed after one week
Borstad et al: randomized trial compared 3 stretch designed to stretch the pectoralis minor-found that door corner to be most effective
McClure et al: Randomized trial compared sleeper stretch and cross arm stretch-found that cross arm stretch more effective
Will need surgery to decompress the subscapular nerve
After 12 weeks of eccentric training, five patients were satisfied with the treatment
For the ‘satisfied’ patients, there was a significant decrease in the VAS (from 62–18 P <0.043
- At the 12-week follow-up, the five patients satisfied with the result of treatment withdrew from the waiting list for surgical treatment.