Document Type: Original Articles
Department of Biomechanics and Sport Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran.
Background: Current conservative management of subacromial impingement syndrome (SIS) involves generic strengthening exercises, especially for internal (IR) and external (ER) shoulder rotators. So far, no study has directly investigated the difference in muscle strength between patients with SIS and normal subjects. Accordingly, the purpose of the current study was to compare the shoulder rotator muscles eccentric and concentric peak torque in patients with SIS and normal subjects.Methods: This study was a cross sectional research. Twenty-four patients with SIS (23.33±2.47 Years) and 24 normal subjects (22.83±2.15 Years), matched for hand dominance and physical activity level, completed isokinetic shoulder IR and ER testing. Within the SIS group, 18 patients had the symptoms in their dominant and 6 patients in their non-dominant side. The IR and ER strengths of both sides were measured separately using continuous reciprocal concentric and eccentric contraction cycles at speeds of 60 and 120 degrees per second, respectively. The values of peak torque were compared using independent t-tests between the SIS and normal groups.Results: Significantly lower concentric ER peak torque at 120 º/second (p = 0.016), eccentric ER peak torque at 60 º/second (p = 0.022), eccentric ER peak torque at 120 º/second (p = 0.043), and eccentric IR peak torque at 60 º/second (p = 0.036) and 120 º/second (p = 0.040) were identified in the symptomatic SIS group dominant shoulder compared to the control group dominant shoulder.Conclusion: Changes in eccentric and concentric peak torque in SIS group may be related to the limb dominancy, which may have clinical implications for strengthening regimes. Therefore, clinicians’ and therapeutic exercise expertise may benefit from eccentric isokinetic exercises for shoulder IR and ER rotators in order to design a treatment plan for patients with SIS.
- Page P. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. International journal of sports physical therapy. 2011;6(1):51.
- Lewis JS, Green AS, Dekel S. The aetiology of subacromial impingement syndrome. Physiotherapy. 2001;87(9):458-69.
- Hanchard N, Cummins J, Jeffries C. Evidence-based clinical guidelines for the diagnosis, assessment and physiotherapy management of shoulder impingement syndrome. The Chartered Society of Physiotherapy. 2004.
- Roren A, Nguyen C, Palazzo C, Fayad F, Revel M, Gregory T, et al. Kinematic analysis of the shoulder complex after anatomic and reverse total shoulder arthroplasty: A cross-sectional study. Musculoskeletal Science and Practice. 2017;29:84-90.
- Lewis JS. Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment? British journal of sports medicine. 2009;43(4):259-64.
- Lewis JS. Rotator cuff tendinopathy: a model for the continuum of pathology and related management. British journal of sports medicine. 2010;44(13):918-23.
- Graichen H, Bonel H, Stammberger T, Haubner M, Rohrer H, Englmeier K, et al. Three-dimensional analysis of the width of the subacromial space in healthy subjects and patients with impingement syndrome. AJR American journal of roentgenology. 1999;172(4):1081-6.
- Hebert LJ, Moffet H, Dufour M, Moisan C. Acromiohumeral distance in a seated position in persons with impingement syndrome. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2003;18(1):72-9.
- HallstrÃ¶m E, KÃ¤rrholm J. Shoulder kinematics in 25 patients with impingement and 12 controls. Clinical Orthopaedics and Related Research (1976-2007). 2006;448:22-7.
- Land H, Gordon S. Clinical assessment of factors associated with subacromial shoulder impingement: a systematic review. Physical Therapy Reviews. 2016;21(3-6):192-206.
- Holmgren T, Hallgren HB, Ãberg B, Adolfsson L, Johansson K. Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. Bmj. 2012;344:e787.
- Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. Journal of shoulder and elbow surgery. 2009;18(1):138-60.
- Land H, Gordon S. What is normal isokinetic shoulder strength or strength ratios? A systematic review. Isokinetics and Exercise Science. 2011;19(4):231-41.
- Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Archives of physical medicine and rehabilitation. 2009;90(11):1898-903.
- Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. JBJS. 2005;87(7):1446-55.
- Hawkins R, Kennedy J. Impingement syndrome in athletes. The American journal of sports medicine. 1980;8(3):151-8.
- Kessel L, Watson M. The painful arc syndrome. Clinical classification as a guide to management. The Journal of bone and joint surgery British volume. 1977;59(2):166-72.
- Hanchard NC, Lenza M, Handoll HH, Takwoingi Y. Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement. The Cochrane database of systematic reviews. 2013.
- Roach KE, BudimanâMak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1991;4(4):143-9.
- Dogu B, Sahin F, Ozmaden A, Yilmaz F, Kuran B. Which questionnaire is more effective for follow-up diagnosed subacromial impingement syndrome? A comparison of the responsiveness of SDQ, SPADI and WORC index. Journal of back and musculoskeletal rehabilitation. 2013;26(1):1-7.
- Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27(1):117-26.
- MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. Journal of Shoulder and Elbow Surgery. 2004;13(6):593-8.
- Erol Ã, ÃzÃ§akar L, Ãeliker R. Shoulder rotator strength in patients with stage I-II subacromial impingement: relationship to pain, disability, and quality of life. Journal of shoulder and elbow surgery. 2008;17(6):893-7.
- Dulgeroglu D, Kirbiyik E, Ersoz M, Ozel S. Evaluation of shoulder rotational strength in patients with subacromial impingement syndrome using a computerized isokinetic dynamometer. Journal of musculoskeletal pain. 2013;21(1):23-30.
- Tyler TF, Nahow RC, Nicholas SJ, McHugh MP. Quantifying shoulder rotation weakness in patients with shoulder impingement. Journal of shoulder and elbow surgery. 2005;14(6):570-4.
- Akyol Y, Yasemin U, DurmuÅ D, Tander B, CantÃ¼rk F, Bilgici A, et al. Shoulder Muscle Strength in Patients With Subacromial Impingement Syndrome: Its Relationship With Duration of Quality of Life and Emotional Status. Journal of Physical Medicine & Rehabilitation Sciences/Fiziksel Tup ve Rehabilitasyon Bilimleri Dergisi. 2013;16(3).
- Moraes GF, Faria CD, Teixeira-Salmela LF. Scapular muscle recruitment patterns and isokinetic strength ratios of the shoulder rotator muscles in individuals with and without impingement syndrome. Journal of Shoulder and Elbow Surgery. 2008;17(1):S48-S53.
- Anderson VB, Bialocerkowski AE, Bennell KL. Testâretest reliability of glenohumeral internal and external rotation strength in chronic rotator cuff pathology. Physical therapy in sport. 2006;7(3):115-21.
- Leroux J-L, Codine P, Thomas E, Pocholle M, Mailhe D, Blotman F. Isokinetic evaluation of rotational strength in normal shoulders and shoulders with impingement syndrome. Clinical orthopaedics and related research. 1994(304):108-15.