Rotator Cuff Impingement

Current evidence for nonpharmacological interventions and criteria for surgical management of persistent acromioclavicular joint osteoarthritis: A systematic review

BACKGROUND

The primary aim of this systematic review was to investigate the individual/combined effectiveness of nonpharmacological interventions in individuals with persistent acromioclavicular joint osteoarthritis. The secondary aims were to investigate the comparative effectiveness of nonpharmacological versus surgical interventions, and to identify the criteria used for defining failure of conservative interventions in individuals who require surgery for persistent acromioclavicular joint osteoarthritis.

METHOD

Major electronic databases were searched from inception until October 2018. Studies involving adults aged 16 years and older, diagnosed clinically and radiologically with isolated acromioclavicular joint osteoarthritis for at least three months or more were included. Studies must explicitly state the type and duration of conservative interventions. Methodological risk of bias was assessed using the Modified Downs and Black checklist.

RESULTS

Ten surgical intervention studies were included for final synthesis. No studies investigated the effectiveness of nonpharmacological interventions or compared them with surgical interventions. Common nonpharmacological interventions trialed from the 10 included studies were activity modification (n = 8) and physiotherapy (n = 4). Four to six months was the most often reported timeframe defining failure of conservative management (range 3-12 months).

CONCLUSIONS

Currently, there is no evidence to guide clinicians about the individual or combined effectiveness of nonpharmacological interventions for individuals with persistent acromioclavicular joint osteoarthritis.

Comparison of the Efficacy of Conventional Physical Therapy Modalities and Kinesio Taping Treatments in Shoulder Impingement Syndrome

Objective

The aim of the present study was to compare the effectiveness of kinesio taping (KT) treatments and conventional physical therapy (PT) modalities that are applied to reduce pain and improve physical movements and functions of patients with sub acromial impingement syndrome (SIS).

Materials and Methods

Forty patients were randomly divided into two equal groups. The first group was assigned KT plus home exercise program (HEP) for 15 days. The second group was given 15 sessions of PT and HEP. Patients were assessed using active joint range of motion (ROM), Visual Analogue Scale (VAS; rest, movement, and night pain), the Society of the American Shoulder and Elbow Surgeons Evaluation (ASESS-100), Constant-Murley (C-M) scale, and Western Ontario Rotator Cuff (WORC) index at before and after treatment and at the end of the study (first month control visit).

Results

Physical therapy was found to be more effective than KT when these two treatment modalities were assessed based on ASESS-100, WORC index values, night pain, and movement pain. PT and KT treatments have similar effects in active ROM, rest pain, and C-M scale. At the end of the study, they were found to have similar effects except the night pain value. PT was found to be more effective for night pain than KT.

Conclusion

Physical therapy was concluded to be more effective after treatment. The application of KT does not appear to be an alternative treatment method for SIS, but it can provide a potential supportive care for SIS. However, the outcomes suggest that KT can provide a remarkable benefit.

Manual physical therapy for injection-confirmed nonacute acromioclavicular joint pain

STUDY DESIGN

Prospective single-cohort study.

OBJECTIVES

To determine and document changes in pain and disability in patients with primary, nonacute acromioclavicular joint (ACJ) pain treated with a manual therapy approach.

BACKGROUND

To our knowledge, there are no published studies on the physical therapy management of nonacute ACJ pain. Manual physical therapy has been successful in the treatment of other shoulder conditions.

METHODS

The chief inclusion criterion was greater than 50% pain relief with an ACJ diagnostic injection. Patients were excluded if they had sustained an ACJ injury within the previous 12 months. Treatment was conducted utilizing a manual physical therapy approach that addressed all associated impairments in the shoulder girdle and cervicothoracic spine. The primary outcome measure was the Shoulder Pain and Disability Index. Secondary measures were the American Shoulder and Elbow Surgeon and global rating of change scales. Outcomes were collected at baseline, 4 weeks, and 6 months. The Shoulder Pain and Disability Index and American Shoulder and Elbow Surgeon scale values were analyzed with a repeated-measures analysis of variance.

RESULTS

Thirteen patients (11 male; mean ± SD age, 41.1 ± 9.6 years) completed treatment consisting of an average of 6.4 sessions. Compared to baseline, there was a statistically significant and clinically meaningful improvement for the Shoulder Pain and Disability Index at 4 weeks (P = .001; mean, 25.9 points; 95% confidence interval [CI]: 11.9, 39.8) and 6 months (P<.001; mean, 29.8 points; 95% CI: 16.5, 43.0), and the American Shoulder and Elbow Surgeon scale at 4 weeks (P<.001; mean, 27.9 points; 95% CI: 14.7, 41.1) and 6 months (P<.001; mean, 32.6 points; 95% CI: 21.2, 43.9).

CONCLUSION

Statistically significant and clinically meaningful improvements were observed in all outcome measures at 4 weeks and 6 months, following a short series of manual therapy interventions. These results, in a small cohort of patients, suggest the efficacy of this treatment approach but need to be verified by a randomized controlled trial.

LEVEL OF EVIDENCE

Therapy, level 4.

A systematic review of manipulative therapy for the treatment of shoulder pain

OBJECTIVE

The purpose of this systematic review is to discuss the evidence for manipulative methods of management of shoulder pain and chiropractic management techniques used within the literature.

METHODS

A literature search of MEDLINE, CINAHL, MANTIS, the Cochrane Musculoskeletal Group trials register and the Cochrane Controlled Trials Register was conducted. Search terms included chiropractic or manipulative therapy and shoulder pain, impingement, rotator cuff, shoulder instability, shoulder joint, treatment or rehabilitation exercises. Publications were included if they contained shoulder pain or contained a specific clinical diagnosis of a shoulder pain syndrome in the title; a detailed description of the treatment intervention which was typical of the profession; treatment performed by a registered practitioner and outcome measures were included in the studies. Exclusion criteria included the diagnosis of adhesive capsultis or referred/pathological pain. The articles were reviewed and clinical trials ranked on the Physiotherapy Evidence Database scale.

RESULTS

From a total of 913 retrieved publications, 22 case reports, 4 case series and 4 randomized, controlled trials met the inclusion and exclusion criteria for this review.

CONCLUSIONS

The literature contains 2 articles of reasonably sound methodology. The evidence for chiropractic management of shoulder pain is limited to low level evidence in the form of case reports and case series and 1 small controlled trial. There is a need for more well-designed, trials investigating multi-modal chiropractic management for shoulder pain.

Chiropractic treatment of upper extremity conditions: a systematic review

OBJECTIVE

This study investigates the scope, type, and quality of chiropractic research conducted on the management of upper limb peripheral conditions.

METHOD

A literature search regarding upper limb and chiropractic treatment was performed on CINAHL, MEDLINE, and MANTIS databases. Search terms included chiropractic, shoulder, elbow, wrist, hand, forearm, and arm, with MeSH terms for each region. For articles to be considered relevant, there had to be a peripheral diagnosis and chiropractic intervention. Papers were excluded if pain was referred from spinal sites. Duplicates, articles published in non-peer-reviewed literature, conference proceedings, grand rounds, and discussion papers where no treatment was actually rendered were also removed. The articles were then reviewed and assessed for quality using the Physiology Evidence Database (PEDro) scale.

RESULTS

There was a total of 64 articles found. There were 36 case reports for the shoulder, 8 case reports for the elbow, 14 case reports for the wrist/hand, and 6 clinical trials (3 shoulder, 1 elbow 2 wrist). For the PEDro score, 58 case reports scored 0, 1 clinical trial scored 7, 2 clinical trials scored 6, 2 clinical trials scored 4, and 1 clinical trial scored 0.

CONCLUSION

There is a small amount of chiropractic research into upper limb conditions that is comprised mostly of case studies (level 4 evidence) and a small number of higher-level publications (level 1-3 evidence). Most treatments are multimodal in nature, which address both spinal and peripheral structures, with joint and soft tissue methods. There is a need for future research to be directed at higher-level evidence, in particular, randomized controlled trials for the chiropractic treatment of upper limb conditions.

Chiropractic Treatment of Lower Extremity Conditions: A Literature Review

OBJECTIVE

The purpose of this study was to document the quantity and type of research conducted on the chiropractic management of lower extremity conditions.

METHODS

A review of the literature was conducted using the CINAHL, MEDLINE, MANTIS, and Science Direct databases (each from inception to December 15, 2005). Search terms included chiropractic, hip, knee, ankle, foot, with Medical Subject Heading terms for each region. Inclusion criteria included studies with a lower extremity diagnosis, and the treatment was performed by doctors of chiropractic. Articles were excluded if pain was referred from spinal sites and if there was a duplicate publication; articles published in non-peer-reviewed literature and abstracts in conference proceedings were also excluded. Of the articles identified, an analysis was conducted assessing those including peripheral and/or spinal treatment. Clinical trials were assessed for quality using the Physiotherapy Evidence Database scale.

RESULTS

There was a total of 1652 citations. Of these, 76 were deemed relevant; 24 were related to the foot, 10 to the ankle, 25 to the knee, and 17 to the hip. Twenty-nine citations included spinal treatment, 47 solely peripheral, and 2 solely spinal. Ten citations were clinical trials and scored on the Physiotherapy Evidence Database scale.

CONCLUSIONS

Literature on the chiropractic management of lower extremity conditions has a large number of case studies (level 4 evidence) and a smaller number of higher-level publications (level 1-3 evidence). The management available in the peer-reviewed literature is predominantly multimodal and contains combined spinal and peripheral components. Future chiropractic research should use higher-level research designs, such as randomized controlled trials.