Hombro

Research Report

Shoulder Function and 3-Dimensional
Kinematics in People With Shoulder
Impingement Syndrome Before and
After a 6-Week Exercise Program
Background and Purpose. Shoulder impingement syndrome is a common condition and is often managed with an exercise program. The purpose of this study was
to examine an exercise program in patients with shoulder impingement syndrome.Specifically, the purpose was to identify changes that might occur in
3-dimensional scapular kinematics, physical impairments, and functional limitations. Subjects. Fifty-nine patients with impingement syndrome were recruited,
and 39 patients successfully completed the 6-week rehabilitation program and
follow-up testing. Impingement was defined as having at least 3 of 6 predefined
clinical signs orsymptoms. Methods. Subjects were assessed before and after a
6-week rehabilitation program and again at 6 months. Pain, satisfaction, and
function were measured using the University of Pennsylvania Shoulder Scale.
Range of motion, isometric muscle force, and 3-dimensional scapular kinematic
data also were collected. Subjects were given a progressive exercise program that
included resistivestrengthening, stretching, and postural exercises that were done
daily at home. Subjects also were given shoulder education related to anatomy, the
basic mechanics of impingement, and strategies for reducing load on the
shoulder. Each subject attended one physical therapy session per week for a
6-week period, primarily for monitoring and upgrading the exercise program.
Pretest and posttest scoreswere compared using paired t tests and repeatedmeasures analysis of variance. Results. Passive range of motion increased for both
external and internal rotation but not for elevation. Abduction external and
internal rotation force all increased. There were no differences in scapular
kinematics. Improvements were found for pain, satisfaction, and shoulder function and for Medical Outcomes Study36-Item Short-Form Health Survey (SF-36)
scores related to physical function. At 6-month follow-up, improvements made in
pain, satisfaction, and function were maintained. Discussion and Conclusion. The
use of this exercise protocol in the management of shoulder impingement
syndrome may have a positive impact on patients’ impairments and functional
limitations. Our findings suggest arelatively simple exercise program combined
with patient education may be effective and, therefore, merits study in a larger
trial using a control group. Changes in scapular kinematics did not appear to be
a primary mechanism underlying improvement in symptoms and function.
[McClure PW, Bialker J, Neff N, et al. Shoulder function and 3-dimensional
kinematics in people with shoulder impingementsyndrome before and after a
6-week exercise program. Phys Ther. 2004;84:832– 848.]

Key Words: Biomechanics, Exercise, Shoulder impingement, Shoulder kinematics.
Philip W McClure, Jason Bialker, Nancy Neff, Gerald Williams, Andrew Karduna

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Physical Therapy . Volume 84 . Number 9 . September 2004

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he term “shoulder impingement” was introduced by Neer1 and refers to the compression ofthe rotator cuff, subacromial bursa, and biceps
tendon against the anterior undersurface of the
acromion and coracoacromial ligament, especially during elevation of the arm. Most authors believe shoulder
impingements are the most common cause of shoulder
pain, and there is general consensus that impingement is
the primary underlying problem or at least a mitigating
factor in many rotatorcuff disorders.2–5 Neer4 estimated
that 95% of rotator cuff tears are due to impingement.
In writing about impingement and rotator cuff disease,
Cofield stated, “Certainly factors other than impingement alone can be involved, but this unifying concept
has been most helpful in viewing various pathologic
entities as being different stages of a common underlying process.”5(p975) Because...