Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series / Treino excêntrico para abdutores do ombro melhora dor, função e desempenho isocinético em sujeitos com síndrome do impacto: série de casos

BACKGROUND: Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. OBJECTIVES: To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. METHODS: Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. RESULTS: DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. CONCLUSIONS: This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.

CONTEXTUALIZAÇÃO: Tratamentos conservadores têm sido propostos para pessoas com síndrome do impacto (SI) do ombro, como fortalecimento do manguito rotador e dos músculos escapulares e alongamento dos tecidos moles do ombro. No entanto, são escassos os estudos que analisaram a eficácia do treinamento excêntrico no tratamento da SI. OBJETIVOS: Avaliar os efeitos do treinamento excêntrico para abdutores do ombro na dor, função e desempenho isocinético durante a abdução concêntrica e excêntrica do ombro em indivíduos com SI. MÉTODOS: Vinte indivíduos (sete mulheres, 34,2 DP 10,2 anos, 1,7 DP 0,1 m, 78,0 DP 16,3 kg) com SI unilateral completaram o protocolo do estudo. Realizou-se treinamento isocinético excêntrico bilateral a 60º/s para abdutores do ombro durante seis semanas consecutivas, duas vezes por semana, em dias alternados. Para cada dia de treinamento, foram realizadas três séries de dez repetições, com um período de descanso de 3 minutos entre as séries para cada lado. A amplitude de movimento treinada foi de 60° (de 80° a 20°). O questionário Disabilities of the Arm, Shoulder and Hand (DASH) foi utilizado para avaliar a função e os sintomas dos membros superiores. O pico de torque, o trabalho total e o tempo de aceleração foram avaliados durante a abdução concêntrica e excêntrica do braço a 60º/s e 180º/s por meio de um dinamômetro isocinético. RESULTADOS: As pontuações do DASH, o pico de torque, o trabalho total e o tempo de aceleração melhoraram (p<0,05) após o período de intervenção. CONCLUSÕES: Este estudo sugere que o treinamento isocinético excêntrico para abdutores do ombro melhora a função física dos membros superiores em indivíduos com SI.

The role of acromioclavicular arthritis in impingement syndromes

The role of acromioclavicular (A-C) arthritis in stage 2 and 3 impingement syndromes was investigated in this study. Twenty-seven patients with stage 2 and 3 impingement syndrome were evaluated both clinically and radiologically for the presence of A-C arthritis. Patients with A-C arthritis who were treated by conservative or surgical methods were rated before and after therapy according to the University of California at Los Angeles (UCLA) shoulder rating scale. The follow-up period ranged from 7 to 16 months, with an average of 13 months. A-C arthritis was diagnosed in 21 of 27 patients (one grade 2 and 20 grade 3, according to Kellegren). Clinical and radiological evaluation of these 21 patients revealed A-C joint pain and a positive lidocaine injection test in all (100%), a positive horizontal adduction test in 20 (95.2%), decreased joint space in 18 (85.75%) and osteophytes in 11 (52.4%). Surgical treatment was considered for 12 A-C arthritis patients; and distal clavicle resection was performed in 11 of these cases. The average score measured by the UCLA rating scale increased from 13 to 28 in the group treated with surgery (satisfactory result), and from 10 to 13 in the group treated with conservative therapy (unsatisfactory result). The results of this study may be interpreted as demonstrating that A-C arthritis is a common etiologic factor in chronic impingement syndromes and its co-existence has a strategic importance in the choice of treatment method. Surgical resection of the distal clavicle should be considered in the presence of this pathology since this technique provides excellent results in pain relief and appears to be superior to conservative therapy in these cases.