Low-level laser therapy in subacromial impingement syndrome.

BACKGROUND DATA AND OBJECTIVE: Although previous studies have evaluated the effect of different kinds of physical therapy in subacromial impingement syndrome (SIS), there have been few investigations assessing the effectiveness of low-level laser therapy (LLLT) in shoulder disorders. The goal of this prospective randomized study was to assess whether gallium-arsenide (Ga-As) laser therapy improves the outcome of a comprehensive home exercise program in patients with SIS. MATERIALS AND METHODS: Forty-four newly-diagnosed SIS patients were enrolled in this study. Group 1 patients (n = 22) received Ga-As laser therapy combined with a 12-wk comprehensive home exercise program, and group 2 patients (n = 22) received the same 12-wk comprehensive home exercise program alone. Night pain, shoulder pain and disability index (SPADI), and University of California-Los Angeles end-result (UCLA) scores were used as outcome measures. RESULTS: Both groups showed a significant reduction in night pain and SPADI scores at the second and 12th weeks with respect to baseline values, with the exception of the SPADI total score at the second week in group 1. UCLA results improved significantly in both groups at the 12th in comparison to the second week. There were no significant differences between groups in mean actual changes in night pain and SPADI scores at the second week from baseline. When values at the 12th week were compared to baseline, mean actual changes in night pain differed significantly between the groups, with a larger change in group 1, but there was no difference between groups in mean actual change in SPADI scores. Second- and 12th-week UCLA scores did not differ between the two groups. CONCLUSION: Our study was unable to demonstrate any distinct advantage of low-level laser therapy over exercise alone. Comprehensive home exercise programs should be the primary therapeutic option in the rehabilitation process in SIS.

Effectiveness of corticosteroid injection in adhesive capsulitis.

OBJECTIVE: To assess whether intraarticular corticosteroids improve the outcome of a comprehensive home exercise programme in patients with adhesive capsulitis. SETTING: The study was undertaken in the Physical Therapy and Rehabilitation Department of a Ministry of Health hospital in Turkey. SUBJECTS: Eighty patients with adhesive capsulitis were enrolled in the study. INTERVENTIONS: The patients were randomly assigned to two groups: Group 1 patients were given intraarticular corticosteroid (1 mL, 40 mg methylprednisolone acetate) followed by a 12-week comprehensive home exercise programme. Group 2 patients were given intraarticular serum physiologic (1 mL solution of 0.9% sodium chloride) followed by a 12-week comprehensive home exercise programme. MAIN MEASURES: The outcome parameters were Shoulder Pain and Disability Index and University of California-Los Angeles end-result scores, night pain and shoulder passive range of motion. RESULTS: Mean actual changes in abduction range of motion, Shoulder Pain and Disability Index-total score and Shoulder Pain and Disability Index-pain score were statistically different between the two groups at the second week, with the better scores determined in group 1. However, there were no significant differences between the groups at the 12th week. Medians of University of California-Los Angeles scores in the second week were significantly different between the two groups (P = 0.02), with better scores in group 1; however, the difference in 12th week scores was insignificant. CONCLUSIONS: Intraarticular corticosteroids have the additive effect of providing rapid pain relief, mainly in the first weeks of the exercise treatment period. In patients with adhesive capsulitis who have pain symptom predominantly, intraarticular corticosteroid therapy could be advised concomitantly with exercise.

Assessment of shoulder involvement and disability in patients with ankylosing spondylitis.

The purpose of the study was to evaluate the parameters which have an important role in shoulder involvement and disability in ankylosing spondylitis (AS). Ninety patients with AS were divided into two groups according to the presence of shoulder involvement. Bath AS metrology index (BASMI), ankylosing spondylitis quality of life (ASQoL) and shoulder pain and disability index (SPADI) were used. Ranges of movements of limited shoulders were measured. Mean disease duration, age, BASMI, and ASQoL were higher and hip involvement was more frequent in the shoulder-involved group. Disease duration was found to be the most significant factor in shoulder involvement. A significant relationship was found between all SPADI scores and ASQoL. The SPADI disability score was affected by flexion limitation. Patients with hip involvement and longer disease duration should be evaluated for shoulder involvement. Flexion limitation of shoulder affected shoulder disability and shoulder disability impaired quality of life.