The Effects of Short-term Scapular Control Training in Overhead Athletes With Shoulder Impingement Syndrome

Not Applicable

Completed

• Conditions: Shoulder Impingement Syndrome; Scapular Dyskinesis
• Interventions: Procedure: Scapular control training; Procedure: General exercise

• Registration Number: NCT04493190
• Lead Sponsor: National Yang Ming Chiao Tung University

Brief Summary

Subacromial impingement syndrome (SIS) is a common disorder of shoulder joint. SIS has been accounted for 44-65 % of all shoulder pain. It is believed that one important contributing factor is scapular dyskinesis. Patients with SIS demonstrates scapular dyskinesis, including decrease in upward rotation, scapular posterior tilt, and external rotation. Altered muscle activity of scapular muscles may contribute to scapular dyskinesis, such as increase in activity of upper trapezius, and decrease in activity of lower trapezius and serratus anterior. In addition to these changes in neuromuscular control, central nervous system may be re-organized in patients with musculoskeletal disorders. Evidence has been reported that center of gravity of motor mapping changes, corticospinal excitability decreases and inhibition increases in patients with shoulder injuries such as instability, rotator cuff tendinopathy and SIS. These corticospinal changes are believed to be related to chronicity of symptoms and lack of treatment effects.

Previous studies have applied many types of treatments to SIS, such as manipulation, taping, and exercises. However, most studies mainly focused on the outcomes of pain and function, few studies investigated changes in neuromuscular control following treatments. Yet, no study has addressed how corticospinal system changes following treatment in patient with shoulder injuries. Motor skill training, which has been widely used in training healthy subjects or patients with neurological disorders, has been shown to change corticospinal systems, including increasing excitability and decreasing inhibition. To our knowledge, no study has integrated the concepts of motor skill learning into a short-term treatment or investigated the effects of motor skill training on corticospinal systems in patients with SIS. The purposes of the study are to investigate the effects of short-term motor skill training on pain, neuromuscular control, corticospinal system in patients with SIS, and also to investigate whether changes in corticospinal parameters will be related to changes in pain, function and neuromuscular control.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2020-06-29
• Study First Submitted QC: 2020-07-28
• Study First Posted: 2020-07-30
• Study Start: 2020-11-02
• Primary Completion: 2021-08-26
• Study Completion: 2021-11-26
• Status Verified: 2022-04
• Last Update Submitted: 2022-04-05
• Last Update Posted: 2022-04-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 55

Inclusion Criteria

Not provided

Exclusion Criteria

1. Have a history of dislocation, fracture, or surgery of upper extremity
2. A history of direct contact injury to the neck or upper extremities within the past 12 months
3. A concussion within the past 12 months or a history of three or more concussions
4. Brain injury and neurological impairment
5. History of frequent headache or dizziness
6. Contraindications to the use of transcranial magnetic stimulation (TMS), assessed with a safety screening questionnaire, including pregnancy, history of seizure, epilepsy and syncope, having cochlear implant, having medal implant and taking anti-depressant medication.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Scapular control training group	Scapular control training	Participants in these group will be taught how to correctly movement arm overhead. And they will undergo series of movement tasks with mirror and also receive scapular-focused exercises. The difficulty of the movements protocol will increase weekly.
General exercise group	General exercise	Participants in this group will receive a general strengthening exercise, focusing on the shoulder muscles. And the load will progressively increase weekly.

Primary Outcome Measures

Name	Time	Method
Change in neurophysiological measures - Cortical silent period	Change from baseline CSP at 6 weeks	Cortical silent period (CSP) will be measured with millisecond (ms).
Long-term change in shoulder pain	Change from baseline pain at 3 months	Pain will be measured with a numerical rating scale (0-10). Zero indicates the absence of pain, while 10 represents the most intense pain possible. No unit.
Change in neurophysiological measures - Active motor threshold	Change from baseline AMT at 6 weeks	Active motor threshold (AMT) will be described with the percentage (%) of maximum stimulator output (MSO).
Change in neurophysiological measures - Motor evoked potential	Change from baseline MEP at 6 weeks	Motor evoked potential (MEP) will be described with millivolt (mV) at different points and with different stimulus intensity
Change in neurophysiological measures - Short interval cortical inhibition and short interval cortical facilitation	Change from baseline SICI and SICF at 6 weeks	Short interval cortical inhibition (SICI) and short interval cortical facilitation (SICF) will be defined as percentage (%) of conditioning responses vs testing responses
Change in shoulder pain	Change from baseline pain at 6 weeks	Pain will be measured with a numerical rating scale (0-10). Zero indicates the absence of pain, while 10 represents the most intense pain possible. No unit.
Change in shoulder function	Change from baseline function at 6 weeks and 3 months	Function will be measured questionnaire, Flexilevel Scale of Shoulder Function (FLEX-SF). There are 15 questions on each difficulty version. Zero indicates the most difficulty, while 3 means the least difficulty.
Long-term change in shoulder function	Change from baseline pain at 3 months	Function will be measured questionnaire, FLEX-SF. There are 15 questions on each

Secondary Outcome Measures

Name	Time	Method
Scapular muscle activation	Change from baseline muscle activation at 6 weeks	The root mean square of electromyography (EMG) data of the upper trapezius, lower trapezius, and serratus anterior will be normalized by the maximum voluntary contraction amplitude (percentage of maximal voluntary contraction, %) and calculated over three 30° increments of motion during arm elevation from 30° to 120°, including 30° - 60°, 60° - 90°, and 90° - 120°
Scapular kinematics	Change from baseline scapular kinematics at 6 weeks	Including anterior/posterior tilt, upward/downward rotation, and internal/external rotation in scapula plan elevation at 30°, 60°, 90°, and 120°, will be calculated and will be described with degree (°).

Trial Locations

Locations (1)

National Yang-Ming University; 🇨🇳 Taipei, Taiwan