The Effects of Short-term Scapular Control Training on Motor Control in Overhead Athletes With Shoulder Impingement Syndrome
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 55
- 试验地点
- 1
- 主要终点
- Change in neurophysiological measures - Cortical silent period
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 20 Years 至 40 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •(patients with shoulder impingement) :
- •perform overhead exercise at least 4 hours a week
- •present type I or II scapular dyskinesis at rest or moving
- •pain at least two weeks
- •3 of 6 impingement test present positive
- •Neer's impingement test: arm abduction overhead with shoulder internal rotation and thumb downward. If feel pain, then positive.
- •Hawkins-Kennedy impingement Test: arm lift to horizontal plane, elbow flexion to 90 degree. Tester put force on forearm toward shoulder internal rotation. If feel pain, then positive.
- •Empty can test: shoulder abduction with thumb down, then give a resistive force toward up. If feel pain, then positive.
- •Resistive shoulder external rotation test: elbow flexion to 90 degrees and do resistive shoulder rotation. If feel pain, then positive.
- •Rotator cuff tenderness test: tester put pressure on rotator cuff. If feel pain, then positive.
- •Painful arc: perform arm elevation. If feel pain during movement, then positive.
- •Inclusion Criteria (healthy people) :
- •perform overhead exercise at least 4 hours a week
- •no any symptoms or injuries on shoulder and neck
排除标准
- •Have a history of dislocation, fracture, or surgery of upper extremity
- •A history of direct contact injury to the neck or upper extremities within the past 12 months
- •A concussion within the past 12 months or a history of three or more concussions
- •Brain injury and neurological impairment
- •History of frequent headache or dizziness
- •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.
研究组 & 干预措施
Scapular control training group
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.
干预措施: Scapular control training (Procedure)
General exercise group
Participants in this group will receive a general strengthening exercise, focusing on the shoulder muscles. And the load will progressively increase weekly.
干预措施: General exercise (Procedure)
Healthy subject group
No intervention.
结局指标
主要结局
Change in neurophysiological measures - Cortical silent period
时间窗: Change from baseline CSP at 6 weeks
Cortical silent period (CSP) will be measured with millisecond (ms).
Long-term change in shoulder pain
时间窗: 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
时间窗: 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
时间窗: 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
时间窗: 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
时间窗: 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
时间窗: 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
时间窗: Change from baseline pain at 3 months
Function will be measured questionnaire, FLEX-SF. There are 15 questions on each
次要结局
- Scapular muscle activation(Change from baseline muscle activation at 6 weeks)
- Scapular kinematics(Change from baseline scapular kinematics at 6 weeks)
研究者
Yin-Liang Lin
Assistant Professor
National Yang Ming Chiao Tung University