Effect of handgrip strengthening exercises and conventional physiotherapy vs eccentric training for external rotators of shoulder and conventional physiotherapy on pain, rotator cuff muscle strength and function of shoulder in patients with subacromial pain syndrome -a comparative study

The term "subacromial pain syndrome" (SAPS) refers to any non-traumatic, mostly unilateral shoulder issues that cause discomfort in the area of the acromion and frequently get worse when lifting one arm. The SAPS includes all disorders about subacromial structures, including tendon cuff degeneration, biceps tendinopathy, rotator cuff tears, subacromial bursitis, calcific tendonitis, and rotator cuff tendinopathy. SAPS is associated with Pain, decreased strength of shoulder; arm and hand muscles, and reduced range of shoulder joint. Common shoulder strengthening rehabilition exercises typically involve movements that result in shortening the muscle length while simultaneously loading the muscles. However, recent studies focus on eccentric training which involves lengthening of muscles during loading and have shown significant improvement in the strength and performance of the rotator cuff in SAPS. Handgrip strength is negatively affected in subacromial pain syndrome and thus, the addition of handgrip-strengthening exercises to conventional physiotherapy has shown to help in the activation of rotator cuff muscles and decrease activation of anterior and middle deltoid. While a variety of exercise protocols demonstrating effectiveness exist, a clearly defined best method of resisted exercise for SAPS has yet to be established. This study will be comparing the effects of handgrip strengthening exercises and eccentric training for external rotators (ETER) of the shoulder in addition to conventional therapy on pain, rotator cuff muscle strength and function of shoulder to increase the efficacy of streamline physiotherapy treatment. Patients will be recruited on the basis of inclusion and exclusion criteria and will be divided into 2 groups. Patients will be assesed pre and post treatment sessions for pain with VAS, for strength of external and internal rotators with dynamometer and function with Shoulder pain and disability index (SPADI).Both groups will receive conventional physiotherapy for 6 weeks which includes TENS for 3 sessions wand exercises and codman exercises, strength training using theraband, Stretching Exercises for pectoralis minor, posterior capsule, levator, and latissimus dorsi. In addition to conventional physiotherapy one group will receive Handgrip strengthening exercise (HGSE) twice a week for 6 weeks and other group will receive -Eccentric training of external rotators (ETER) twice a week for 6 weeks.