The POST Study; POsterior Shoulder Tightness in Rotator Cuff Related Disorders (POST)
Shoulder Impingement Syndrome
About this trial
This is an interventional treatment trial for Shoulder Impingement Syndrome focused on measuring posterior shoulder tightness, shoulder impingement syndrome, Glenohumeral joint, exercise
Eligibility Criteria
Inclusion Criteria:
- Listed for subacromial decompression surgery by a consultant orthopaedic surgeon
- Presence of posterior shoulder tightness, based on a positive result in 2 of 3 clinical tests (see below for explanation)
- Comprehensive in spoken and written English
- Site of mechanical pain consistent with shoulder impingement syndrome
- At least 3 months duration of shoulder pain
- A minimum SPADI score of 20
- Clinical examination revealing a positive tests for pain with either Neer's test or Hawkins-Kennedy test
Using the SEM values obtained from the recent reliability study conducted at the University of Brighton (see appendix 1), side-to-side differences of more than 2×SEM are associated with a 95% probability that the difference is not caused by the inaccuracy of the clinical test. Using the SEM values obtained from this study, it is possible to be 95% confident that the difference identified is not due to an error of measurement when the side-to-side difference is greater than;
- 7.4 degrees for horizontal adduction
- 9.6 degrees for internal rotation in abduction
- 7 degrees for low flexion
Based on these results a side-to-side difference of 10 degrees or more on two out of three clinical tests will be considered positive for the presence of posterior shoulder tightness.
Clustering tests enables the clinician to overcome the inherent weaknesses of individual tests. Making a decision relating to the presence of posterior shoulder tightness on the outcome of a cluster of tests may better reflect the complex anatomy of the posterior shoulder and the multiple layers of connective tissue and muscle acting as passive restraint to movement.
Exclusion Criteria;
- Clinically detectable large full thickness rotator cuff tear
- Recent trauma (last 3 months) involving the shoulder
- Clinical and radiologically evidence of osteoarthritis of the glenohumeral joint
- Symptomatic osteoarthritis of the acromioclavicular joint
- Adhesive capsulitis (50% deficit of range of movement in 2 or more directions)
- Malignancy
- Previous fracture or surgery of the symptomatic shoulder
- Polyarthritis
- Past diagnosis of fibromyalgia
- Rheumatiod arthritis
- Cervical source of shoulder pain; somatic or radicular (reproduction of familiar shoulder pain during a clinical examination of the cervical spine)
- Ipsilateral shoulder dislocation in last 2 years
- Multidirectional instability
Sites / Locations
- Kevin Hall
Arms of the Study
Arm 1
Arm 2
Experimental
Sham Comparator
Posterior shoulder tightness group
Posterior shoulder tightness sham group
As well as receiving a strengthening program for the scapular and rotator cuff musculature, subjects allocated to the 'posterior shoulder tightness' treatment group will also receive specific manual therapy and home stretches to address stiffness of the posterior shoulder
The 'sham posterior shoulder tightness' group will receive the same strengthening program for the scapular and rotator cuff musculature, in addition they will receive home stretches and manual therapy of similar durations to the 'posterior shoulder tightness' group, but delivered to structures that have no known direct structural influence on the posterior shoulder