Effects of progressive rotator cuff exercises performed at varying shoulder abduction angles on pain, function and acromiohumeral distance in patients with subacromial pain syndrome

The aim of this study was to investigate the effects of scapula based (SBE) and scapula-rotator cuff based (SRBE) exercises on pain, function and acromiohumeral distance (AHD) in patients with subacromial pain syndrome (SPS), and to compare AHD values with healthy controls. 33 SPS patients, aged 18-45, and 16 healthy controls (age: 28 (6.3); BMI: 23.8 (3.3) kg/m2) were included in this study. Patients were randomly divided into two groups. Both groups received a 12-week program consisting of coldpack, manual therapy and exercise interventions. SBE group (n=17; mean age: 28.8 (7.04) years; BMI: 22.5 (2.5) kg/m2) received periscapular control exercises; SRBE group (n=16; mean age: 30.3 (8.7) years; BMI: 22.7 (3.1) kg/m2) received rotator cuff loading exercises in addition to periscapular control exercises. Patients were assessed by Visual Analog Scale (VAS) for pain intensity, functional activity level with Shoulder Pain and Disability Index (SPADI). AHD was measured using real-time ultrasound at five shoulder positions (0°, 30°, 45°, 60° and 90° of abduction) at baseline and at the end of the intervention. A paired samples T-tests were applied for determining the statistical significance of pre-post treatment results between groups, and independent samples T-test was employed for intergroup results. AHD data was analyzed using a two-way repeated-measures analysis of variance. Intra-group analysis demonstrated that, there were significant decrease in pain intensity (p<0.001), functional activity level (p<0.001) and AHD (p<0.001) compared to baseline values. Inter-group analysis showed SRBE group was found to more effective than SBE group in decreasing activity pain p=0.036), SPADI-Disability (p=0.003), SPADI-Total (p=0.009) scores, and increasing AHD values (p<0.001). We conclude that, SRBE training was found to be effective in decreasing activity pain, and increasing functionality and AHD values in patients with SPS. We believe that SRBE training is an alternative method to be implemented in the rehabilitations of patients with SPS. Keywords: Shoulder, subacromial pain syndrome, pain, acromiohumeral distance