The effectiveness of proprioceptive exercises in patient with subacromial impingement syndrome: A randomized controlled study

Objective:The objective of this study is to evaluate the effectiveness of proprioceptive exercises in the patients suffering from the subacromial impingement syndrome on the range of motion, pain, proprioception, muscle strength and functional tests.Material Method:61 patients with the diagnosis of subacromial impingement syndrome were involved in the study. The patients were classified into two groups randomly. One group (n=30) was given Transcutaneous electrical nerve stimulation, hot package and standard exercise program and the other group (n=31) was given proprioseptive exercise program in addition to this treatment. Then the patients were followed up for 12 weeks. The shoulder range of motion (ROM) of the patients was evaluated with goniometer ; the shoulder pain that has occurred due to the relaxation and motion and during the night times with visual analogue scale of 0-10 cm; the isometric muscle strength and proprioception measurements at 0 and 10 degrees (kinaesthesia, active and passive repositioning) with isokinetic dynamometer and the functional status with Western Ontario Rotator Cuff Index, The Society of the American Shoulder and Elbow Surgeons Evaluation and Constant scoring (CS). These evaluations were done at the periods of pre-treatment and post-treatment on the 6th and 12th weeks.Findings:Before treatment, there was no significant difference among both groups from the point of view of age, sex, occupation, education level, symptom duration, trauma history, shoulder magnetic resonance imaging phase (p>0.05). Correlatively any significant difference was not observed after treatment as well in scope of the exercise phase to which each group reached, the number of exercise that were done by each group and using antienflamatuar medicine (p> 0.05).The significant recovery was determined related to ROM, pain values, muscle strength, 0º external rotation (ER), kinaesthesia sense and functional tests in each group due to treatment (p<0.05). However any significant recovery was not observed related to 0º ER passive repositioning sense in any group (p>0.05). when it was noticed that there was no significant difference in the variances of the senses related to 10º ER kinaesthesia, 10º ER active and passive repositioning in the group which was not given the proprioception exercise, it was observed that there was a meaningful recovery in those measurements of the group which was given the proprioseption exercise (p<0.05).In comparison of the groups, before treatment even if it was determined that the passive flexion and internal rotation and night pain and CS values were found in the group which was given proprioception exercise as worse significant (p<0.05), Any significant difference was not found in the other (p>0.05). After treatment, there was no significant difference at any parameter among the groups. However, when variances, which occurred in groups due to treatment, were compared, it was observed that the recovery in the passive flexion, abduction and internal rotation angles and the night pain was better significant in the group that was given the proprioception exercise (p<0.05), However any significant difference was not found among the groups from the point of view of variances that occurred in the functional tests, 0º ER kinaesthesia sense and isometric muscle strength (p>0.05).Conclusion:It was found that the proprioception exercises to be applied additionally to the conventional exercise and physiotherapy program for the patients with the diagnosis of subacromial impingement syndrome shall reduce the night pain and increase the joint motion gap of abduction, passive flexion and internal rotation as well as providing additional contribution in the development of kinaesthesia and repositioning sense at various angles.