THE EFFECT OF JOINT MOBILIZATION AS A COMPONENT OF COMPREHENSIVE TREATMENT FOR PRIMARY SHOULDER IMPINGEMENT SYNDROME

Primary shoulder impingement syndrome is a common shoulder problem whi ch, if treated ineffectively, can lead to more serious pathology and e xpensive treatment. This study examined whether subjects receiving joi nt mobilization and comprehensive treatment (hot packs, active range o f motion, physiologic stretching, muscle strengthening, soft tissue mo bilization, and patient education) would have improved pain, mobility, and function compared with similar patients receiving comprehensive t reatment alone. Subjects were eight men and six women (mean age = 52.9 years) with primary shoulder impingement syndrome (superolateral shou lder pain, decreased active humeral elevation, limited overhead functi on). Following random assignment to experimental (N = 7) and control g roups (N = 7), three blinded evaluators tested 24-hour pain (visual an alog scale), pain with subacromial compression test (visual analog sca le), active range of motion (goniometry), and function (reaching forwa rd, behind the head, and across the body in an overhead position) befo re and alter nine treatments. One-tailed analyses of covariance (basel ine values as covariates) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differe nces in range of motion and function (Mann-Whitney U) compared with co ntrols. The experimental group improved on all variables, while the co ntrol group improved only on mobility and function (one-tailed paired t tests; Wilcoxon matched pairs). Age, side of dominance, duration of symptoms, treatment attendance, exercise quality, and adherence had no effect on the outcomes. Results may be affected by inadequate sample size, minimal capsular tightness, insensitive functional scale, nonspe cific motion measurements, position at which mobilization treatment wa s given, or a strong effect of comprehensive treatment Mobilization de creased 24-hour pain and pain with subacromial compression test in pat ients with primary shoulder impingement syndrome, but larger replicati on studies are needed to assess more clearly mobilization's influence on motion and function.