Subakromiyal sıkışma sendromunda iki farklı yöntemle yapılan skapular retraksiyon egzersizlerinin skapular diskinezi, ağrı, fonksiyon ve normal eklem hareketi üzerine etkisi

Abstract

Subacromial impingement syndrome (SSS) is one of the most common shoulder pathologies. This pathology is a painful condition with compression of the supraspinatus, infraspinatus, subacromial bursa and biceps tendon between the humerus and the coracoacromial arch with the upper arm elevation. Conservative and surgical treatment methods have been reported in the SSS. Conservative treatment includes medical therapy (anti-inflammatory drugs), physical therapy modalities (shock wave, ultrasound, ice, TENS, etc.) and exercise therapy; surgical treatment includes subacromial decompression therapy. The purpose of conservative treatment, which is mostly used in the SSS, is to reduce subacromial inflammation, to provide healing of the rotator cuff and to restore function to the painful shoulder joint. Strength and flexibility exercises are used as basic exercises in the exercise program of these patients. With basic exercises, it is aimed to increase painless range of motion, strength and endurance and to provide independence in daily living activities. Scapular retraction exercises are one of these exercises. In this study, it was aimed to investigate the effects of scapular retraction exercises performed with two different methods on scapular dyskinesia, pain, function and normal joint movements in patients with SSS. 45 patients with a diagnosis of SSS, 29 female and 16 male, aged between 33-60 years were included in the study. Patients were randomly divided into three groups as Control Group (Routine Physiotherapy and Rehabilitation Program), Scapular Retraction Exercises Group (SRE) and Elastic Band Resistant Scapular Retraction Exercises Group (EDSRE). To the control group; hotpack, therapeutic ultrasound, TENS and mobilization (anterior-posterior-inferior glenohumeral mobilization) were performed and basic exercises including anteriorposterior-inferior capsular stretching, codman exercises and wall proprioception exercise were given. In addition to the treatment program in the control group, the SRE group was given three non-resistance scapular retraction exercises, while the EDSRE group received three resistant scapular retraction exercises with elastic bands in addition to the treatment program in the control group. A total of 15 sessions of physiotherapy and rehabilitation program were applied to the groups 5 days a week. Before and after treatment, scapular dyskinesia, pain, function and normal joint movements were evaluated. Lateral Scapular Slide Test was used for scapular dyskinesia evaluation, Visual Analogue Scale for pain severity evaluation, DASH questionnaire for function evaluation and universal goniometer for range of motion evaluation. SPSS 21.0 program was used for data analysis. The level of significance was accepted as p<0,05 for all analyzes. At the end of the treatment, statistically significant improvement was observed in scapular dyskinesia, pain, function and normal range of motion values in all groups. In the intergroup evaluations, it was seen that scapular retraction exercises performed with elastic resistant bands, in addition to the control group, were a more effective method in reducing scapular dyskinesia and increasing the shoulder extension angle. Considering the literature and the results of our study, it was concluded that scapular retraction exercise can be applied to patients with SSS, and the addition of a routine physiotherapy and rehabilitation program.