Stela M. Mattiello-Rosa

Effects of strengthening and stretching exercises applied during working hours on pain and physical impairment in workers with subacromial impingement syndrome

This study evaluated the effectiveness of a rehabilitation program performed during working hours on function and pain in workers with subacromial impingement syndrome. Fourteen male workers (31.93 ± 5.86 years) in the school supply industry were assessed. The duration of their shoulder pain was 28.50 ± 33.64 months, and their amount of time in this industry was 9.07 ± 3.68 years. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire evaluated function of the upper limbs. The Mc Gill Pain Questionnaire quantified the pain by the number of words chosen and the pain rating index (PRI). Subjects completed an 8-week rehabilitation program, twice a week, consisting of cryotherapy, strengthening, and stretching exercises. Subjects’ outcome data were collected pre- and post-intervention. The results showed that DASH scores improved (p<0.05) and the number of words chosen and PRI decreased (p<0.05) on the McGill Pain Questionnaire at post-intervention. Results should be interpreted cautiously, considering the lack of a control group in the investigation. In conclusion, it is suggested that an intervention program consisting of cryotherapy, strengthening, and stretching applied during working hours and twice a week may be effective to decrease pain and physical impairment in male workers with subacromial impingement syndrome.

Pain in workers with shoulder impingement syndrome: an assessment using the DASH and McGill pain questionnaires

Objective: This study assessed physical function and pain in male and female workers with shoulder impingement syndrome using the Brazilian Portuguese versions of the Disabilities of the Arm, Shoulder and Hand (DASH) and McGill pain questionnaires. Methods: Twenty-seven assembly line workers (18 men and 9 women; mean age of 33.26 ± 6.49 years) in the school supply industry were evaluated. The duration of the shoulder impingement pain was 31.74 ± 32.92 months and the amount of time of the workers in this industry was 11.08 ± 6.41 years. The DASH questionnaire was used to evaluate functional status and symptoms of the upper limbs of the workers. Using the McGill Pain Questionnaire, the pain was quantified by the number of words chosen and by the pain rating index (PRI). Results: The women presented higher scores (P< 0.05) than the men for both DASH overall and DASH work scores. The women chose more words (17.00 ± 2.59) than the men (13.33 ± 3.16) and also presented the highest total PRI (P< 0.05). Conclusions: The results obtained in this group of Brazilian workers with shoulder impingement identify the most commonly used descriptors of shoulder pain. Further, this study shows that females are more likely than males to refer physical disability and pain. Also, the DASH and McGill pain questionnaires are important and helpful tools in the clinical evaluation of shoulder impingement syndrome.

Abnormal isokinetic time-to-peak torque of the medial rotators of the shoulder in subjects with impingement syndrome

The time-to-peak torque (TPT) and the peak torque ratio of the lateral to medial rotators (LR/MR) during isokinetic lateral and medial rotation of the shoulder were evaluated in patients with shoulder impingement and in healthy subjects. Fifteen patients with shoulder impingement on the dominant side and 9 healthy subjects were evaluated. TPT and LR/MR were measured bilaterally during isokinetic concentric lateral and medial rotation at 60 degrees/s and 180 degrees/s. The impingement group showed a bilateral decrease in the TPT during medial rotation for both 60 degrees/s and 180 degrees/s. No differences were found in the LR/MR between the groups. It is proposed that decreased (TPT) of the medial rotators can be used as a tool for early detection of shoulder impingement. Notably, the decreased time-to-peak torque of the medial rotators may occur before the alteration in the peak torque ratio.

Functional torque ratios and torque curve analysis of shoulder rotations in overhead athletes with and without impingement symptoms

Abstract In this study, we evaluated the peak torque, functional torque ratios, and torque curve profile of the shoulder rotators in overhead athletes with impingement symptoms so as to examine possible alterations in response to sports training and shoulder pain. Twenty-one overhead athletes with impingement symptoms were compared with 25 overhead athletes and 21 non-athletes, none of whom were symptomatic for impingement. The participants performed five maximal isokinetic concentric and eccentric contractions of medial and lateral shoulder rotations at 1.57 rad · s−1 and 3.14 rad · s−1. Isokinetic peak torque was used to calculate the eccentric lateral rotation-to-concentric medial rotation and the eccentric medial rotation-to-concentric lateral rotation ratios. An analysis of the torque curve profiles was also carried out. The eccentric lateral rotation-to-concentric medial rotation torque ratio of asymptomatic athletes was lower than that of non-athletes at both test velocities. The concentric medial rotation isokinetic peak torque of the asymptomatic athletes, at 3.14 rad · s−1, was greater than that of the non-athletes, and the peak appeared to occur earlier in the movement for athletes than non-athletes. These findings suggest that there may be adaptations to shoulder function in response to throwing practice. The eccentric medial rotation-to-concentric lateral rotation torque ratio was altered neither by the practice of university-level overhead sports nor impingement symptoms.

Joint position sense is not altered during shoulder medial and lateral rotations in female assembly line workers with shoulder impingement syndrome

This study evaluated joint position sense (JPS) during medial and lateral rotations of the shoulder in female workers with and without shoulder impingement syndrome (SIS). Three groups were assessed. The case group consisted of 15 female assembly line workers (35.5, SD 5.8 years) with unilateral SIS. Control group 1 consisted of 15 female assembly line workers asymptomatic for SIS (34.4, SD 5.5 years) and control group 2 consisted of 15 female subjects (33.1, SD 6.2 years) asymptomatic for SIS and with no exposure to activities with the upper limbs. The JPS was evaluated bilaterally during passive (2°/sec) and active (5°/sec) repositioning tests using an isokinetic dynamometer. The target angles were 45° of lateral rotation (achieved by medially rotating the shoulder from 90° of lateral rotation) and 75° of lateral rotation (achieved by laterally rotating the shoulder from neutral rotation). There were no differences between sides for all groups (p  >  0.05). There were no differences in any of the variables between the case group and the control groups (p  >  0.05). The results of this study suggest that JPS during medial and lateral rotations of the shoulder is not altered in female assembly line workers with SIS.

Isokinetic dynamometry applied to shoulder rotators - velocity limitations in eccentric evaluations.

The objectives of this study were to evaluate if collegiate overhead athletes, with and without shoulder pain, and non-athletes could reach a preset velocity in internal and external shoulder rotation isokinetic evaluations; and to evaluate the correlation between torque and velocity. Controlled laboratory study, cross-sectional. Evaluations were performed using the isokinetic dynamometer Biodex System 3. Participants were assessed seated, with the arm at 90° of shoulder abduction and 90° of elbow flexion, from neutral rotation to 90° of external rotation. Five maximal contractions of isokinetic concentric and reactive eccentric internal and external rotation were performed at the velocities 90°/s, 180°/s and 240°/s. Data were processed with using MatLab. Most participants did not reach the isokinetic phase during eccentric tests at 180°/s and 240°/s, particularly in the external rotators evaluation. High correlations between torque and velocity of eccentric tests were found. The groups presented no differences in maximal velocity attained in trials which preset velocity was not reached. These results call into question the use of reactive eccentric tests at velocities higher than 180°/s for the isokinetic evaluation of shoulder external rotators in collegiate overhead athletes and non-athletes in this specific position. In such cases, careful evaluation of the velocity is recommended to determine if the isokinetic phase was reached.

Isometric medial and lateral rotations torque steadiness in female workers with shoulder impingement

This study compared peak torque and torque steadiness during isometric lateral and medial rotations in workers with shoulder impingement syndrome (SIS) and those with no upper limb disorders. Twenty-nine female workers were evaluated. The SIS group consisted of 14 workers (36.57± 5.23 years) with unilateral SIS. The control group consisted of 15 healthy workers (35.53 ± 5.46 years). Three maximal voluntary isometric contractions (MVIC) of 5-s duration were performed to determine the peak torque, which was used to calculate the target torque (50% MVIC). For assessment of the torque steadiness 3 trials were performed at the target torque for 5 s each, with visual feedback. Standard deviation (SD) and coefficient of variati on (CV) were measured from the steadiness trials. Peak torque, SD and CV were not different (P > 0.05) between groups neither between affected and unaffected sides of the SIS group for both rotations. It was possible to suggest that torque steadin ess, during isometric medial and lateral rotations of the shoulder, is n ot altered in workers with SIS when compared to healthy workers, and that maintenance of regular work activities may play an important role in preservation of the steadiness in this populat ion.