Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported...
Transcript of Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported...
![Page 1: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/1.jpg)
Evidence Based Approach to the Treatment of Subacromial Impingement Syndrome with
Kinesiology Tape
Cage SA, Gallegos DM, Warner BJ
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Thank you
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Outline
• Quicker reminder on evidence based practice
• PICO Question
• Anatomy of the Subacromial Arch
• Subacromial Impingement Syndrome Epidemiology
• Traditional Treatments
• A Brief Overview of Kinesiology Taping
• Use of Kinesiology Taping to Treat Subacromial Impingement Syndrome
• Conclusions
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Evidence Based Practice
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What is evidence based practice?
• Incorporates
• Best Research Evidence
• Clinical Expertise
• Patient Values and Preferences
EBP
Pro
fess
ion
al E
xper
tise
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PICO Question
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PICO Question
• Patients – Patients suffering from subacromial impingement syndreom
• Intervention – Kinesiology Taping
• Control – Conventional Treatment
• Outcome – Reduction in amount of pain and disability
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Anatomy of the Subacromial Arch
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Subacromial Arch
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Subacromial Arch
• Major structures of note
• Supraspinatus tendon
• Long head of the biceps brachii
• Subacromial bursa
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Subacromial Arch
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Types of Acromion Processes
• Type I – Flat Acromion
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Types of Acromion Processes
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Types of Acromion Processes
• Type I – Flat Acromion
• Type II – Gently Curved Acromion
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Types of Acromion Processes
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Types of Acromion Processes
• Type I – Flat Acromion
• Type II – Gently Curved Acromion
• Type III – Hooked Acromion
![Page 17: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/17.jpg)
Types of Acromion Processes
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Types of Acromion Processes
• Type I – Flat Acromion
• Type II – Gently Curved Acromion
• Type III – Hooked Acromion
• *Type IV – Acromion with Inferior Spur
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Types of Acromion Processes
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Subacromial Impingement Syndrome Epidemiology
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Subacromial Impingement Syndrome
• Collection of conditions with similar symptoms
• Subacromial bursitis
![Page 22: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/22.jpg)
Subacromial Impingement Syndrome
![Page 23: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/23.jpg)
Subacromial Impingement Syndrome
• Collection of conditions with similar symptoms
• Subacromial bursitis
• Rotator cuff tendinopathy
![Page 24: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/24.jpg)
Subacromial Impingement Syndrome
![Page 25: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/25.jpg)
Subacromial Impingement Syndrome
• Collection of conditions with similar symptoms
• Subacromial bursitis
• Rotator cuff tendinopathy
• Rotator cuff strains/ruptures
![Page 26: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/26.jpg)
Subacromial Impingement Syndrome
![Page 27: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/27.jpg)
Subacromial Impingement Syndrome
• Collection of conditions with similar symptoms
• Subacromial bursitis
• Rotator cuff tendinopathy
• Rotator cuff strains/ruptures
• Biceps brachii tendinopathy
![Page 28: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/28.jpg)
Subacromial Impingement Syndrome
![Page 29: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/29.jpg)
Subacromial Impingement Syndrome
• In patients suffering from shoulder pain, SIS accounts for as many as 2/3 of cases.
• Seen often in patients involved in overhead physical activity.
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Subacromial Impingement Syndrome
• Common Causes:
• Spur formation under the acromion process
• Tension on the coracoacromial ligament
• Changes to the shape of the acromion process
• Rotator cuff strains
• Tendinopathies related to overuse
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Subacromial Impingement Syndrome
• Signs & Symptoms
• Anterolateral shoulder pain
• Pain with active glenohumeral abduction
• Weakness with resisted glenohumeral external rotation
• (+) Neer’s Impingement Test
• (+) Hawkins-Kennedy Test
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Why the refresher?
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Common Treatments
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Treating SIS
• Best practices are widely debated
• Commonly accepted that therapeutic exercise needs to be part of all treatment plans
• Only outcome that improved across 11 RCTs was pain
• What about:
• Strength?
• ROM?
• Function?
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Treating SIS
• Other commonly reported treatments:
• Oral NSAIDs
• Oral analgesics
• Steroidal injections
• Cryotherapy
![Page 36: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/36.jpg)
Treating SIS
• If conservative treatment fails, surgical interventions are indicated.
• Acromioplasty
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Treating SIS
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Treating SIS
• If conservative treatment fails, surgical interventions are indicated.
• Acromioplasty
• Distal clavicle excision
![Page 39: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/39.jpg)
Treating SIS
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Treating SIS
• If conservative treatment fails, surgical interventions are indicated.
• Acromioplasty
• Distal clavicle excision
• Subacromial Debridement
![Page 41: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/41.jpg)
Treating SIS
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Kinesiology Taping
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Kinesiology Taping
• Popular modality for treating a variety of musculoskeletal conditions
• Shown to improve outcomes such as pain and disability
• Mode of action is still a topic of debate
• Mechanical?
• Neurological?
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Kinesiology Taping
• Has become more widely used for a variety of shoulder pathologies
• Rotator cuff pathology
• Biceps tendinopathy
• Postural correction
• Subacromial impingement syndrome
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Kinesiology Taping
• Shown to improve patient reported outcomes such as pain and disability
• Certain patterns of taping have been found to increase subacromial distance
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Kinesiology Taping
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Kinesiology Taping
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Kinesiology Taping
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Kinesiology Taping
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Kinesiology Taping
• Shown to improve patient reported outcomes such as pain and disability
• Certain patterns of taping have been found to increase subacromial distance
• Improves pain free active range of motion
• Abduction
• Flexion
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Kinesiology Taping
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Demonstration
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Considerations
• Does your patient have a latex allergy?
• Postural corrections?
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Conclusions
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Conclusions
• Clinicians working with patients participating in overhead activities will encounter SIS at some point in their careers
• There is still no universally accepted treatment protocol
• Failure of conservative treatment necessitates surgical intervention
![Page 56: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/56.jpg)
Conclusions
• Kinesiology taping shows promising results
• Decreased pain
• Increased function
• Increased subacromial arch space
• Increase pain free active range of motion
• Different methods have been used in the past to achieve these goals.
![Page 57: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/57.jpg)
Quiz Time
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Question 1
• Which of the following is NOT a structure involved with subacromial impingement syndrome?
• Supraspinatus tendon
• Infraspinatus tendon
• Long head of the biceps tendon
• Subacromial bursa
![Page 59: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/59.jpg)
Question 1
• Which of the following is NOT a structure involved with subacromial impingement syndrome?
• Supraspinatus tendon
• Infraspinatus tendon
• Long head of the biceps tendon
• Subacromial bursa
![Page 60: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/60.jpg)
Question 2
• True/False: There are never surgical implications for subacromial impingement syndrome.
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Question 2
• True/False: There are never surgical implications for subacromial impingement syndrome.
![Page 62: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/62.jpg)
Question 3
• True/False: Latex allergies are not a consideration for kinesiology taping.
![Page 63: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/63.jpg)
Question 3
• True/False: Latex allergies are not a consideration for kinesiology taping.
![Page 64: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/64.jpg)
Question 4
• True/False: Forward or rounded shoulders can increase the risk of developing subacromial impingement syndrome
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Question 4
• True/False: Forward or rounded shoulders can increase the risk of developing subacromial impingement syndrome
![Page 66: Evidence Based Approach to the Treatment of Subacromial ... Winter... · •Other commonly reported treatments: •Oral NSAIDs •Oral analgesics •Steroidal injections •Cryotherapy.](https://reader034.fdocuments.in/reader034/viewer/2022051923/6010670602d2f50ea9471b96/html5/thumbnails/66.jpg)
Question 5
• Which of the following has been used to demonstrate that kinesiology taping can have a decompressive effect on the subacromial space?
• Diagnostic Ultrasound
• X-ray
• MRI
• CT-Scan
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Question 5
• Which of the following has been used to demonstrate that kinesiology taping can have a decompressive effect on the subacromial space?
• Diagnostic Ultrasound
• X-ray
• MRI
• CT-Scan
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References
1. Cummins CA, Sasso LM, Nicholson D. Impingement syndrome: Temporal outcomes of nonoperative treatment. J Shoulder Elbow Surg. 2009;18:172-177.
2. Djordjevic OC, Vukicevic D, Katunac L, Jovic S. Mobilization with movement and kinesiotaping compared with a supervised exercise program for painful shoulder: Results of a clinical trail. Journal of Manipulative and Physiological Therapeutics. 2012;35(6):454-563.
3. Kaya OD, Baltaci G, Toprak U, Atay AO. The clinical and sonographic effects of kinesiotaping and exercise in comparison with manual therapy and exercise for patients with subacromial impingement syndrome: A preliminary trial. Journal of Manipulative and Physiological Therapeutics. 2014;37(6):422-432.
4. Kuh JE. Exercise in the treatment of rotator cuff impingement: A systematic review. J Shoulder Elbow Surg. 2009;18: 138-60.
5. Kulkarni R, Gibson J, Brownson P, Thomas M, Rangan A, Carr AJ, et al. Subacromial shoulder pain. Shoulder Elbow. 2015;7:135-143.
6. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73-81.
7. Luque-Suarez A, Navarro-Ledesma S, Petocz P, Hancock MJ, Hush J. Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: A randomized controlled trial. Manual Therapy. 2013;18:573-577.
8. Lyman KJ, Gange KN, Hanson TA, Mellinger CD. Effects of 3 different elastic therapeutic taping methods on subacromial joint space. Journal of Manipulative and Physiological Therapeutics. 2017;40(7):494-500.
9. Singh B, Bakti N, Gulihar A. Current Concepts in the Diagnosis and Treatment of Shoulder Impingement. Indian Journal of Orthopaedics. 2017;51(5): 516-523.
10. Singh HP, Mehta SS, Pandey R. A preoperative scoring system to select patients for arthroscopic subacromial decompression. J Shoulder Elbow Surg. 2014;23: 1251-1256.
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Questions