title: Comprehensive impairment-based exercise and manual therapy intervention for patients with subacromial impingement syndrome: a case series.
abstract: METHODS
  Case series.
  
  
  BACKGROUND
  Few studies have defined the dosage and specific techniques of manual therapy and exercise for rehabilitation for patients with subacromial impingement syndrome. This case series describes a standardized treatment program for subacromial impingement syndrome and the time course and outcomes over a 12-week period.
  
  
  METHODS
  Ten patients (age range, 19-70 years) with subacromial impingement syndrome defined by inclusion and exclusion criteria were treated with a standardized protocol for 10 visits over 6 to 8 weeks. The protocol included a 3-phase progressive strengthening program, manual stretching, thrust and nonthrust manipulation to the shoulder and spine, patient education, activity modification, and a daily home exercise program of stretching and strengthening. Patients completed a history and measures of impairments and functional disability at 2, 4, 6, and 12 weeks.
  
  
  RESULTS
  Treatment success was defined as both a 50% improvement on the Disabilities of the Arm, Shoulder, and Hand (DASH) score and a global rating of change of at least "moderately better." At 6 weeks, 6 of 10 patients had a successful (mean +/- SD) DASH outcome score (initial, 33.9 +/- 16.2; 6 weeks, 8.1 +/- 9.2). At 12 weeks, 8 of 10 patients had a successful DASH outcome score (initial, 33.1 +/- 14; 12 weeks, 8.3 +/- 6.4). As a group, the largest improvement was in the first 2 weeks. The most common impairments for all 10 patients were rotator cuff and trapezius muscle weakness (10 of 10 patients), limited shoulder internal rotation motion (8 of 10 patients), and reduced kyphosis of the midthoracic area (7 of 10 patients).
  
  
  CONCLUSIONS
  A program aimed at strengthening rotator cuff and scapular muscles, with stretching and manual therapy aimed at thoracic spine and the posterior and inferior soft-tissue structures of the glenohumeral joint appeared to be successful in the majority of patients. This case series describes a comprehensive impairment-based treatment which resulted in symptomatic and functional improvement in 8 of 10 patients in 6 to 12 weeks.
  
  
  METHODS
  Therapy, level 4.
authors: Arcadia University, Department of Physical Therapy, 450 S Easton Rd, Glenside, PA 19038, USA. tatea@arcadia.edu
authors: Angela R
authors: AR
authors: Tate
authors: Philip W
authors: PW
authors: McClure
authors: Ian A
authors: IA
authors: Young
authors: Renata
authors: R
authors: Salvatori
authors: Lori A
authors: LA
authors: Michener
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D053580:Muscle Strength; D010147:Pain Measurement; D010353:Patient Education as Topic; D019534:Shoulder Impingement Syndrome / Q000628:therapy*; D055815:Young Adult