title: Is Extracorporeal Shockwave Therapy Combined With Isokinetic Exercise More Effective Than Extracorporeal Shockwave Therapy Alone for Subacromial Impingement Syndrome? A Randomized Clinical Trial.
abstract: Study Design Single-blind randomized trial. Background Extracorporeal shockwave therapy (ESWT) has been shown to produce good results in the treatment of subacromial impingement syndrome (SAIS). The efficacy of a combined administration of ESWT and isokinetic exercise (IE) has not yet been studied. Objectives To evaluate the efficacy of focused ESWT combined with IE for the rotator cuff versus focused ESWT alone in the treatment of SAIS. The secondary objective was to assess the isokinetic torque recovery (external rotation at 210°/s, 180°/s, and 120°/s). Methods Thirty participants with SAIS were randomly assigned to a focused-ESWT group or focused ESWT-plus-IE group. Subjects of both groups received 3 treatment sessions of focused ESWT over a period of 10 days. Participants in the second group also received IE for 10 therapy sessions. Outcome measures were the Constant-Murley score (CMS), the visual analog scale (VAS), and isokinetic parameters (peak torque and total work calculated from 5 repetitions) measured with the isokinetic test. Subjects were assessed at baseline, 10 days after the last treatment session with focused ESWT, and after 2 months of follow-up. Results At 2 months posttreatment, participants in the focused ESWT-plus-IE group showed significantly less pain (focused-ESWT VAS, 3.4 ± 0.8 versus focused ESWT-plus-IE VAS, 1.5 ± 0.5; P<.001) and greater improvement in functionality (focused-ESWT CMS, 75.9 ± 6.7 versus focused ESWT-plus-IE CMS, 92.1 ± 6.3; P<.001) and muscle endurance than the subjects in the focused-ESWT group. Conclusion In subjects with SAIS, combined administration of focused ESWT and IE for the rotator cuff resulted in greater reduction of pain, as well as superior functional recovery and muscle endurance in the short to medium term, compared with ESWT alone. Level of evidence Therapy, 2b.
  
  
  BACKGROUND
  unregistered 2011 trial. J Orthop Sports Phys Ther 2016;46(9):714-725. Epub 5 Aug 2016. doi:10.2519/jospt.2016.4629.
authors.forename: Andrea
authors.initials: A
authors.lastname: Santamato
authors.forename: Francesco
authors.initials: F
authors.lastname: Panza
authors.forename: Angela
authors.initials: A
authors.lastname: Notarnicola
authors.forename: Gennaro
authors.initials: G
authors.lastname: Cassatella
authors.forename: Francesca
authors.initials: F
authors.lastname: Fortunato
authors.forename: Jula Laura
authors.initials: JL
authors.lastname: de Sanctis
authors.forename: Giovanni
authors.initials: G
authors.lastname: Valeno
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Kehoe
authors.forename: Davide
authors.initials: D
authors.lastname: Seripa
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.forename: Pietro
authors.initials: P
authors.lastname: Fiore
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ranieri
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017006:Rotator Cuff / Q000503:physiopathology*; D019534:Shoulder Impingement Syndrome / Q000628:therapy*; D016037:Single-Blind Method; D052256:Tendinopathy / Q000628:therapy*
keywords: Constant-Murley score; isokinetic parameters; muscle torque; physical therapy; rotator cuff tendinopathy; shoulder pain; visual analog scale