evidence based approach to the treatment of subacromial ... winter... · •other commonly reported...

Evidence Based Approach to the Treatment of Subacromial Impingement Syndrome with

Kinesiology Tape

Cage SA, Gallegos DM, Warner BJ

Thank you

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

Evidence Based Practice

What is evidence based practice?

• Incorporates

• Best Research Evidence

• Clinical Expertise

• Patient Values and Preferences

EBP

Pro

fess

ion

al E

xper

tise

PICO Question

PICO Question

• Patients – Patients suffering from subacromial impingement syndreom

• Intervention – Kinesiology Taping

• Control – Conventional Treatment

• Outcome – Reduction in amount of pain and disability

Anatomy of the Subacromial Arch

Subacromial Arch

Subacromial Arch

• Major structures of note

• Supraspinatus tendon

• Long head of the biceps brachii

• Subacromial bursa

Subacromial Arch

Types of Acromion Processes

• Type I – Flat Acromion

Types of Acromion Processes

Types of Acromion Processes

• Type I – Flat Acromion

• Type II – Gently Curved Acromion

Types of Acromion Processes

Types of Acromion Processes

• Type I – Flat Acromion

• Type II – Gently Curved Acromion

• Type III – Hooked Acromion

Types of Acromion Processes

Types of Acromion Processes

• Type I – Flat Acromion

• Type II – Gently Curved Acromion

• Type III – Hooked Acromion

• *Type IV – Acromion with Inferior Spur

Types of Acromion Processes

Subacromial Impingement Syndrome Epidemiology

Subacromial Impingement Syndrome

• Collection of conditions with similar symptoms

• Subacromial bursitis

Subacromial Impingement Syndrome

Subacromial Impingement Syndrome

• Collection of conditions with similar symptoms

• Subacromial bursitis

• Rotator cuff tendinopathy

Subacromial Impingement Syndrome

Subacromial Impingement Syndrome

• Collection of conditions with similar symptoms

• Subacromial bursitis

• Rotator cuff tendinopathy

• Rotator cuff strains/ruptures

Subacromial Impingement Syndrome

Subacromial Impingement Syndrome

• Collection of conditions with similar symptoms

• Subacromial bursitis

• Rotator cuff tendinopathy

• Rotator cuff strains/ruptures

• Biceps brachii tendinopathy

Subacromial Impingement Syndrome

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.

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

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

Why the refresher?

Common Treatments

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?

Treating SIS

• Other commonly reported treatments:

• Oral NSAIDs

• Oral analgesics

• Steroidal injections

• Cryotherapy

Treating SIS

• If conservative treatment fails, surgical interventions are indicated.

• Acromioplasty

Treating SIS

Treating SIS

• If conservative treatment fails, surgical interventions are indicated.

• Acromioplasty

• Distal clavicle excision

Treating SIS

Treating SIS

• If conservative treatment fails, surgical interventions are indicated.

• Acromioplasty

• Distal clavicle excision

• Subacromial Debridement

Treating SIS

Kinesiology Taping

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?

Kinesiology Taping

• Has become more widely used for a variety of shoulder pathologies

• Rotator cuff pathology

• Biceps tendinopathy

• Postural correction

• Subacromial impingement syndrome

Kinesiology Taping

• Shown to improve patient reported outcomes such as pain and disability

• Certain patterns of taping have been found to increase subacromial distance

Kinesiology Taping

Kinesiology Taping

Kinesiology Taping

Kinesiology Taping

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

Kinesiology Taping

Demonstration

Considerations

• Does your patient have a latex allergy?

• Postural corrections?

Conclusions

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

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.

Quiz Time

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

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

Question 2

• True/False: There are never surgical implications for subacromial impingement syndrome.

Question 2

• True/False: There are never surgical implications for subacromial impingement syndrome.

Question 3

• True/False: Latex allergies are not a consideration for kinesiology taping.

Question 3

• True/False: Latex allergies are not a consideration for kinesiology taping.

Question 4

• True/False: Forward or rounded shoulders can increase the risk of developing subacromial impingement syndrome

Question 4

• True/False: Forward or rounded shoulders can increase the risk of developing subacromial impingement syndrome

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

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

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.

Questions