Neurophysiology of Weakness and Exercise in Rotator Cuff Tendinopathy

University of Oregon

Status: Completed

Conditions: Atrophic; Impairment; Pathology; Acute Pain; Syndrome; Shoulder Pain; Infiltration; Muscle Weakness; Goals; Pain; Injury; Tendinopathy

Treatments: Procedure: Subacromial injection; Other: Physical Therapy

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02971072

05022014.005

1R01AR063713-01A1 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The purpose of this study is to examine deficits in activation and motor patterns, as well as central drive in patients with rotator cuff tendinopathy. There are three specific aims: (1) determine the effect of acute pain relief on rotator cuff muscle activation in patients with rotator cuff tendinopathy, (2) determine the effect of exercise on rotator cuff muscle activation in patients with rotator cuff tendinopathy, and (3) compare rotator cuff muscle activation between patients with rotator cuff tendinopathy and healthy controls.

Full description

The long-term goal of our research agenda is to identify the mechanisms associated with rotator cuff tendinopathy (impingement syndrome) and subsequently evaluate novel treatment strategies that address these mechanisms. The objectives of this application are to study the muscle patterns in patients with rotator cuff tendinopathy as well as the effects of both pain and exercise on these patterns. Our first hypothesis is that pain relief from a shoulder injection will result in increased rotator cuff activity. Our second hypothesis is that patients with tendinopathy will demonstrate improved rotator cuff muscle activity following a six-week exercise program and that this improvement will be higher in patients that respond favorably to treatment. Our final hypothesis is that patients with cuff tendinopathy will show decreased rotator cuff activity compared to healthy subjects. The investigators plan on addressing these hypotheses using several novel techniques for muscle activity assessment.

Enrollment: 180 estimated patients

Sex: All

Ages: 21 to 45 years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Patient Inclusion Criteria:

• pain with passive provocative maneuvers (positive Hawkins or Neer test)
• pain with active elevation (positive painful arc)
• pain with isometric resisted movements (Jobe's "empty can" test or resisted shoulder external rotation with the arm at the side)
• demonstrate weakness (>10% force deficit in external rotation)

Patient Exclusion Criteria:

• shoulder surgery on the symptomatic side
• positive Spurling test
• traumatic shoulder dislocation or instability in the past 3 months
• reproduction of shoulder pain with active or passive cervical range of motion
• signs of rotator cuff tear (drop-arm test, lag signs, gross external rotation weakness, or positive image findings)
• current musculoskeletal, neurologic or cardiovascular compromise

Control Inclusion Criteria:

• no current or previous shoulder injury
• matched for age (within 5 years) and sex
• meet Patient Exclusion Criteria (minus musculoskeletal, neurologic, or cardiovascular compromise)

Control Exclusion Criteria:

• pain with active arm elevation
• positive Hawkins, Neer, or Jobe's test

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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180 participants in 1 patient group

Patients

Experimental group

Description:

Subjects with shoulder tendinopathy who will undergo both a subacromial injection and physical therapy

Treatment:

Other: Physical Therapy

Procedure: Subacromial injection