Effect of thoracic mobilization on acmio-humeral distance, thoracic kyphosis angle, pain and shoulder function in patients with subacromial impingement syndrome: A randomized controlled trial.

Abstract

Purpose: Thoracic hyperkyphosis, an extrinsic cause of subacromial impingement syndrome (SIS), can contribute to a decrease in the acromio-humeral distance (AHD). Thoracic mobility is necessary to reduce pain and maintain function during shoulder elevation. The aim of this study was to investigate the effect of thoracic mobilization on AHD, thoracic kyphosis angle, pain, and shoulder function in patients with SIS.

Methods: Thirty-two patients with SIS, aged between 25 and 50 years, were included in the study. The exercise group (EG) performed the home exercises (rotator cuff and scapulothoracic joint-based exercises) for 12 weeks. The thoracic mobilization group (TMG) received thoracic mobilization for the first 6 weeks in addition to the same exercise program. AHD was assessed with ultrasonography, thoracic kyphosis angle with the Goniometer-pro, pain intensity with a visual analog scale (VAS), and shoulder function with American Shoulder and Elbow Surgeons (ASES) at before treatment, and follow-up at 6-week and 12-week.

Results: The TMG had a greater increase in AHD at 60º and 90º (at 60º;6th weeks, p = 0.000; 12th weeks, p = 0.000, at 90º;6th weeks, p = 0.048;12th weeks, p = 0.000) and shoulder function (6th weeks, p = 0.000;12th weeks, p = 0.000) and a decrease in thoracic kyphosis angle (6th weeks, p = 0.002;12th weeks, p = 0.000) and pain intensity in night and activity (night pain;6th weeks, p = 0.000;12th weeks, p = 0.042, activity pain;6th weeks, p = 0.000;12th weeks, p = 0.000) than the EG both at 6th and 12th weeks.

Conclusion: Thoracic mobilization applied in addition to the rotator cuff and scapulothoracic joint-based exercises was found to be more effective in increasing AHD and shoulder function in patients with SIS and reducing pain intensity and thoracic kyphosis angle.