Omuz impingement (subakromiyal sıkışma) sendromlu hastalarda manipülasyon tedavisinin etkinliği
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2017
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info:eu-repo/semantics/openAccess
Özet
Bu çalışma, omuz impingement (subakromiyal sıkışma) sendromu olan hastalarda tek başına uygulanan konvansiyonel fizik tedavi ile, fizik tedavi ile birlikte uygulanan manipülasyon tekniklerinin etkinliklerini karşılaştırmak için yapıldı. YÖNTEM: Haziran 2015 ve Haziran 2016 yılları arasında, Necmettin Erbakan Üniversitesi Merap Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı polikliniklerine, 3 aydan uzun süredir olan omuz ağrısı şikayeti ile başvuran ve subakromiyal sıkışma sendromu tanısı konan, 60 hasta çalışmaya alındı. Hastalar kapalı zarf yöntemi ile rastgele olarak 2 gruba ayrıldı. İlk gruba 12 seans fizik tedavi (HP,US, TENS) programı uygulandı. İkinci gruptaki hastalara 12 seans fizik tedavi programı ile birlikte 4 hafta boyunca haftada iki gün toplam 8 seans klaviküler abduksiyon için mobilizasyon, klavikula fleksiyonu için mobilizasyon ve glenohumeral eklem itme'den oluşan manipülasyon teknikleri uygulandı. Hastaların tedavi öncesi, tedavi sonrası erken dönem ve tedavi sonrası 3. ayda ağrı skorları(Vizüel Analog Skala, VAS), omuz eklem hareket açıklıkları, fonksiyonel durumları (Disabilities of the Arm, Shoulder and Hand, (DASH) questionnaire ve günlük yaşam kaliteleri (Short Form-12, SF-12)değerlendirildi. BULGULAR: Çalışmaya alınan hastaların yaşı 22 ile 78 arasındaydı. Fizik tedavi (FT) grubunun 15'i (%50) erkek, 15'i(%50) kadın yaş ortalaması 55,06 ±14,28 iken FT+manüpilasyon grubunun 13'ü (%43,3) erkek, 17'si (%56,7) kadın ve yaş ortalaması 49,7 ±12,44 idi. Hastaların 28 (%46,7)' i erkek, 32 (%53,3)'i kadın idi. Hastaların VKI'leri 17,01 kg/m2 ile 41,8 kg/m2 arasındaydı. FT grubunun VKI ortalaması 27,61 ±4,00 kg/m2 iken FT + MP grubun VKI ortalaması 27,00 ±5,19 kg/m2 idi ve demografik veriler açısından gruplar birbirine benzer idi. Tedavi sonrasında her iki gruptaomuz fleksiyon ve skapular abduksiyon derecelerinde, VAS ile değerlendirilen istirahat, gece ve baş üstü aktiviteler sırasında görülen ağrda, DASH ile gösterilen omuz fonksiyonlarında ve SF-12 ile gösterilen yaşam kalitelerinde anlamlı bir iyileşme mevcut idi. Tedavi sonrası 3. ayda, istirahat, gece ve baş üstü VAS, DASH skorları manipülatif tedavi eklenen grupta daha düşük, ağrısız omuz fleksiyon ve skapular abduksiyon dereceleri daha yüksek idi.SF-12 ile değerlendirilen yaşam kalitesi alt ölçeklerinin hepsinin de her iki tedavi grubunda tedavi sonrasında artış gösterdiği görülmüştür. Ancak manipülasyon grubunda SF-12 alt ölçeklerinden sadece FFS (Fiziksel fonksiyonel skor) ve FRS (fiziksel rol kısıtlılığı) iv konvansiyonel tedavi grubuna kıyasla yüksek bulunmuştur. İki grup arasında genel yaşam kalitesi skorları olan FSS (fiziksel sağlık skoru) ve GMS (genel mental sağlık skoru) ve diğer alt ölçekler açısından anlamlı farklılık görülmemiştir. SONUÇ: Çalışmamızda gerek tek başına fizik tedavinin gerekse fizik tedavi ile kombine edilen manipulatif tedavinin SaSS'u olan hastalarda ağrı, eklem hareket açıklığı, fonksiyonel durum ve yaşam kalitesi üzerine olumlu etkisinin olduğu gösterilmiştir. Tedaviden hemen sonra her iki tedavi grubu benzer özellikte iken, tedavi sonrası 3. ayda manipülasyon eklenen grupta istirahat, gece ve baş üstü VAS değerlerinin ve DASH skorunun daha düşük olması, ağrısız fleksiyon ve skapular abduksiyon derecelerinin daha yüksek olması; manüplasyon ile ağrı, EHA ve fonksiyonel durum üzerine daha uzun süre etkinlik sağlanabileceğini göstermektedir. Rekürenslerin yüksek, tedavi başarısızlığının sık ve tedavi süresinin uzun olduğu omuz impingement sendromunda çalışmamız klavikula ve glenohumeral eklem manipülasyonunun tedavi yelpazesi içerisinde dikkate değer bir yeri olduğunu göstermiştir. Maliyetinin ihmal edilebilir düzeyde olması, ekipman gereksiniminin oldukça az olması, tecrübeli ve ehliyetli hekimler tarafından uygulandığında hızlı ve güvenilir olması, ağrı, hareket açıklığı ve fonksiyonlarda belirgin fayda sağlaması nedeniyle manuel tedavinin tedavi protokoluna eklenmesi önemli fayda sağlayacaktır.
This study was carried out to compare the effectiveness of manipulative therapy combined with physical therapy versus physical therapy alone in patients with shoulder subacromial impingement syndrome. METHOD: 60 patients who applied to outpatient clinics of the Physical Medicine and Rehabilitation Department of Necmettin Erbakan University with the complaint of shoulder pain lasting more than 3 months and diagnosed with subacromial impingement syndrome participated in this study. Patients were randomly assigned to two groups using concealed envelops. 12-session physiotherapy (HP, US, TENS) program was implemented to first group. For the second group, in addition to 12-session physiotherapy, 8 sessions (4 weeks, twice a week) of manipulative therapy, consisting of mobilization for clavicular abduction, mobilization for clavicular flexion and thrust technique for glenohumeral joint interventions were implemented. Severity of pain (Visual Analog Scale, VAS), glenohumeral joint range of motions, functional status (Disabilities of the Arm, Shoulder and Hand, (DASH) questionnaire) and quality of life (Short Form-12, SF-12) were evaluated before treatment, at early period of treatment and in the third month after treatment. RESULTS: The age of the patients ranged from 22 to 78. Physiotherapy (PT) group consisted of 15 men (50%) and 15 women (50%) with an age average of 55,06 ±14,28. Physiotherapy + manipulation (PT+MP) group consisted of 13 men (43,3%) and 17 women (56,7%) and age average was 49,7 ±12,44. 28 (46,7%) of the patients were men and 32 (53,3%) of them were women. Body mass index (BMI) of the patients was between 17,01 kg/m2 to 41,8 kg/m2. Mean value of the BMI for PT group was 27,61 ±4,00 kg/m2 while that of PT+MP group was 27,00 ±5,19 kg/m2.Both groups were demographically similar. After treatment, there was a significant improvement in shoulder flexion and scapular abduction degrees, in VAS scores at rest, night and overhead activities, shoulder functions shown with DASH and quality of life shown with SF-12 in both groups. In the 3rd month after treatment, VAS scores at rest, night and overhead activities and DASH scores was lower, painless shoulder flexion and scapular abduction degrees were higher in vi the PT+MP group. Statistically significant increase was seen in all subscales of the SF-12 for both groups. However, only PFS (Physical Function Score) and PRL (Physical Role Limitation) of SF-12 scales were found higher in PT+MP group compared to PT group. There was no significant difference in terms of PHS (Physical Health Score) , GMHS (General Mental Health Score) and other subscales between two groups. CONCLUSION: In this study, both physiotherapy and manipulative treatment combined with physiotherapy had positive effects on pain, range of joint motion, functional status and quality of life in the patients with SaSS. While immediately after treatment, both group had the same characteristics, in the 3rd month after treatment VAS scores at rest, night and overhead activities and DASH score were lower and painless flexion and scapular abduction degrees were higher in the PT+MP group. This shows that longer effect can be expected by manual therapy in terms of pain, range of motion and functional status. Our study showed that clavicular and glenohumeral joint manipulation techniques have an important role in the treatment of subacromial impingement syndrome in which recurrences are high, treatment failure is frequent and treatment period is long. Manual therapy may enrich the treatment milieu because its cost is negligible, the need for equipment is low, it is fast acting and safe when carried out by experienced and qualified doctors, it has significantly positive effects on pain, range of motion and functions.
This study was carried out to compare the effectiveness of manipulative therapy combined with physical therapy versus physical therapy alone in patients with shoulder subacromial impingement syndrome. METHOD: 60 patients who applied to outpatient clinics of the Physical Medicine and Rehabilitation Department of Necmettin Erbakan University with the complaint of shoulder pain lasting more than 3 months and diagnosed with subacromial impingement syndrome participated in this study. Patients were randomly assigned to two groups using concealed envelops. 12-session physiotherapy (HP, US, TENS) program was implemented to first group. For the second group, in addition to 12-session physiotherapy, 8 sessions (4 weeks, twice a week) of manipulative therapy, consisting of mobilization for clavicular abduction, mobilization for clavicular flexion and thrust technique for glenohumeral joint interventions were implemented. Severity of pain (Visual Analog Scale, VAS), glenohumeral joint range of motions, functional status (Disabilities of the Arm, Shoulder and Hand, (DASH) questionnaire) and quality of life (Short Form-12, SF-12) were evaluated before treatment, at early period of treatment and in the third month after treatment. RESULTS: The age of the patients ranged from 22 to 78. Physiotherapy (PT) group consisted of 15 men (50%) and 15 women (50%) with an age average of 55,06 ±14,28. Physiotherapy + manipulation (PT+MP) group consisted of 13 men (43,3%) and 17 women (56,7%) and age average was 49,7 ±12,44. 28 (46,7%) of the patients were men and 32 (53,3%) of them were women. Body mass index (BMI) of the patients was between 17,01 kg/m2 to 41,8 kg/m2. Mean value of the BMI for PT group was 27,61 ±4,00 kg/m2 while that of PT+MP group was 27,00 ±5,19 kg/m2.Both groups were demographically similar. After treatment, there was a significant improvement in shoulder flexion and scapular abduction degrees, in VAS scores at rest, night and overhead activities, shoulder functions shown with DASH and quality of life shown with SF-12 in both groups. In the 3rd month after treatment, VAS scores at rest, night and overhead activities and DASH scores was lower, painless shoulder flexion and scapular abduction degrees were higher in vi the PT+MP group. Statistically significant increase was seen in all subscales of the SF-12 for both groups. However, only PFS (Physical Function Score) and PRL (Physical Role Limitation) of SF-12 scales were found higher in PT+MP group compared to PT group. There was no significant difference in terms of PHS (Physical Health Score) , GMHS (General Mental Health Score) and other subscales between two groups. CONCLUSION: In this study, both physiotherapy and manipulative treatment combined with physiotherapy had positive effects on pain, range of joint motion, functional status and quality of life in the patients with SaSS. While immediately after treatment, both group had the same characteristics, in the 3rd month after treatment VAS scores at rest, night and overhead activities and DASH score were lower and painless flexion and scapular abduction degrees were higher in the PT+MP group. This shows that longer effect can be expected by manual therapy in terms of pain, range of motion and functional status. Our study showed that clavicular and glenohumeral joint manipulation techniques have an important role in the treatment of subacromial impingement syndrome in which recurrences are high, treatment failure is frequent and treatment period is long. Manual therapy may enrich the treatment milieu because its cost is negligible, the need for equipment is low, it is fast acting and safe when carried out by experienced and qualified doctors, it has significantly positive effects on pain, range of motion and functions.
Açıklama
Anahtar Kelimeler
Ağrı, Pain, Fizik tedavi, Physical therapy, Kas-iskelet manipülasyonları, Musculoskeletal manipulations
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Sodalı, E. (2017). Omuz impingement (subakromiyal sıkışma) sendromlu hastalarda manipülasyon tedavisinin etkinliği. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Bölümü Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Konya.
