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Randomized Clinical Trial of Rehabilitation for Subacromial Impingement Syndrome

This study has been completed.
Virginia Commonwealth University
Arcadia University
National Athletic Trainers’ Association Research & Education Foundation (NATA Foundation)
Information provided by (Responsible Party):
Chuck Thigpen, Proaxis Therapy Identifier:
First received: March 4, 2008
Last updated: March 26, 2013
Last verified: March 2013
The purpose of this randomized double-blind clinical trial is to determine the effectiveness of manual therapy for patients with subacromial impingement syndrome of the shoulder. We hypothesize that a combination of therapeutic exercise and manual therapy to the shoulder and spine will be more effective in reducing pain and shoulder disability at short-term (6 wk) and long-term (3, 6, 12 months) as compared to therapeutic exercise only.

Condition Intervention
Shoulder Impingement Syndrome
Other: Manual Therapy and Exercise
Other: Exercise Only

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Care Provider)
Primary Purpose: Treatment
Official Title: Randomized Clinical Trial of Rehabilitation for Subacromial Impingement Syndrome: A Comparison of Manual Therapy + Exercise to Exercise Only

Resource links provided by NLM:

Further study details as provided by Chuck Thigpen, Proaxis Therapy:

Primary Outcome Measures:
  • Shoulder disability and pain [ Time Frame: 6 weeks and 3, 6,12 months ]

Secondary Outcome Measures:
  • Patient satisfaction Quality of life (SF-36) Additional healthcare utilization and medication [ Time Frame: 6 weeks, and 3, 6, 12 months ]
  • Patient perceived global rating of effect [ Time Frame: 6 weeks and 3 months ]

Enrollment: 109
Study Start Date: February 2008
Study Completion Date: September 2012
Primary Completion Date: September 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Manual Therapy + Exercise
Other: Manual Therapy and Exercise
Manual therapy to the thoracic spine and shoulder, and therapeutic exercise to the shoulder and spine applied in a prescribed progression of therapeutic exercise aimed at improving shoulder function.
Other Name: Manual Therapy and Therapeutic Exercise
Active Comparator: 2
Exercise Only
Other: Exercise Only
A prescribed progression of therapeutic exercise for the shoulder and spine aimed at improving shoulder function
Other Name: Therapeutic Exercise

Detailed Description:
Subacromial impingement syndrome (SAIS) is a frequent cause of shoulder pain. Clinical trials investigating the effectiveness of manual therapy have demonstrated improvements in outcomes when manual therapy has been added to a program of therapeutic exercise. However, the these clinical trials (3) have significant limitations and generalizability. Two of the three 3 trials had a small number of subjects (14 & 22 subjects) and all 3 trials had only short term follow up (<12 weeks) and used non-validated self report outcome measures. These limitations reduce the confidence with which clinicians can apply these results to the patients they treat with SAIS. Clear evidence is needed to justify the cost and clinician time required to perform manual therapy in the delivery of patient care. Therefore, the purpose of this randomized clinical trial is to examine the short-term and long-term effectiveness of manual therapy in addition to therapeutic exercise as compared to therapeutic exercise only in patients diagnosed with SAIS.

Ages Eligible for Study:   18 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Symptoms associated with athletic activity (35% of patients)
  • Diagnosis of shoulder impingement syndrome as evidence by all 3 criteria:

    1. Reproduction of symptoms with impingement test: either Hawkins- Kennedy or Neer Test
    2. Pain during active shoulder elevation at or above 60 degrees
    3. Weakness of rotator cuff or pain during the Empty Can test or during resisted shoulder external rotation
  • Shoulder disability: 25/100 (0 = no disability)
  • Able to understand written and spoken

Exclusion Criteria:

  • Severe pain; pain is > 7/10 on NPRS (0 = no pain)
  • Shoulder surgery on affected shoulder
  • Traumatic shoulder dislocation within the past 3 months
  • Previous rehabilitation for this episode of shoulder pain
  • Reproduction of shoulder pain with active or passive cervical motion
  • Systemic inflammatory joint disease
  • Global loss of passive shoulder ROM, indicative of adhesive capsulitis
  • Full-thickness rotator cuff tear, as evidenced by any one of the following:

    1. Markedly reduced shoulder external rotation strength
    2. Drop arm test
    3. External rotation lag sign
    4. Lift off test
    5. Positive findings on MRI or ultrasonography
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Please refer to this study by its identifier: NCT00633451

United States, South Carolina
Proaxis Therapy
Greenville, South Carolina, United States, 29607
Sponsors and Collaborators
Proaxis Therapy
Virginia Commonwealth University
Arcadia University
National Athletic Trainers’ Association Research & Education Foundation (NATA Foundation)
Principal Investigator: Charles A Thigpen, PhD, PT, ATC University of North Florida
Principal Investigator: Lori A Michener, PhD, PT, ATC Virginia Commonwealth University
Principal Investigator: Phil McClure, PhD, PT Arcadia University
Study Director: Angela R Tate, PhD, PT Arcadia University
  More Information

Additional Information:
Responsible Party: Chuck Thigpen, Clinical Research Scientist, Proaxis Therapy Identifier: NCT00633451     History of Changes
Other Study ID Numbers: 07-173
Study First Received: March 4, 2008
Last Updated: March 26, 2013

Keywords provided by Chuck Thigpen, Proaxis Therapy:
shoulder pain
shoulder impingement syndrome
manual therapy

Additional relevant MeSH terms:
Shoulder Impingement Syndrome
Pathologic Processes
Joint Diseases
Musculoskeletal Diseases processed this record on May 25, 2017