Effect of Myofascial Trigger Points Therapy and Subacromial Corticosteroid Injection in Patients with Unilateral Shoulder Impingement Syndrome

探討肌筋膜激痛點治療及肩峰下類固醇注射對肩峰下夾擠症候群患者之療效

陳恩賜(En-Tsz Chen) ； 黃昱豪(Yu-Hao Huang) ； 謝霖芬(Lin-Fen Hsieh) ； 王子娟(Tzyy-Jiuan Wang)

《物理治療》 42卷2期 (2017/06) Pp. 146-147

https://doi.org/10.6215/FJPT.2017.73.O19

摘要

Background and Purpose: Shoulder impingement syndrome (SIS) is the most prevalent diagnosis of shoulder pain. Restoration of normal muscle function is crucial in treating SIS. Recent studies reveal that myofascial trigger points (MTrPs) are associated with shoulder muscle dysfunction and SIS. Manual compression on MTrPs and subacromial corticosteroid injection are commonly used to reduce pain in individuals with SIS, but the evidence of MTrPs therapy and corticosteroid injection for SIS is still limited. In addition, previous clinical trials did not reflect the influence of MTrPs therapy and corticosteroid injection on motor control. Therefore, the aim of this study is to investigate the immediate and short-term effects of MTrPs therapy combined with corticosteroid injection in patients with SIS. Methods: This was a prospective, randomized clinical trial. Forty-five patients with unilateral SIS and MTrPs in the scapular muscles were randomly allocated to corticosteroid injection group (N = 15, mean age = 56.62 ± 14.71 y), MTrPs therapy group (N = 15, mean age = 55.82 ± 11.24 y), and combined therapy group (N = 15, mean age = 54.27 ± 13.71 y). Outcomes included pain, pressure pain threshold (PPT), shoulder movement control, shoulder mobility, disability, function, and global rating of change score (GROC). Two-way repeated measures ANOVAs or ANCOVAs were used to determine the treatment effects. Results: For the pain intensity, a significant group by time interaction (p = 0.029) was observed among three groups. For the outcome of GROC (p = 0.015～0.025) and shoulder external rotation mobility (p = 0.004) after 7 days, both MTrPs therapy group and combined therapy group demonstrated more significant improvement than the corticosteroid injection group. Better treatment effects on movement control ability in arm flexion control (p ＜ 0.001) and abduction control (p = 0.004), higher PPT (p ＜ 0.044) in shoulder muscles were shown in MTrP group and combined therapy group than the corticosteroid group immediately and 7 days after the intervention. Conclusion: One session of MTrPs therapy alone or MTrPs therapy combined with subacromial corticosteroid injection are more effective than subacromial corticosteroid injection alone on reducing worst pain intensity, increasing shoulder mobility, decreasing pressure pain sensitivity, and improving shoulder movement control in patients with SIS.