Korean J Sports Med KJSM The Korean Journal of Sports Medicine 1226-3729 2288-6028 The Korean Society of Sports Medicine 10.5763/kjsm.2018.36.1.34 Clinical Article Sports Science Effect of a Specific Rehabilitation Program of Serratus Anterior and Lower Trapezius Muscles for Subacromial Impingement Syndrome on Subacromial Space and the Vascularity of Supraspinatus Tendon Kim Eunkuk Choi Hokyung Department of Physical Education, Korea National Sport University, Seoul, Korea. Correspondence: Hokyung Choi. Department of Physical Education, Korea National Sport University, 1239 Yangjae-daero, Songpa-gu, Seoul 05541, Korea. Tel: +82-2-410-6830, Fax: +82-2-418-1877, ghruddl82@gmail.com 03 2018 07 03 2018 36 1 34 44 02 02 2018 28 02 2018 28 02 2018 Copyright © 2018 The Korean Society of Sports Medicine 2018 The Korean Society of Sports Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose

This study was designed to assess the effects of a rehabilitation program on clinical symptoms, subacromial space parameters and the supraspinatus vascularity in individuals with subacromial impingement syndrome (SIS).

 Methods

Thirty-five participants (exercise group with SIS [EG]=11, non-exercise group with SIS [NEG]=10, control group [CG]=14) took part in this study. Only EG participated in 6-week rehabilitation program. Outcomes were evaluated at baseline, 6 weeks, and 10 weeks. Changes in symptoms and functional limitations were assessed using Shoulder Pain and Disability Index (SPADI) questionnaire. Changes in acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT)/AHD were assessed using ultrasonographic measures. Quantitative analysis of tendon blood flow was performed by determining four regions of interest with power Doppler quantification and analysis software to normalize data for interpretation of the mean ratio of colored pixel to the region of interest (vascularization index [VI]) and the intensity per pixel (flow index [FI]).

 Results

Following the rehabilitation program, the scores on SPADI were significantly improved (p<0.05). However, AHD, STT/AHD, VI, and FI indicated no significant difference within groups or interactions of time and group in between groups.

 Conclusion

The rehabilitation program yielded improvements in symptoms, but not in subacromial parameters and the vascularity of supraspinatus in participants with SIS.

 Acromiohumeral distance Power Doppler Subacromial impingement syndrome Supraspinatus tendon thickness Ultrasonography National Research Foundation of Korea http://dx.doi.org/10.13039/501100003725 NRF-2015S1A5A8014725

No potential conflict of interest relevant to this article was reported.

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2015S1A5A8014725).

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Measurement of acromiohumeral distance (A) and position (B). QLAB analysis of power Doppler ultrasound of supraspinatus tendon. Rehabilitation program. (A) Robbery exercise for lower trapezius. (B) Lawn mower exercise for lower trapezius. (C) Low exercise for lower trapezius. (D) Inferior glide exercise for lower trapezius. (E) Prone shoulder flexion at 135° abduction for lower trapezius. (F) Push-ups with a plus for serratus anterior. Characteristics of participants

Values are presented as mean±standard deviation.

EG: exercise group, NEG: non-exercise group, CG: control group.

 Comparison of Shoulder Pain and Disability Index score between groups at baseline and after rehabilitation program

Values are presented as mean±standard deviation.

EG: exercise group, NEG: non-exercise group, CG: control group.

*p<0.05, compared to baseline; †p<0.05, compared to NEG.

 STT and AHD according to arm position

Values are presented as mean±standard deviation.

STT: supraspinatus tendon thickness, AHD: acromiohumeral distance, EG: exercise group, NEG: non-exercise group, CG: control group.

 The ratio of STT/AHD according to arm position

Values are presented as mean±standard deviation.

STT: supraspinatus tendon thickness, AHD: acromiohumeral distance, EG: exercise group, NEG: non-exercise group, CG: control group.

 The QLAB analysis of power Doppler ultrasound in bursal lateral region of supraspinatus tendon

Values are presented as mean±standard deviation.

VI: vascularization index, EG: exercise group, NEG: non-exercise group, CG: control group, FI: flow index, VFI: vascularization flow index.

 The QLAB analysis of power Doppler ultrasound in articular lateral region of supraspinatus tendon

Values are presented as mean±standard deviation.

VI: vascularization index, EG: exercise group, NEG: non-exercise group, CG: control group, FI: flow index, VFI: vascularization flow index.

 The QLAB analysis of power Doppler ultrasound in bursal medial region of supraspinatus tendon

Values are presented as mean±standard deviation.

VI: vascularization index, EG: exercise group, NEG: non-exercise group, CG: control group, FI: flow index, VFI: vascularization flow index.

 The QLAB analysis of power Doppler ultrasound in articular medial region of supraspinatus tendon

Values are presented as mean±standard deviation.

VI: vascularization index, EG: exercise group, NEG: non-exercise group, CG: control group, FI: flow index, VFI: vascularization flow index.