Evidence Based Approach to the Treatment of Subacromial Impingement Syndrome with
Kinesiology Tape
Cage SA, Gallegos DM, Warner BJ
Thank you
Outline
• Quicker reminder on evidence based practice
• PICO Question
• Anatomy of the Subacromial Arch
• Subacromial Impingement Syndrome Epidemiology
• Traditional Treatments
• A Brief Overview of Kinesiology Taping
• Use of Kinesiology Taping to Treat Subacromial Impingement Syndrome
• Conclusions
Evidence Based Practice
What is evidence based practice?
• Incorporates
• Best Research Evidence
• Clinical Expertise
• Patient Values and Preferences
EBP
Pro
fess
ion
al E
xper
tise
PICO Question
PICO Question
• Patients – Patients suffering from subacromial impingement syndreom
• Intervention – Kinesiology Taping
• Control – Conventional Treatment
• Outcome – Reduction in amount of pain and disability
Anatomy of the Subacromial Arch
Subacromial Arch
Subacromial Arch
• Major structures of note
• Supraspinatus tendon
• Long head of the biceps brachii
• Subacromial bursa
Subacromial Arch
Types of Acromion Processes
• Type I – Flat Acromion
Types of Acromion Processes
Types of Acromion Processes
• Type I – Flat Acromion
• Type II – Gently Curved Acromion
Types of Acromion Processes
Types of Acromion Processes
• Type I – Flat Acromion
• Type II – Gently Curved Acromion
• Type III – Hooked Acromion
Types of Acromion Processes
Types of Acromion Processes
• Type I – Flat Acromion
• Type II – Gently Curved Acromion
• Type III – Hooked Acromion
• *Type IV – Acromion with Inferior Spur
Types of Acromion Processes
Subacromial Impingement Syndrome Epidemiology
Subacromial Impingement Syndrome
• Collection of conditions with similar symptoms
• Subacromial bursitis
Subacromial Impingement Syndrome
Subacromial Impingement Syndrome
• Collection of conditions with similar symptoms
• Subacromial bursitis
• Rotator cuff tendinopathy
Subacromial Impingement Syndrome
Subacromial Impingement Syndrome
• Collection of conditions with similar symptoms
• Subacromial bursitis
• Rotator cuff tendinopathy
• Rotator cuff strains/ruptures
Subacromial Impingement Syndrome
Subacromial Impingement Syndrome
• Collection of conditions with similar symptoms
• Subacromial bursitis
• Rotator cuff tendinopathy
• Rotator cuff strains/ruptures
• Biceps brachii tendinopathy
Subacromial Impingement Syndrome
Subacromial Impingement Syndrome
• In patients suffering from shoulder pain, SIS accounts for as many as 2/3 of cases.
• Seen often in patients involved in overhead physical activity.
Subacromial Impingement Syndrome
• Common Causes:
• Spur formation under the acromion process
• Tension on the coracoacromial ligament
• Changes to the shape of the acromion process
• Rotator cuff strains
• Tendinopathies related to overuse
Subacromial Impingement Syndrome
• Signs & Symptoms
• Anterolateral shoulder pain
• Pain with active glenohumeral abduction
• Weakness with resisted glenohumeral external rotation
• (+) Neer’s Impingement Test
• (+) Hawkins-Kennedy Test
Why the refresher?
Common Treatments
Treating SIS
• Best practices are widely debated
• Commonly accepted that therapeutic exercise needs to be part of all treatment plans
• Only outcome that improved across 11 RCTs was pain
• What about:
• Strength?
• ROM?
• Function?
Treating SIS
• Other commonly reported treatments:
• Oral NSAIDs
• Oral analgesics
• Steroidal injections
• Cryotherapy
Treating SIS
• If conservative treatment fails, surgical interventions are indicated.
• Acromioplasty
Treating SIS
Treating SIS
• If conservative treatment fails, surgical interventions are indicated.
• Acromioplasty
• Distal clavicle excision
Treating SIS
Treating SIS
• If conservative treatment fails, surgical interventions are indicated.
• Acromioplasty
• Distal clavicle excision
• Subacromial Debridement
Treating SIS
Kinesiology Taping
Kinesiology Taping
• Popular modality for treating a variety of musculoskeletal conditions
• Shown to improve outcomes such as pain and disability
• Mode of action is still a topic of debate
• Mechanical?
• Neurological?
Kinesiology Taping
• Has become more widely used for a variety of shoulder pathologies
• Rotator cuff pathology
• Biceps tendinopathy
• Postural correction
• Subacromial impingement syndrome
Kinesiology Taping
• Shown to improve patient reported outcomes such as pain and disability
• Certain patterns of taping have been found to increase subacromial distance
Kinesiology Taping
Kinesiology Taping
Kinesiology Taping
Kinesiology Taping
Kinesiology Taping
• Shown to improve patient reported outcomes such as pain and disability
• Certain patterns of taping have been found to increase subacromial distance
• Improves pain free active range of motion
• Abduction
• Flexion
Kinesiology Taping
Demonstration
Considerations
• Does your patient have a latex allergy?
• Postural corrections?
Conclusions
Conclusions
• Clinicians working with patients participating in overhead activities will encounter SIS at some point in their careers
• There is still no universally accepted treatment protocol
• Failure of conservative treatment necessitates surgical intervention
Conclusions
• Kinesiology taping shows promising results
• Decreased pain
• Increased function
• Increased subacromial arch space
• Increase pain free active range of motion
• Different methods have been used in the past to achieve these goals.
Quiz Time
Question 1
• Which of the following is NOT a structure involved with subacromial impingement syndrome?
• Supraspinatus tendon
• Infraspinatus tendon
• Long head of the biceps tendon
• Subacromial bursa
Question 1
• Which of the following is NOT a structure involved with subacromial impingement syndrome?
• Supraspinatus tendon
• Infraspinatus tendon
• Long head of the biceps tendon
• Subacromial bursa
Question 2
• True/False: There are never surgical implications for subacromial impingement syndrome.
Question 2
• True/False: There are never surgical implications for subacromial impingement syndrome.
Question 3
• True/False: Latex allergies are not a consideration for kinesiology taping.
Question 3
• True/False: Latex allergies are not a consideration for kinesiology taping.
Question 4
• True/False: Forward or rounded shoulders can increase the risk of developing subacromial impingement syndrome
Question 4
• True/False: Forward or rounded shoulders can increase the risk of developing subacromial impingement syndrome
Question 5
• Which of the following has been used to demonstrate that kinesiology taping can have a decompressive effect on the subacromial space?
• Diagnostic Ultrasound
• X-ray
• MRI
• CT-Scan
Question 5
• Which of the following has been used to demonstrate that kinesiology taping can have a decompressive effect on the subacromial space?
• Diagnostic Ultrasound
• X-ray
• MRI
• CT-Scan
References
1. Cummins CA, Sasso LM, Nicholson D. Impingement syndrome: Temporal outcomes of nonoperative treatment. J Shoulder Elbow Surg. 2009;18:172-177.
2. Djordjevic OC, Vukicevic D, Katunac L, Jovic S. Mobilization with movement and kinesiotaping compared with a supervised exercise program for painful shoulder: Results of a clinical trail. Journal of Manipulative and Physiological Therapeutics. 2012;35(6):454-563.
3. Kaya OD, Baltaci G, Toprak U, Atay AO. The clinical and sonographic effects of kinesiotaping and exercise in comparison with manual therapy and exercise for patients with subacromial impingement syndrome: A preliminary trial. Journal of Manipulative and Physiological Therapeutics. 2014;37(6):422-432.
4. Kuh JE. Exercise in the treatment of rotator cuff impingement: A systematic review. J Shoulder Elbow Surg. 2009;18: 138-60.
5. Kulkarni R, Gibson J, Brownson P, Thomas M, Rangan A, Carr AJ, et al. Subacromial shoulder pain. Shoulder Elbow. 2015;7:135-143.
6. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33:73-81.
7. Luque-Suarez A, Navarro-Ledesma S, Petocz P, Hancock MJ, Hush J. Short term effects of kinesiotaping on acromiohumeral distance in asymptomatic subjects: A randomized controlled trial. Manual Therapy. 2013;18:573-577.
8. Lyman KJ, Gange KN, Hanson TA, Mellinger CD. Effects of 3 different elastic therapeutic taping methods on subacromial joint space. Journal of Manipulative and Physiological Therapeutics. 2017;40(7):494-500.
9. Singh B, Bakti N, Gulihar A. Current Concepts in the Diagnosis and Treatment of Shoulder Impingement. Indian Journal of Orthopaedics. 2017;51(5): 516-523.
10. Singh HP, Mehta SS, Pandey R. A preoperative scoring system to select patients for arthroscopic subacromial decompression. J Shoulder Elbow Surg. 2014;23: 1251-1256.
Questions