Comparison of kinematics, sense of position and movement of the upper limb in patients with subacromial impingement syndrome and asymptomatic

Abstract

Introduction: The glenoumeral joint, when it is injured and when it is present, may lead in most cases to changes in the motor and may cause proprioceptive alterations, interfering in the efficiency, precision and improving the qualitative reduction of the praxis. Objective: To assess the relationship between sense of joint position, kinesthesia and kinematic behavior during the movement of arm elevation in patients with subacromial impact syndrome. Methods: An observational, case-control, single-blind study was performed in 10 patients with subacromial impact syndrome and 10 healthy individuals selected at the Physical and Functional Rehabilitation Service and at the Physiotherapy Service Brazil's Navy of the Policlínica Naval Nossa Senhora da Glória. The included symptomatic participants were those with a clinical diagnosis of subacromial impact syndrome, completed the demographic
questionnaire, performed a clinical examination for the upper extremity, and self-applied questionnaires of pain intensity (Numerical Pain Scale) and functionality (Pain and Disability Index on the Shoulder - SPADI-Brazil). Afterwards, the participants performed the positional and kinesthetic evaluation using the isokinetic dynamometer and evaluation of the functionality of the shoulder using kinematic analysis. For the asymptomatic participants, the same activities of the symptomatic patients were applied. Results: The symptomatic patients showed score of 4.8 (± 2.2) in analog pain scale, 46.2% of the SPADI-total score. There were statistically significant differences in the active sense of position for medial rotation (symptomatic group: 3.9 ± 2.2; asymptomatic: 1.5 ± 1.1, p= 0.011) and kinesthesia for medial rotation (symptomatic group: 16.8 ± 1.6; asymptomatic: 6.3 ± 6.3, p= 0.001). Kinematic analysis showed a quantitative difference between groups, though not statistically significant. Correlation analysis between the clinical data, proprioceptive and kinematic analysis showed a strong, negative correlation between the variables: EVA and maximum velocity in the concentric and eccentric phases (r = - 0.643 and r = -0.745); EVA and maximum acceleration in the concentric and eccentric phase (r = -0.694 and r = -0.672); EVA and maximum deceleration in the eccentric phase (r = -0.545); SPADI-Total and eccentric maximum
velocity (r = -0.833); SPADI-Total and maximum acceleration and maximum deceleration in the eccentric phase (r = -0.772 and r = -0.737); SPP-RM and vertical displacement in eccentric phase (r = -0.657); SPP-RL and duration of movement in the concentric (r = -0.636) and eccentric phases (r = -0.546) and with the vertical displacement in the concentric phase (r = -0.808). Conclusion: Proprioception, pain intensity and level of disability are negatively related to the symptomatic movement pattern. Individuals with SIS had a reduction in proprioceptive acuity. Kinematics evidenced a tendency of impairment in motor behavior of the upper limb during its elevation.