Brazilian Journal of Pain
Brazilian Journal of Pain
Original Article

Comparison of isometric muscle strength between painful and non-painful shoulders in patients with symptoms of subacromial impingement

Comparação da força da musculatura isométrica entre ombro doloroso e não doloroso em pacientes com sintomas de impacto subacromial

Elias Pereira de Almeida; Marcelo Eder Salgasso; Anamaria Siriani de Oliveira; Thiele de Cássia Libardoni

Downloads: 1
Views: 439


BACKGROUND AND OBJECTIVES: The subacromial impingement syndrome is a dysfunction of the glenohumeral joint which can cause pain, functional disability, dependence, and low quality of life. The aim of this study was to compare the muscle strength between painful and non-painful shoulders and to verify the relationship between shoulder pain and disability and isometric muscle strength of the upper limb and kinesiophobia level in individuals with symptoms of subacromial impingement syndrome.

METHODS: Twenty volunteers with symptoms of subacromial impingement syndrome participated in the study. The evaluation was carried out by means of an evaluation form, the Shoulder Pain and Disability Index questionnaire (SPADI - BRAZIL) to assess disability and shoulder pain and the TAMPA questionnaire to analyze the level of kinesiophobia. The evaluation of shoulder isometric muscle strength was performed using the Manual Hand-Held Dynamometer stabilized by a rigid band in the movements of flexion, extension, abduction and internal and external rotation of the shoulder.

RESULTS: In the comparison of muscle strength between symptomatic and asymptomatic side, evidence of significant difference (p<0.05) was verified for all movements evaluated. There was a significant negative relationship between shoulder pain and disability index and isometric muscle strength of flexion and internal rotation, and a significant positive relationship with the level of kinesiophobia.

CONCLUSION: Individuals with symptoms of subacromial impingement syndrome showed a significant reduction in muscle strength of the symptomatic shoulder. The shoulder pain and disability index is related to the isometric muscle strength of the shoulder and to the level of kinesiophobia.


Muscle strength, Muscle strength dynamometer, Physical therapy modalities, Shoulder impingement syndrome


RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome do impacto subacromial é uma disfunção da articulação glenoumeral, podendo gerar dor, incapacidade funcional, dependência e baixa qualidade de vida. O objetivo deste estudo foi comparar a força muscular isométrica entre ombro doloroso e não doloroso e verificar a relação entre dor e incapacidade no ombro e força muscular isométrica do ombro e nível de cinesiofobia em indivíduos com sintomas de síndrome do impacto subacromial. MÉTODOS: Participaram do estudo 20 voluntários com sintomas de síndrome do impacto subacromial. A avaliação foi realizada por meio de ficha de avaliação, questionário Shoulder Pain and Disability Index (SPADI - BRASIL) para avaliação da incapacidade e dor no ombro e questionário TAMPA para analisar o nível de cinesiofobia. A avaliação da força muscular isométrica do ombro foi realizada utilizando o instrumento Manual Hand-Held Dynamometer estabilizado por faixa rígida nos movimentos de flexão, extensão, abdução, rotação interna e externa do ombro. RESULTADOS: Na comparação de força muscular isométrica entre lado sintomático e assintomático foi verificada evidência de diferença significativa (p<0,05) para todos os movimentos avaliados. Houve relação negativa significativa entre índice de dor e incapacidade no ombro e força muscular isométrica no movimento de flexão e rotação interna, além de relação positiva significativa com nível de cinesiofobia. CONCLUSÃO: Indivíduos com sintomas de síndrome do impacto subacromial apresentaram redução significativa da força muscular isométrica do ombro sintomático. O índice de dor e incapacidade no ombro está relacionado com força muscular isométrica do ombro e com nível de cinesiofobia.


Dinamômetro de força muscular, Fisioterapia, Força muscular, Síndrome do impacto do ombro


Saito H, Harrold ME, Cavalheri V, McKenna L. Scapular focused interventions to improve shoulder pain and function in adults with subacromial pain: a systematic review and meta-analysis. Physiother Theory Pract. 2018;34(9):653-70.

Singh B, Bakti N, Gulihar A. Current concepts in the diagnosis and treatment of shoulder impingement. Indian J Orthop. 2017;51(5):516-23.

Turner N, Ferguson K, Mobley BW, Riemann B, Davies G. Establishing normative data on scapulothoracic musculature using handheld dynamometry. J Sport Rehabil. 2009;18(4):502-20.

Nazligul T, Akpinar P, Aktas I, Unlu Ozkan F, Cagliyan Hartevioglu H. The effect of interferential current therapy on patients with subacromial impingement syndrome: a randomized, double-blind, sham-controlled study. Eur J Phys Rehabil Med. 2018;54(3):351-7.

Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765-76.

Alizadehkhaiyat O, Roebuck MM, Makki AT, Frostick SP. Subacromial impingement syndrome: An electromyographic study of shoulder girdle muscle fatigue. J Electromyogr Kinesiol. 2018;38:136-42.

Kinsella R, Cowan SM, Watson L, Pizzari T. A comparison of isometric, isotonic concentric and isotonic eccentric exercises in the physiotherapy management of subacromial pain syndrome/rotator cuff tendinopathy: study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud. 2017;14(3):45.

Haider R, Bashir MS, Adeel M, Ijaz MJ, Ayub A. Comparison of conservative exercise therapy with and without Maitland Thoracic Manipulative therapy in patients with subacromial pain: clinical trial. J Pak Med Assoc. 2018;68(3):381-7.

Clausen MB, Bandholm T, Rathleff MS, Christensen KB, Zebis MK, Graven-Nielsen T. The Strengthening Exercises in Shoulder Impingement trial (The SExSI-trial) investigating the effectiveness of a simple add-on shoulder strengthening exercise programme in patients with long-lasting subacromial impingement syndrome: Study protocol for a pragmatic, assessor blinded, parallel-group, randomised, controlled trial. Trials. 2018;19(1):154.

Tyler TF, Nahow RC, Nicholas SJ, McHugh MP. Quantifying shoulder rotation weakness in patients with shoulder impingement. J Shoulder Elbow Surg. 2005;14(6):570-4.

Clausen MB, Witten A, Holm K, Christensen KB, Attrup ML, Hölmich P. Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index. BMC Musculoskelet Disord. 2017;18(1):302.

Witten A, Clausen MB, Thorborg K, Attrup ML, Hölmich P. Patients who are candidates for subacromial decompression have more pronounced range of motion deficits, but do not differ in self-reported shoulder function, strength or pain compared to non-candidates. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2505-11.

Dabholkar AS, Sha IK, Dabholkar TA. Assessment and correlation of perceived harmfulness with psychological variables in patients with chronic shoulder pain. Ind J Pain. 2018;32(2):76-80.

Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009;90(11):1898-903.

Martins J, Napoles BV, Hoffman CB, Oliveira AS. Versão brasileira do shoulder pain and disability index tradução, adaptação cultural e confiabilidade. Rev Bras Fisioter. 2010;14(6):527-36.

Cordeiro N, Pezarat-Correia P, Gil J, Cabri J. Portuguese language version of the Tampa Scale for Kinesiophobia [13 items]. J Musculoskel Pain. 2013;21(1):58-63.

Gallagher EJ, Bijur PE, Latimer C, Silver W. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med. 2002;20(4):287-90.

Martin KD, McBride T, Wake J, Van Buren JP, Dewar C. Comparison of visual analog pain score reported to physician vs nurse in nonoperatively treated foot and ankle patients. Foot Ankle Int. 2018;39(12):1444-8.

Schrama PP, Stenneberg MS, Lucas C, van Trijffel E. Intraexaminer reliability of hand-held dynamometry in the upper extremity: a systematic review. Arch Phys Med Rehabil. 2014;95(12):2444-69.

McCabe RA, Nicholas SJ, Montgomery KD, Finneran JJ, McHugh MP. The effect of rotator cuff tear size on shoulder strength and range of motion. J Orthop Sports Phys Ther. 2005;35(3):130-5.

Marcondes FB, Rosa SG, Vasconcelos RA, Basta A. Rotator cuff strength in subjects with shoulder impingement syndrome compared with the asymptomatic side. Acta Ortop Bras. 2011;19(6):333-7.

Celik D, Sirmen B, Demirhan M. The relationship of muscle strength and pain in subacromial impingement syndrome. Acta Orthop Traumatol Turc. 2011;45(2):79-84.

Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80(3):276-91.

Ben-Yishay A, Zuckerman JD, Gallagher M, Cuomo F. Pain inhibition of shoulder strength in patients with impingement syndrome. Orthopedics. 1994;17(8):685-8.

MacDermid JC, Ramos J, Drosdowech D, Faber K, Patterson S. The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life. J Shoulder Elbow Surg. 2004;13(6):593-8.

Engebretsen K, Grotle M, Bautz-Holter E, Ekeberg OM, Brox JI. Determinants of the shoulder pain and disability index in patients with subacromial shoulder pain. J Rehabil Med. 2010;42(5):499-505.

Trost Z, France CR, Thomas JS. Examination of the photograph series of daily activities (PHODA) scale in chronic low back pain patients with high and low kinesiophobia. Pain. 2009;141(3):276-82.

Barth RJ. Clinician and patient-reported outcomes are associated with psychological factors in patients with chronic shoulder pain. Clin Orthop Relat Res. 2016;474(9):2040-3.

George SZ, Wu SS, Wallace MR, Moser MW, Wright TW, Fazendeiro KW. Biopsychosocial Influence on shoulder pain: influence of genetic and psychological combinations on twelve-month postoperative pain and disability outcomes. Arthritis Care Res. 2016;68(11):1671-80.

Thorpe AM, O'Sullivan PB, Mitchell T, Hurworth M, Spencer J, Booth G. Are psychologic factors associated with shoulder scores after rotator cuff surgery?. Clin Orthop Relat Res. 2018;476(10):2062-73.

Submitted date:

Accepted date:

60872afba953954e512b1548 brjp Articles


Share this page
Page Sections