Shoulder Manual Therapy for Aging and Older Adults Part 1: Subacromial Impingement Syndrome
Subacromial impingement is a common cause of shoulder pain in aging and older adults. This narrative review synthesizes recent literature on manual therapy to the shoulder joint for subacromial impingement. Emphasis has been placed on summarizing high-quality randomized clinical trials, systematic reviews with a narrative synthesis or meta-analysis, and clinical practice guidelines. The synthesis suggests that although there is limited high-quality evidence, manual therapy and exercise seem effective in improving outcomes in aging and older adults with subacromial impingement, and there is limited evidence to support the superiority of manual therapy over other interventions. Additional research using consistent outcome measures is needed to establish the optimal manual therapy techniques and parameters for subacromial impingement, both alone and in combination with exercise. Research that focuses exclusively on the effects of manual therapy on aging and older adults with subacromial impingement is warranted.
Shoulder pain is the third most common musculoskeletal reason for physician consultation and the second most common musculoskeletal problem referred for physical therapy. Luime and colleagues synthesized the findings from 18 studies on the prevalence and 1 study on the incidence of shoulder pain from the general populations of the UK, Spain, Sweden, Nigeria, Finland, the United States, Cuba, South Africa, Norway, and Denmark. Point prevalence is 6.9% to 26%, 1-month prevalence is 18.6% to 31%, 1-year prevalence is 4.7% to 46.7%, and lifetime prevalence is 6.7% to 66.7% for shoulder pain. Incidence data were reported by age groups: 0.9% for those 31 to 35 years, 2.5% for 42 to 46 years, 1.1% for 56 to 60 years, and 1.6% for 70 to 74 years. In Sweden, the new-onset consultation rate (per year) because of shoulder pain peaks for women 50 to 59 years of age (129 of the 10 000) and for men 60 to 69 years of age (116 of the 10 000). In the United States, the direct cost for the treatment of shoulder pain exceeds $7 billion each year.
Shoulder impingement ranks as the second most common subgroup/cause of shoulder pain, only after rotator cuff syndrome (which is not distinct from impingement). When disaggregating the data by diagnostic code, the new-onset consultation rate for impingement syndrome in Sweden is 17 in 10 000 for women and 21 in 10 000 for men and the annual consultation prevalence is 25 in 10 000 for women and 30 in 10 000 for men.
Although beyond the scope of this article, there are several useful reviews on the pathophysiology, imaging, and conservative and surgical management of shoulder impingement. What follows is a synthesis of recent literature on manual therapy to the shoulder joint for subacromial impingement (SAI) in aging and older adults. Emphasis has been placed on summarizing high-quality randomized clinical trials, systematic reviews with a narrative synthesis or meta-analysis, and clinical practice guidelines.
Chui, K.K., Yen, S., Wormley, M.E., Grimes, J. (2015). Shoulder manual therapy for aging and older adults part 1: subacromial impingement syndrome. Topics in Geriatric Rehabilitation, 31(3), 217-224. doi:10.1097/TGR.0000000000000068