The Effect of Humeral Head Depressor Strengthening in Individuals With Subacromial Impingement Syndrome

Subacromial impingement syndrome is a common musculoskeletal disorder. Therefore, to improve the shoulder biomechanics affected by the syndrome, an intervention group was compared with a control group. The exercise program applied to the intervention group is expected to improve the function of the shoulder complex.

Study Overview

• Status: Completed
• Conditions: Subacromial Impingement Syndrome
• Intervention / Treatment: Behavioral: Humeral Head Depressor Exercises; Behavioral: Standard physical therapy

Detailed Description

Subacromial Impingement Syndrome (SIS) is one of the most common musculoskeletal problems in the shoulder joint. This study aimed to investigate the effectiveness of a rehabilitation program targeting humeral head depressor muscles on symptoms in individuals with SIS.Participants were randomly divided into study and control groups.Volunteers who complained of shoulder pain for more than a month, who had limitation in passive movement compared to the other side shoulder, who had Neer impingement test, Hawkins test, Jobe supraspinatus test, and who were able to com-municate were included in the study. Individuals 1) Having any neurological condition affecting the upper extremity, 2) having neurological findings related to cervical disc herniation, 3) having a full-thickness rupture of one of the rotator cuff tendons, 4) having calcific tendonitis, 5) having undergone previous shoulder surgery and 6) Physical therapy-rehabilitation for the shoulder with the same complaints in the last 6 months, or 7) receiving corticosteroid injection were excluded from the study. While the control group received standard physical therapy and rehabilitation, the study group underwent a progressive resistance exercise program to strengthen the humeral head depressors and peri-articular muscles, including the rotator cuff. Acromio-humeral distance (AHD) and tendon thickness measurements were evaluated by ultrasonography, while pain intensity was measured through VAS and McGill Questionnaire, upper extremity disability through DASH-T, and kinesiophobia through Fear Avoidance Beliefs Questionnaire, respectively.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Cyprus
  • Nicosia, Cyprus
    • Near East University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Volunteers who complained of shoulder pain for more than a month,
• Who had limitation in passive movement compared to the other side shoulder,
• Who had Neer impingement test, Hawkins test, Jobe supraspinatus test, and -
• Who were able to com-municate were included in the study

Exclusion Criteria:

• Having any neurological condition affecting the upper extremity,
• Having neuro-logical findings related to cervical disc herniation,
• Having a full-thickness rupture of one of the rotator cuff tendons,
• Having calcific tendonitis,
• Having undergone previous shoulder surgery,
• Physical therapy-rehabilitation for the shoulder with the same complaints in the last 6 months,
• Receiving corticosteroid injection were excluded from the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: The Intervention Group; The Intervention group underwent a progressive resistance exercise program to strengthen the humeral head depressors and peri-articular muscles, including the rotator cuff. The exercises were performed 3 times per week for 6 weeks, with each session lasting approximately 1 hour	Behavioral: Humeral Head Depressor Exercises; The Intervention group underwent a progressive resistance exercise program to strengthen the humeral head depressors and peri-articular muscles, including the rotator cuff. Exercises were performed 3 times per week for 6 weeks, each session lasting approximately 1 hour
Active Comparator: The Control Group; Participants in the control group received standard physical therapy and rehabilitation as usually applied in routine care. Sessions were performed 3 times per week for 6 weeks, each lasting approximately 1 hour.	Behavioral: Standard physical therapy; Participants in this group received standard physical therapy and rehabilitation as usually applied in routine care. Exercises were performed 3 times per week for 6 weeks, each session lasting approximately 1 hour. Outcomes were measured at the same time points as the intervention group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Acromio-humeral Distance (Ultrasonography, USG)	Baseline and 6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tendon Thickness Measurment	Supraspinatus Tendon, Infraspinatus Tendon, subscapularis Tendon, Teres Minor Tendon, Long Head Biceps Tendon, Rotator Cuff group Tendons General Thicknesses were evaluated in all planes, by USG using a GE LogiqP6 Pro device and a linear transducer. Imaging was performed using standard shoulder sections while the patients were in a sitting position	Baseline and 6 week
Pain (Visual Analog Scale, VAS)	Pain intensity will be assessed using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate greater pain intensity.	Baseline and 6 weeks
Pain (McGill Pain Questionnaire-Pain Rating Index)	Pain will be assessed using the McGill Pain Questionnaire, specifically the Pain Rating Index (PRI). The total score ranges from 0 to 78, with higher scores indicating more severe pain.	Baseline and 6 weeks
Kinesiophobia (Fear Avoidance Beliefs Questionnaire - FABQ, Physical Activity subscale)	Kinesiophobia will be assessed using the Fear Avoidance Beliefs Questionnaire (FABQ) - Physical Activity subscale (items 2-5). Score range: 0 to 24 (higher scores indicate greater fear-avoidance beliefs related to physical activity). Time Frame: Baseline and 6 weeks.	Baseline and 6 weeks
Kinesiophobia (Fear Avoidance Beliefs Questionnaire - FABQ, Work subscale)	Kinesiophobia will also be assessed using the FABQ - Work subscale (items 6, 7, 9-12, 15). Score range: 0 to 42 (higher scores indicate greater fear-avoidance beliefs related to work).	Baseline and 6 weeks.
Upper Extremity Disability Through (DASH-T)		Baseline and 6 weeks

Collaborators and Investigators

• Sponsor: Near East University, Turkey
• Investigators: Principal Investigator: Ahmet OZGUL, Prof., Department of Physical Medicine and Rehabilitation, Kyrenia University Hospital, Kyrenia, Cyprus

Study record dates

Study Major Dates

• Study Start (Actual): July 3, 2023
• Primary Completion (Actual): July 3, 2024
• Study Completion (Actual): July 3, 2024

Study Registration Dates

• First Submitted: September 29, 2025
• First Submitted That Met QC Criteria: November 13, 2025
• First Posted (Estimated): November 14, 2025

Study Record Updates

• Last Update Posted (Estimated): November 14, 2025
• Last Update Submitted That Met QC Criteria: November 13, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Shoulder Injuries; Musculoskeletal Diseases; Wounds and Injuries; Joint Diseases; Shoulder Impingement Syndrome
• Other Study ID Numbers: 2023/115-1751

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The individual participant data from this study will not be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No