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Photobiostimulation in patients with shoulder impact syndrome. Randomized clinical trial

ABSTRACT

BACKGROUND AND OBJECTIVES:

To evaluate the effects of cluster therapy (Laser+LED) on shoulder impact syndrome, aiming at modulating pain and functionality.

METHODS:

Clinical, randomized, non double-blind study. Consisting of 28 individuals of both sexes, aged between 18 and 50 years, who were separated into: control group (CG n=13) and treatment group (TG n=15). The volunteers answered the Shoulder Pain and Disability Index (SPADI) questionnaire and goniometric evaluation of three active movements: flexion, abduction, and external rotation. The treatment group was submitted to Fluence Cluster - HTM, with energy of 12.8J, for 1 min and 30 seconds, 3 times a week, for 4 weeks, totaling 12 therapies, in the insertion of the tendon of the supraspinatus muscle and the passage of the long portion of the biceps brachii. The control group received orientation regarding daily activities.

RESULTS:

In both groups there was a reduction in pain, but the effect size observed was greater for the treatment group In the total SPADI evaluation, treatment presented a significant reduction in values, again with a greater effect size. In active movements, both flexion and external rotation, again the group that used the cluster had advantages, both inferential and in effect sizes.

CONCLUSION:

The cluster significantly reduced pain and increased functionality in patients with shoulder impingement syndrome.

Keywords:
Low-level light therapy; Physical therapy specialty; Tendinopathy

RESUMO

JUSTIFICATIVA E OBJETIVOS:

Avaliar os efeitos da terapia com cluster Laser+LED na síndrome do impacto do ombro, visando modulação da dor e funcionalidade.

MÉTODOS:

Estudo clínico, randomizado, não duplo-cego, que incluiu 28 indivíduos de ambos os sexos, com idade entre 18 e 50 anos, separados em grupo controle (GC n=13) e tratamento (GT n=15). Após responderem o questionário Shoulder Pain and Disability Index (SPADI) foi realizada avaliação goniométrica de três movimentos ativos: flexão, abdução e rotação externa. O grupo tratamento foi submetido ao Fluence Cluster - HTM com energia de 12,8J, durante 1 min e 30 segundos, 3 vezes por semana, durante 4 semanas, totalizando 12 terapias, na região de inserção do tendão do músculo supraespinhal e passagem da porção longa do bíceps braquial. O grupo controle recebeu orientações quanto às atividades diárias.

RESULTADOS:

Em ambos os grupos houve redução do quadro álgico, porém o efeito observado foi maior para o grupo tratamento. Na avaliação total do SPADI o grupo tratamento apresentou redução significativa dos valores com maior tamanho de efeito. Nos movimentos ativos, tanto flexão quanto rotação externa, o grupo tratamento apresentou vantagens, tanto de forma inferencial quanto nos tamanhos de efeito.

CONCLUSÃO:

A fotobioestimulação reduziu de modo significativo a dor e aumentou a funcionalidade dos pacientes com síndrome do impacto do ombro.

Descritores:
Fisioterapia; Tendinopatia; Terapia com luz de baixa intensidade

INTRODUCTION

Shoulder impingement syndrome (SIS) is an inflammatory and degenerative disease. The most common symptom is shoulder pain due to compression and mechanical abrasion of the subacromial structures against the anteroinferior surface of the acromion and the coracoacromial ligament during arm elevation11 Camargo PR, Avila MA, Alburquerque-Sendín F, Asso NA, Hashimoto LH, Salvini TF. Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series. Rev Bras Fisioter. 2012;16(1):74-83., especially in a range between 60 and 120 degrees22 Takeno K, Glaviano NR, Norte GE, Ingersoll CD. Therapeutic interventions for scapular kinematics and disability in patients with subacromial impingement: a systematic review. J Athl Train. 2019;54(3):283-95.. Besides this painful arc, complaints usually occur when the patient remains in lateral decubitus, compressing the affected shoulder33 Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765-76.. The syndrome can be defined as painful, of microtraumatic and degenerative nature and accompanied or not by loss of muscle strength44 Barbosa EC, Peres CM, Lucca SR, Oliveira JI. Melhora na qualidade de vida e da dor referida em trabalhadores com síndrome do impacto após aplicação do método Isostretching. Acta Fisiátrica. 2012;19(3):178-83..

SIS represents 44 to 65% of all cases of shoulder pain conditions22 Takeno K, Glaviano NR, Norte GE, Ingersoll CD. Therapeutic interventions for scapular kinematics and disability in patients with subacromial impingement: a systematic review. J Athl Train. 2019;54(3):283-95.. About 33% of SIS patients present scapular dyskinesia55 Moghadam AN, Rahnama L, Dehkordi SN, Abdollahi S. Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials. J Shoulder Elb Surg. 2020;29(1):e29-e36., of multifactorial etiology related to functional, degenerative, and mechanical causes. Treatment can be conservative with non-hormonal anti-inflammatory drugs, infiltrations and physical therapy33 Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765-76.,66 Salom-Moreno J, Jiménez-Gómez L, Gómez-Ahufinger V, Palacios Ceña M, Arias-Buría JL, Koppenhaver SL, et al. Effects of low-load exercise on postneedling-induced pain after dry needling of active trigger point in individuals with subacromial pain syndrome. PM R. 2017;9(12):1208-16..

Subacromial decompression has been the therapy of choice for cases with worse development, but there is evidence that this technique is not more advantageous than conservative treatment77 Gleich J. Diagnostik und therapie bei thyreoiditis. Fortschr Med. 2019;73(43):62-8., with analgesic and anti-inflammatory techniques to decrease shoulder dysfunction, improving neuromuscular control of the rotator cuff and scapular muscles, with the objective of stabilizing or adequately position the scapula during dynamic shoulder movement22 Takeno K, Glaviano NR, Norte GE, Ingersoll CD. Therapeutic interventions for scapular kinematics and disability in patients with subacromial impingement: a systematic review. J Athl Train. 2019;54(3):283-95.,88 Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, et al. Treatments for shoulder impingement syndrome a prisma systematic review and network meta-analysis. Medicine. 2015;94(10):E510..

Photobiomodulation (PBM) is the use of red or infrared spectrum radiation that, by reaching specific receptors, promotes the release of chemical mediators and modifies enzyme action, favoring tissue regeneration and pain reduction99 Sanchez AD, Andrade ALM, Parizotto NA. Eficácia da terapia a laser de baixa intensidade no controle da dor neuropática em camundongos. Fisioter Pesqui. 2018;25(1):20-7.,1010 Ferraresi C, Huang YY, Hamblin MR. Photobiomodulation in human muscle tissue: an advantage in sports performance? J Biophotonics. 2016;9(11-12):1273-99.. Effects on the increase of performance in athletes, influencing muscle mass, reducing the inflammatory process and oxidative stress in muscle biopsies have been observed1010 Ferraresi C, Huang YY, Hamblin MR. Photobiomodulation in human muscle tissue: an advantage in sports performance? J Biophotonics. 2016;9(11-12):1273-99.. PBM can act in the several dysfunctions caused by the cumulative effects of the impact of the SIS development1111 Kelle B, Kozanoglu E. Low-level laser and local corticosteroid injection in the treatment of subacromial impingement syndrome: a controlled clinical trial. Clin Rehabil. 2014;28(8):762-71.,1212 Ökmen BM, Ökmen K. Comparison of photobiomodulation therapy and suprascapular nerve-pulsed radiofrequency in chronic shoulder pain: a randomized controlled, single-blind, clinical trial. Lasers Med Sci. 2017;32(8):1719-26.. Although It’s still commonly used in clinical pract(i)ce, low-power laser therapy is not indicated in this dysfunction88 Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, et al. Treatments for shoulder impingement syndrome a prisma systematic review and network meta-analysis. Medicine. 2015;94(10):E510., and it’s important to evaluate the effects of cluster laser+LED therapy in SIS, aiming at pain modulation, as well as general and specific functionality of active movement.

METHODS

Experimental, randomized, single evaluators-blinded study, following the CONSORT criteria, carried out at the Physical Rehabilitation Center (PRC) of the Universidade Estadual do Oeste, Cascavel Campus (UNIOESTE). The sample consisted of 30 volunteers of both genders, aged between 18 and 50 years old, divided into control group (CG, n=15) and treatment group (TG, n=15).

The inclusion criteria were diagnosis of impingement syndrome, unilateral or bilateral shoulder pain, and positive results in at least three tests for SIS. The exclusion criteria were having a history of cervical spine and upper limb surgery, shoulder pain of neurological or rheumatic origin, and not undergoing all the PBM sessions.

The individuals were familiarized with the procedures that would be performed, which could be destined for PBM group or orientation, signed the Free and Informed Consent Term (FICT), and answered the Shoulder Pain and Disability Index (SPADI). Next, the following tests specific for impingement syndrome were performed: Neer, Hawkins-Kennedy, Jobe, Arc Pain, Speed Test, and Gerber1313 Maeda EY, Helfenstein Jr M, Ascencio JEB, Feldman D. The shoulder in a production line: clinical and ultrasound study. Rev Bras Reumatol. 2009;49(4):375-86.

The SPADI, used for evaluation of shoulder associated pain and disability1414 Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Rheum. 1991;4(4):143-9.,1515 Vascellari A, Venturin D, Ramponi C, Ben G, Poser A, Rossi A, et al. Psychometric properties of three different scales for subjective evaluation of shoulder pain and dysfunction in Italian patients after shoulder surgery for anterior instability. J Shoulder Elbow Surg. 2018;27(8):1497-504., consists of 13 questions, distributed in two domains: pain (five items) and function (eight items), and each item was scored on a numerical scale from zero to 10 points. The final score, as well as the score obtained separately by domain, was converted into percentages for values ranging from zero to 100, and the higher the score, the worse the condition of the dysfunction1616 Martins J, Napoles B V., 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.. Next, they were evaluated through goniometry for the three active movements: flexion, abduction and external rotation (EV1). Only the SPADI and goniometry evaluators were blinded with respect to the groups. For randomization, the web page https://www.graphpad.com/quickcalcs/randomize1/ was used.

The TG was submitted to Fluence LED (617nm±10%, 1500mW) and Laser (830nm, 150mW, beam area 12.57mm) - HTM® (Amparo - São Paulo), with combined energy of 12.8J per area, during 1 minute and 30 seconds. The radiation was applied to the insertion region of the supraspinatus tendon and the long portion of the biceps brachii three times a week for four weeks. The CG received orientation regarding the performance of activities of daily living (ADL) and a folder about the prevention of repetitive movements of the shoulder joint. At the end of the intervention, the patients from both groups were reevaluated after 24 hours (EV2) and at 30 days’ follow-up (EV3).

Study approved by the Research Ethics Committee (CEP) of UNIOESTE under number 2.958.408 in 2018.

Statistical analysis

The total sample size was calculated in 30 individuals through the G*Power 3.1.9.7 software, with an effect size of 0.53, α=0.05, and a power of 0.955. For inferential analysis, the SPSS 20.0 program was used, with analyses performed by Generalized Mixed Models, and LSD post-test. A significance level of 5% was determined in all cases. Effect size was also assessed by Cohen’s d based on the first assessment for each group and classified as: <0.2: very low; 0.2-0.5: small; 0.5-0.8: moderate; >0.8: large.

RESULTS

Eighteen individuals were included, 10 men and 18 women with a mean age of 26.8±10.4 years, height 1.68±0.08m, body mass 69.39±15.04kg and body mass index 24.25±3.95 (Figure 1). The algic scenario evaluated by the SPADI questionnaire showed interaction (p=0.016). The behavior was similar in both groups, with higher values in the first evaluation and reduction in EV2 and EV3 (Table 1). However, the analysis of effect sizes, which indicates the qualitative effect of the adopted therapy, showed small effect sizes for CG (EV1-EV2 and EV1-EV3) and moderate (EV1-EV2) and large effect sizes (EV1-EV3) for the TG (Figure 2 - A and B).

Table 1
Condition of shoulder dysfunction in both groups

Figure 1
CONSORT 2010 flow diagram

Figure 2
Size of effects obtained in the Shoulder Pain and Disability Index for pain

There were no differences between groups for disability (p=0.649) neither interaction of factors (p=0.522), only differences between assessments (p<0.001) (Table 1). Effect sizes were moderate for CG (EV1 with EV2 and EV3) and large for TG (EV1 with EV2 and EV3) (Figure 2 - C and D).

There was interaction (p=0.022) in the total evaluation of SPADI. There were no differences between the groups, but the TG presented higher values in EV1 compared to EV2 and EV3 (Table 1). For CG the effect sizes were very low (EV1 with EV2 and EV3) and for TG small between EV1-EV2 and moderate between EV1-EV3 (Figure 2 - E and F).

There was interaction of the ranges of motion (ROM) for flexion (p<0.001) and external rotation (p=0.016). In the first evaluation the groups were different (p=0.011) but became similar in the following. Within the groups, the CG showed similarity in the evaluations, while the TG showed a significant increase in ROM. There was also interaction for abduction (p=0.012), with CG being higher than TG in EV1 and EV2, becoming similar in EV3. In the comparison within groups, CG was always similar, whereas TG showed an increase in EV2 and EV3 (Table 2). Effect sizes were very low for CG, and for TG they ranged from small to large (Figure 3).

Table 2
Data in movement degree for both groups

Figure 3
Presentation of effect sizes observed in range of motion specific to flexion

DISCUSSION

The present study showed that the isolated effect of the associated laser and LED cluster reduced pain, improved function, and ROM in individuals with SIS.

The specific SPADI questionnaire for pain and disability of the shoulder joint evaluation is recommended because it has all the assessed psychometric properties, with a numerical scale response format and short questions that facilitate its completion. The Brazilian version is validated and reliable, low cost, and feasible for research1616 Martins J, Napoles B V., 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.. The other variable analyzed was the ROM, through goniometry, which, despite being very simple, is reliable and useful to assess small movement differences1717 Santos JDM, Oliveira MA, Silveira NJF, Carvalho SS, Oliveira AG. Confiabilidade inter e intraexaminadores nas mensurações angulares por fotogrametria digital e goniometria. Fisioter Mov. 2011;24(3):389-400.,1818 Naki IK, Rodrigues TA, Andrade TS, Esotico AP, Heyn D, Imamura M, et al. Acute encephalic vascular accident: rehabilitation. Acta Fisiátrica. 2012;19(2):60-5..

Laser treatments can be done with high-power equipment1212 Ökmen BM, Ökmen K. Comparison of photobiomodulation therapy and suprascapular nerve-pulsed radiofrequency in chronic shoulder pain: a randomized controlled, single-blind, clinical trial. Lasers Med Sci. 2017;32(8):1719-26. with the 1064nm, 7W laser, in two energy densities (20 and 100J/cm2), obtaining pain and function improvement in two weeks of treatment. A study1919 Santamato A, Solfrizzi V, Panza F, Tondi G, Frisardi V, Leggin BG, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther. 2009;89(7):643-52. compared the short-term effect of ultrasound therapy with a high-intensity laser with an average power of 6W during 10 treatment sessions for two consecutive weeks, and presented a significant improvement in pain, joint movement, functionality, and muscle strength in patients who underwent laser therapy compared to those who underwent ultrasound therapy. The current study confirms the result of the laser, which provided significant improvement in pain, joint movement, and functionality, despite the much lower power used.

Also comparing ultrasound with laser (850nm), but with low power (100mW), a study2020 Yavuz F, Duman I, Taskaynatan MA, Tan AK. Low-level laser therapy versus ultrasound therapy in the treatment of subacromial impingement syndrome: a randomized clinical trial. J Back Musculoskelet Rehabil. 2014;27(3):315-20. with two weeks of treatment in individuals with SIS and follow-up between 1 and 3 months showed a reduction in pain and functional improvement, suggesting that laser can be a good alternative to ultrasound when the latter is contraindicated for treatment. Nevertheless, another study2121 Calis HT, Berberoglu N, Calis M. Are ultrasound, laser and exercise superior to each other in the treatment of subacromial impingement syndrome? A randomized clinical trial. Eur J Phys Rehabil Med. 2011;47(3):375-80. did not show advantages of one form of therapy over the other in cases of SIS. Some studies that associated low power infrared laser with exercise protocols, both in clinics and at home, showed both positive2222 Abrisham SM, Kermani-Alghoraishi M, Ghahramani R, Jabbari L, Jomeh H, Zare M. Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial. Clin Rheumatol. 2011;30(10):1341-6.,2323 Alfredo PP, Bjordal JM, Junior WS, Marques AP, Casarotto RA. Efficacy of low-level laser therapy combined with exercise for subacromial impingement syndrome: a randomised controlled trial. Clin Rehabil. 2020; Ahed of print: 269215520980984. and negative2424 Bal A, Eksioglu E, Gurcay E, Gulec B, Karaahmet O, Cakci A. Low-level laser therapy in subacromial impingement syndrome. Photomed Laser Surg. 2009;27(1):31-6.

25 Dogan SK, Saime A, Evcik D. The effectiveness of low laser therapy in subacromial impingement syndrome: A randomized placebo controlled double-blind prospective study. Clinics. 2010;65(10):1019-22.
-2626 Yeldan I, Cetin E, Razak Ozdincler A. The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome. Disabil Rehabil. 2009;31(11):935-40. results. As an isolated treatment, the laser was as effective as corticoid injections in the shoulder1111 Kelle B, Kozanoglu E. Low-level laser and local corticosteroid injection in the treatment of subacromial impingement syndrome: a controlled clinical trial. Clin Rehabil. 2014;28(8):762-71., but inferior to treatment with shock waves2727 Badil Güloglu S. Comparison of low-level laser treatment and extracorporeal shock wave therapy in subacromial impingement syndrome: a randomized, prospective clinical study. Lasers Med Sci. 2020. Ahead of Print..

Laser has analgesic and anti-inflammatory properties, helping to reduce edema by reducing the synthesis of prostaglandins and inhibiting prostacyclins, and may increase nerve stimulation and the regulation of microcirculation, explaining the sensory changes in the central nervous system2424 Bal A, Eksioglu E, Gurcay E, Gulec B, Karaahmet O, Cakci A. Low-level laser therapy in subacromial impingement syndrome. Photomed Laser Surg. 2009;27(1):31-6. Because its biostimulating activity acts on a cellular level, when it interacts with the tissue it’s absorbed by the mitochondria, interacting with cytochrome C oxidase, which plays a central role in cell bioenergetics, generating a greater production of ATP, favoring tissue repair2828 Smith KC. Review article: molecular targets for low level light therapy. Laser Ther. 2010;19(3):135-42..

LED has also been useful in reducing inflammatory processes and pain, with significant reduction of inflammatory mediators such as prostaglandins, prostacyclins, bradykinin, substance P, histamine, interleukin-1β (IL1β) and tumor necrosis factor (TNF-α), reducing the activation of nociceptors. Furthermore, LED provides increased activity of macrophages, neutrophils, production of interleukin-10 (IL10) and increased cellular metabolism. This is due to the increase in mitotic activity, which acts in the repair process and in the improvement of the metabolic defense system related to the cellular antioxidant action in catalase and the activity of superoxide dismutase2929 Langella LG, Casalechi HL, Tomazoni SS, Johnson DS, Albertini R, Pallotta RC, et al. Photobiomodulation therapy (PBMT) on acute pain and inflammation in patients who underwent total hip arthroplasty-a randomized, triple-blind, placebo-controlled clinical trial. Lasers Med Sci. 2018;33(9):1933-40.

30 Pigatto GR, Silva CS, Parizotto NA. Photobiomodulation therapy reduces acute pain and inflammation in mice. J Photochem Photobiol B. 2019;196:111513.
-3131 Costa DR, Costa DR, Pessoa DR, Masulo LJ, Arisawa EALS, Nicolau RA. Efeito da terapia LED na disfunção temporomandibular: estudo de caso. Sci Med. 2017;27(2):ID25872..

In the present study, orientations were given to the CG about the best way to perform the ADL and an educational folder was made available with explanations about the disease and prevention in performing repetitive movements, with significant improvement in the pain domain evaluated by the SPADI questionnaire. Technologies for health education can range from media to games, to printed content, such as serial albums and booklets with recommendations for planning, delivery, and evaluation of health care based on benefits and partnerships between health professionals, patients, and families3232 Carvalho KM, Figueiredo MDLF, Galindo Neto NM, Sá GGM. Construction and validation of a sleep hygiene booklet for the elderly. Rev Bras Enferm. 2019;72(Suppl 2):214-20.,3333 Parent K, Jones K, Phillips L, Stojan JN, House B. Teaching patient- and family-centered care: Integrating shared humanity into medical education curricula. AMA J Ethics. 2016;18(1):24-32..

Limitations of this study are the absence of image and muscle strength assessments, as well as the lack of a placebo group or total control, since health education measures may have interfered with the natural development of the dysfunction in the CG members3434 Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiother Theory Pract. 2016;32(5):332-55..

CONCLUSION

The Laser+LED cluster provided reduction in pain and increase in functionality in patients with SIS.

  • Eduarda Bosa Dalmolin Data Collection, Conceptualization, Research, Methodology, Writing - Preparation of the original, Visualization
  • Gabriela Taborda Nath Data Collection, Conceptualization, Research, Methodology, Writing - Preparation of the original, Visualization
  • Pedro Augusto da Silva Data Collection, Conceptualization, Research, Methodology, Writing - Preparation of the original, Visualization
  • Morgana Neves Data Collection, Conceptualization, Research, Methodology, Writing - Review and Editing, Visualization
  • Carlos Eduardo de Albuquerque Funding Acquisition, Data Collection, Conceptualization, Resource Management, Research, Methodology, Writing - Review and Editing, Software, Visualization
  • Gladson Ricardo Flor Bertolini Statistical Analysis, Funding Acquisition, Data Collection, Conceptualization, Resource Management, Project Management, Research, Methodology, Writing - Review and Editing, Supervision

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  • 2
    Takeno K, Glaviano NR, Norte GE, Ingersoll CD. Therapeutic interventions for scapular kinematics and disability in patients with subacromial impingement: a systematic review. J Athl Train. 2019;54(3):283-95.
  • 3
    Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017;114(45):765-76.
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    Barbosa EC, Peres CM, Lucca SR, Oliveira JI. Melhora na qualidade de vida e da dor referida em trabalhadores com síndrome do impacto após aplicação do método Isostretching. Acta Fisiátrica. 2012;19(3):178-83.
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    Moghadam AN, Rahnama L, Dehkordi SN, Abdollahi S. Exercise therapy may affect scapular position and motion in individuals with scapular dyskinesis: a systematic review of clinical trials. J Shoulder Elb Surg. 2020;29(1):e29-e36.
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    Salom-Moreno J, Jiménez-Gómez L, Gómez-Ahufinger V, Palacios Ceña M, Arias-Buría JL, Koppenhaver SL, et al. Effects of low-load exercise on postneedling-induced pain after dry needling of active trigger point in individuals with subacromial pain syndrome. PM R. 2017;9(12):1208-16.
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    Gleich J. Diagnostik und therapie bei thyreoiditis. Fortschr Med. 2019;73(43):62-8.
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    Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, et al. Treatments for shoulder impingement syndrome a prisma systematic review and network meta-analysis. Medicine. 2015;94(10):E510.
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    Sanchez AD, Andrade ALM, Parizotto NA. Eficácia da terapia a laser de baixa intensidade no controle da dor neuropática em camundongos. Fisioter Pesqui. 2018;25(1):20-7.
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    Ferraresi C, Huang YY, Hamblin MR. Photobiomodulation in human muscle tissue: an advantage in sports performance? J Biophotonics. 2016;9(11-12):1273-99.
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    Kelle B, Kozanoglu E. Low-level laser and local corticosteroid injection in the treatment of subacromial impingement syndrome: a controlled clinical trial. Clin Rehabil. 2014;28(8):762-71.
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    Ökmen BM, Ökmen K. Comparison of photobiomodulation therapy and suprascapular nerve-pulsed radiofrequency in chronic shoulder pain: a randomized controlled, single-blind, clinical trial. Lasers Med Sci. 2017;32(8):1719-26.
  • 13
    Maeda EY, Helfenstein Jr M, Ascencio JEB, Feldman D. The shoulder in a production line: clinical and ultrasound study. Rev Bras Reumatol. 2009;49(4):375-86.
  • 14
    Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Rheum. 1991;4(4):143-9.
  • 15
    Vascellari A, Venturin D, Ramponi C, Ben G, Poser A, Rossi A, et al. Psychometric properties of three different scales for subjective evaluation of shoulder pain and dysfunction in Italian patients after shoulder surgery for anterior instability. J Shoulder Elbow Surg. 2018;27(8):1497-504.
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    Martins J, Napoles B V., 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.
  • 17
    Santos JDM, Oliveira MA, Silveira NJF, Carvalho SS, Oliveira AG. Confiabilidade inter e intraexaminadores nas mensurações angulares por fotogrametria digital e goniometria. Fisioter Mov. 2011;24(3):389-400.
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    Naki IK, Rodrigues TA, Andrade TS, Esotico AP, Heyn D, Imamura M, et al. Acute encephalic vascular accident: rehabilitation. Acta Fisiátrica. 2012;19(2):60-5.
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    Santamato A, Solfrizzi V, Panza F, Tondi G, Frisardi V, Leggin BG, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther. 2009;89(7):643-52.
  • 20
    Yavuz F, Duman I, Taskaynatan MA, Tan AK. Low-level laser therapy versus ultrasound therapy in the treatment of subacromial impingement syndrome: a randomized clinical trial. J Back Musculoskelet Rehabil. 2014;27(3):315-20.
  • 21
    Calis HT, Berberoglu N, Calis M. Are ultrasound, laser and exercise superior to each other in the treatment of subacromial impingement syndrome? A randomized clinical trial. Eur J Phys Rehabil Med. 2011;47(3):375-80.
  • 22
    Abrisham SM, Kermani-Alghoraishi M, Ghahramani R, Jabbari L, Jomeh H, Zare M. Additive effects of low-level laser therapy with exercise on subacromial syndrome: a randomised, double-blind, controlled trial. Clin Rheumatol. 2011;30(10):1341-6.
  • 23
    Alfredo PP, Bjordal JM, Junior WS, Marques AP, Casarotto RA. Efficacy of low-level laser therapy combined with exercise for subacromial impingement syndrome: a randomised controlled trial. Clin Rehabil. 2020; Ahed of print: 269215520980984.
  • 24
    Bal A, Eksioglu E, Gurcay E, Gulec B, Karaahmet O, Cakci A. Low-level laser therapy in subacromial impingement syndrome. Photomed Laser Surg. 2009;27(1):31-6.
  • 25
    Dogan SK, Saime A, Evcik D. The effectiveness of low laser therapy in subacromial impingement syndrome: A randomized placebo controlled double-blind prospective study. Clinics. 2010;65(10):1019-22.
  • 26
    Yeldan I, Cetin E, Razak Ozdincler A. The effectiveness of low-level laser therapy on shoulder function in subacromial impingement syndrome. Disabil Rehabil. 2009;31(11):935-40.
  • 27
    Badil Güloglu S. Comparison of low-level laser treatment and extracorporeal shock wave therapy in subacromial impingement syndrome: a randomized, prospective clinical study. Lasers Med Sci. 2020. Ahead of Print.
  • 28
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Publication Dates

  • Publication in this collection
    21 July 2021
  • Date of issue
    Apr-Jun 2021

History

  • Received
    15 Dec 2020
  • Accepted
    05 Apr 2021
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