Pro Tip In cases where there is significant weakness in the cuff muscles or weakness in the lower trapezius, consider using neuromuscular electrical stimulation (NMES) to help promote contraction in these muscle groups.
A prospective clinical trial by Moroder et al concluded the shoulder-pacemaker therapy concept, using the Chattanooga Wireless Pro muscle stimulator, is an effective treatment with rapid improvement and sustained outcome over the course of 2 years in patients with noncontrollable PP-FSI (positional functional shoulder instability) with previously failed conventional treatment. Young and more athletic patients with lower weight and unilateral pathology respond best to the treatment. 66
Research supporting use of different modalities to address pain and function for shoulder tendinopathy. • A clinical practice guide by Yu et al. recommends using laser therapy for short-term pain relief in patients with subacromial impingement syndrome as studies demonstrated laser was more effective than placebo or ultrasound. 53 • A clinical study conducted by Yilmaz and colleagues demonstrated that combining high intensity laser therapy with exercise gave patients better pain relief, quality of life, function, and ROM than patients receiving exercise and sham laser. 54 • A retrospective study by Karaca concluded that high-power laser therapy was effective at reducing pain and disability in patients with subacromial impingement syndrome out to 8 weeks post-treatment. 55 • Elsodany and colleagues demonstrated that laser therapy combined with exercise therapy is more effective at improving pain and function in patients with rotator cuff tendinopathy when compared to sham laser and exercise. 28 • The Cochrane Review by Page et al concludes that both ultrasound and laser therapy may have short-term benefits in patients with rotator cuff disease compared to placebo. 29 • A study by Dedes and colleagues showed that using RPW to treat rotator cuff tendinopathy resulted in improved pain, function, and quality of life when compared to control groups. 7 • A review by Haslerud et al. reported that laser therapy, whether used alone or in conjunction with other physiotherapy treatments, can provide shoulder tendinopathy patients clinically significant pain relief. 30
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