Effect of High-Power Laser on Shoulder Mobility in Sub Acromial Impingement Syndrome: Randomized Controlled Trial

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 3, Pages: 1157-1162

J. Environ. Treat. Tech.

ISSN: 2309-1185

Journal web link: http://www.jett.dormaj.com

Effect of High-Power Laser on Shoulder Mobility in

Sub Acromial Impingement Syndrome: Randomized

Controlled Trial

Walid ahmed Kamal , Mahmood Saber , Khalid Aiad , Mohamed Serag Eldein Mahgoub

Mostafa , Heba A. Bahey El- Deen

Physical Therapist MSC, ministry of interior, Egypt

Professor of laser application in surgery National institute of laser Enhanced science, Cairo University, Giza, Egypt

Professor of orthopedic physical Therapy, Cairo University, Giza, Egypt

Associate professor Basic Sciences department -Faculty of Physical Therapy, Cairo University, Giza, Egypt

Associate Professor of Physical Therapy, Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University,

Kingdom of Saudi Arabia and Assistant Professor of Physical Therapy, Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Misr

University for Science and Technology, Egypt

Received: 06/05/2020

Accepted: 15/07/2020

Published: 20/09/2020

Abstract

The effect of high-power laser on shoulder mobility in subacromial impingement syndrome had been not investigated yet. Objective of

study was to investigate the effect of high-power laser therapy on shoulder mobility in subacromial impingement syndrome. A Prospective,

Randomized, pre - post- Test, controlled trial was conducted. Setting: Outpatient clinic of Cleopatra Hospital – Egypt. The Study was conducted

between June 2017 and Feb 2018. Participants: Forty Patients who were diagnosed with 1 - 2 stage impingement syndrome pain was randomly

divided into two equal groups. Interventions. Group (A) received a program of Neodymium- yttrium aluminum Garnet Laser 1064 nm wave

Length Hiro 3 high intensity pulsed Laser was used in the study, Power of 8 W, dose of 12 J/cm2 and Total maximum energy of 10000 J were

Applied for 15 min and duration for single impulse 150 `us, fluency 760 mj, two sessions per week over six weeks' period in addition to

exercise Group (B) Received Exercise in the form of Pendulum Ex. For 5 minutes, strengthen Ex for Anterior fiber of deltoid, stretching ex

for sub scapularis muscle and anterior and posterior capsule. Main outcome measure: Visual Analogue Scale (VAS), active shoulder flexion

and abduction, Ultrasonography of supraspinatus tendon thickness. Comparing both groups post-program revealed a statistically significant

reduction in Ultrasonography Dimension of supraspinatus and VAS and significant increase in ROM of shoulder flexion and abduction in favor

to group A in compared to group B (p > 0.05). It’s concluded that high level laser Therapy was yielding more improvement for shoulder

mobility in impingement syndrome.

Keywords: Impingement syndrome, High level Laser Therapy, Shoulder mobility

Introduction¹

SAIS induces edema, swelling, and can become chronic if

appropriate treatment is not implemented, conservative and

surgical treatment methods can be used to minimize discomfort,

increase joint mobility, enhance muscle strength and quality of life

in SAIS. Conservative treatment strategies include analgesic and

non-steroidal anti-inflammatory or corticosteroid medications,

resting, adjustment of routine triggers, approaches to physical

activity, range of movement and strengthening exercises, local

anesthetic subacromial injections [6]. Laser therapy is based on the

belief that laser radiation and possible monochromatic light in

general are capable of changing the function of the cell and tissue

in a way that depends on the characteristics of the light itself, e.g.,

wavelength, coherence [7]. High-intensive laser therapy (HILT)

involving high-intensity laser radiation causing minor and slow

light absorption by chromium spheres, this absorption is not

obtained with concentrated, light by diffuse light in all directions

subacromial impingement syndrome is characterized as an

asymptomatic irritation of the rotator cuff and the subacromial

bursa in the subacromial space [1] the term encompasses a wide

range of disorders, causing an alteration in the relationship

between the [inflammation] soft tissue and the [stiffness] structure,

which is especially critical when the arm is removed in an arc

between 60 degrees and 120 degrees [2]. Sub-acromial

impingement syndrome (SIS) is characterized by extreme pain

spreading across biceps and deltoid from the shoulder, pain rises

at night, and with abduction and interned rotation [3]. Sub-

acromial impingement syndrome is one of the most common

causes of shoulder pain and occurs when the rotator cuff muscles

are squeezed in the sub-acromial space and the acromial arch of

curacao [4]. Numerous predisposing factors play a role in the

development of SIS, with the most prominent risk factors being

poor rotator cuff muscles, irregular scapular muscle function,

articular capsule defects and long-term overhead arm movement,

the muscle imbalances between upper and lower trapezius muscle

activity are related to abnormal scapular motion in patients with

shoulder pain [5].

scattering phenomena, increasing mitochondrial oxidative

reaction and adenosine triphosphate, RNA or DNA photochemical

8]. This study reported that high power laser improves shoulder

mobility in subacromial impingement syndrome. Up to our

knowledge there is no one use ultrasonography as objective

method to assess this improvement and also use different type of

[

Corresponding author: Walid ahmed Kamal, Physical Therapist MSC, ministry of interior, Egypt. Email: walidkamal558@gmail.com.

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2020, Volume 8, Issue 3, Pages: 1157-1162

exercises. There is limited research studying the effect of high-

power laser therapy on shoulder mobility in subacromial

impingement syndrome. Did high power laser improve shoulder

mobility in subacromial impingement syndrome?

physic examination [9]. Patients with a restricted passive range of

motion in the shoulder, severe cervical spondylosis, radicular arm

pain, inflammatory rheumatoid disorders, acromioclavicular or

glenohumeral osteoarthritis, calcium deposition, diabetes mellitus,

thyroid disease, ischemic heart disease, or a cardiac pacemaker,

and those with previous history of neurological disorders were

excluded. Patients who had received physical therapy and

rehabilitation, who had been injected steroids within 6 months

preceding the study, and those who underwent shoulder surgery,

were also excluded. All patients were screened, and No one were

excluded.

Materials and methods

.1 Study design

Study design the study was designed as a prospective,

randomized - pre – post – test-controlled trial. The study was con

ducted between June 2017 and February 2018.

.2 Participants

0 patients (20 males - 20 females), with SAIS was selected

.3 Randomization

Informed consent was obtained from each participant after

from outpatient's physical therapy department of Cleopatra

hospital. The patients confirmed their agreement to participate in

the study by signing an informed consent form. The inclusion

criteria of this study included patients clinically and radiologically

diagnosed as subacromial impingement syndrome with their ages

ranged from 28 – 45 years old and complained from unilateral

stage 1 - 2 subacromial impingement syndrome from one month

or longer and had finding compatible with nerve compression on

explaining the nature purpose and benefits of the study, informing

them of their right to refuse or withdraw at any time, and about the

confidentiality of any obtained information, the patients were

randomly assigned into Two groups " study group and control

group " by a blinded and an independent research assistant who

opened sealed envelopes that contained a computer generated

randomization card.

No subjects dropped out of the study after Randomization

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2020, Volume 8, Issue 3, Pages: 1157-1162

.3 Interventions

The patients were randomly divided into two groups. Group

by 4 physical therapists from outpatient clinic of Cleopatra

hospital for both groups [11].

(A): Composed of 20 patients. Who received 12 consecutive

session of HILT Twice a weekly over 6 weeks in addition to

therapeutic exercises. Group (B): composed of 20 patients who

received therapeutic exercises alone. High intensity laser therapy

treatment was done using (HIRO3.0 Nd: YAG pulsed laser)

2.4 Outcome Measures

All the assessment procedures were done before treatment and

after finishing the treatment plan.

(Arcugnano, Via Volta, 9 Vicenza, Italy) peak power 3kW

2.4.1Visual Analogue scale (VAS)

intensity 15000W/cm energy per pulse 350 mj.the treatment

consisted of 3 phases in each session. the initial phase involved

rapid manual scanning (100 cm /30s) of the anterior joint line of

Pain is assessed by using VAS which is a 10 cm calibrated line

with zero representing no pain and 10 representing worst pain [12].

the shoulder with one shot of 850 mj at frequency of 30 Hz. the

scanning was performed parallel to the joint line, with the patient

arm internally rotated on the posterior scan and externally rotated

on the anterior scan the total energy dose administered during this

phase was 4000J. the intermediate phase was a fixed scan phase ,

with one -shot emission of 350mj at a frequency of 20-25Hz.0.the

total delivered energy was 4000J in this phase, the hand piece was

applied vertically perpendicular to the shoulder joint for 5 sec.in

each scan, the scanning included both the anterior and posterior

joint line of the shoulder. The final phase involved rapid manual

scanning of the same areas treated in the initial phase and the

deltoid area until a total energy dose of 2000J.Application of all 3

stages of HILS took approximately 15 min. A stander hand piece

equipped with affixed spacer was used to ensure the same distance

to the skin. Both the subject and the operator wore protective

goggles throughout the procedure to shield their eyes from laser.

The patients were encouraged to exercise between sessions [10].

Each exercise session began with warm-up aerobic activities

lasting for 10 to 15 minutes and ended with ice packs being applied

on the affected areas for 5 minutes to relieve pain. The exercises

were performed in 4 phases. Each patient, depending on his or her

condition, started with phase 1 and progressed to phase 4. Phase 1

was aimed at achieving passive range of motion (ROM) without

pain. For this purpose, the isometric shoulder exercise and the

passive ROM exercise were performed in all directions 8 to 10

times per day. Postural exercises (eg, chin tuck and scapular

retraction) and glenohumeral ROM exercises were also performed

2.4.2 Active shoulder flexion and abduction

Electro goniometer was used to evaluate the mechanical

condition of the joint by electronic components and is used today

in research centers compared to radiography, the assessment of the

Angle with the electrogoniometer shown high level of accuracy

[13]. Active shoulder flexion and abduction were measured by the

electrogoniometer device through a stander measuring procedure

[14, 15].

2.5 Ultrasonography of supraspinatus tendon thickness

Ultrasonography was used as noninvasive examination with

practically no side effects, it is beneficial in dynamic examination

of the tendons during movement of the shoulder and assess the

integrity of the rotator cuff tendons. If ultrasound is to reliably

diagnose impingement, a dynamic assessment of shoulder

abduction is required. The ultrasound test of impingement is

performed with the arm abducted in or slightly forward of the

scapular plane, as this facilitates simultaneous visualization of the

relevant anatomical landmarks throughout the arc of elevation.

The ultrasound literature reports an additional four dynamic signs

of subacromial impingement: (a) “bunching” or fluid distension of

the SA‐SD bursa lateral to the impingement point at curacao‐

acromial arch [16] (b) “bunching” of the supraspinatus tendon

lateral to the impingement point at curacao‐acromial arch 5 , 6 ;

commonly, complete “blocking” of supraspinatus tendon motion

due to “migration of the humeral head upward to prevent its

passage beneath the acromion.

5 to 20 times per day. In the event of a 50% increase in the ROM,

the active-assistive ROM exercise was performed in all directions

with the help of a strap. Also, in this phase cross-body and neck

stretches were performed 4 times a day, each for a length of 10

seconds. Mobilization exercises were performed once per week.

When a patient was able to perform the passive and active-

assistive ROM exercises fully and painlessly, phase 2 (active

ROM exercises) began. Shoulder abduction or scaption (scapular

plane elevation) was performed by elevating the arm in the

scapular plane to an angle of less than 60. Strength training was

performed on the external and internal rotator cuff muscles while

the arms were placed at the sides of the body. This exercise was in

the form of 3 sets per day, each with 10 repetitions. The stretching

exercises performed in phase 1 were also performed in phase 2,

but their duration was increased to 15 to 20 seconds. The aim of

phase 3 was to strengthen the muscles of the rotator cuff and

scapula. Scaption was performed at an angle greater than 60. The

exercises intended to strengthen the rotator cuff muscles

responsible for external and internal rotation of the humerus were

performed at a 90 angle to shoulder abduction. The reverse-fly,

shoulder extension, and bent-over row exercises were performed

using an elastic band or a 1- to 1.5-kg weight in 3 sets of 10

repetitions each. In phase 4, the exercises intended to train the

scapular muscles were performed using a medicine ball. The

exercises for strengthening the muscles of the rotator cuff and

biceps were performed in 3 sets of 15 repetitions with a gradual

increase of 25% to 50% in external resistance. Exercises were done

Ultrasound examination was performed by a single radiologist

with experience in musculoskeletal ultrasound scanning for more

than 10 years. Both shoulders were evaluated in everyone. Acuson

Sequoia 512 (Siemens, Germany) ultrasound scanner with an 8-15

MHz linear array probe was used. The axial spatial resolution for

this probe was 0.280 mm. Ultrasonographic scanning was

performed according to the protocol recommended by the

European Society of Musculoskeletal Radiology, measurements of

the thickness of supraspinatus tendon. The thickness of

supraspinatus tendon was measured on the coronal view at the

sulcus located between greater tuberosity and articular cartilage

with the Modified Crass position. The Modified Crass position

means placing the subjects’ arm posteriorly and the palmar side of

the hand on the superior aspect of the iliac wing with the elbow

flexed, directed posteriorly. With this position, the probe was

positioned more parallel to the supraspinatus tendon at the

insertion site. The reason why we chose the Modified Crass

position over the Crass position is that most patients with rotator

cuff pathology experience less pain and are able to position closer

to the instruction in the former than the latter. The probe was

moved anteriorly and posteriorly to precisely observe the insertion

of supraspinatus tendon located anteriorly to the running of the

biceps tendon [17].

2.6 Statistical analysis

Results were expressed as mean ± standard deviation (SD). A

two-way mixed design MANOVA was run with two independent

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2020, Volume 8, Issue 3, Pages: 1157-1162

variables – intervention and measuring periods– and four

dependent variables (Ultrasonography of supraspinatus tendon

thickness, VAS, ROM of shoulder flexion and abduction). There

was a linear relationship between the dependent variables, as

assessed by scatterplot, and no evidence of multicollinearity, as

assessed by Pearson correlation (|r| < 0.9). There were no

univariate outliers in the data, as assessed by inspection of a

boxplot, and no multivariate outliers in the data, as assessed by

Mahalanobis distance (p > .001). Ultrasonography Dimension of

supraspinatus, VAS, ROM of shoulder flexion and abduction were

normally distributed, as assessed by Shapiro-Wilk's test (p > .05).

There was homogeneity of covariance matrices, as assessed by

Box's M test (p = .009), and homogeneity of variances, as assessed

by Levene's Test of Homogeneity of Variance (p > .05). Statistical

Package for Social Sciences (SPSS) computer program (version

this study can therefore suffice to decrease subacromial and sub

deltoid bursitis This is the first study on the use of high intensity

laser therapy in subacromial impingement syndrome and the use

of ultrasonography as an objective method for assessment of

subacromial and sub deltoid bursitis. A variety of causes, such as

poor posture, weakness and deterioration of the rotator cuff and

scapular muscles, decrease of ROM in the shoulder complex,

degeneration and inflammation of tendons and bursa, acromial

dysmorphology, capsular tightness and gleno-humeral instability

are generally thought to lead rotator cuff disease [18]. The protocol

used by karaka [19] and pekyvas [20] stipulated nine sessions on

alternating days, three weeks, and Santa Mato et al. used 10

sessions " five sessions/week for two weeks',' while our

intervention protocol called for 12 laser sessions

" two

sessions/weeks for 6 weeks so our results come in agreement with

Santa Mato et al who reported that high-intensity laser community

had stronger improvements than ultrasonic [21].

3 windows) was used for data analysis. P value ≤ 0.05 was

considered significant and < 0.01 was considered highly

significant.

Pakhavajs and Baltaci applied a placebo-free design and

analyzed only the post-treatment outcomes, which showed that

high-intensity laser therapy combined with other techniques of

physiotherapy contributes to better results. This study is in line

with other study published in 2015 by Sae Hoon et al. [10] who

examined HILT's therapeutic effectiveness in patients with frozen

shoulder [10]. 66 patients were divided randomly into two groups:

HILT (n=33) and placebo laser (n=33). The HILT protocol

required a therapeutic dose of 4000J for 15 minutes. Three weeks

of treatment were given three times a week. VAS for pain, VAS

for satisfaction and passive ROM were measured at baseline, after

Results

A total of 40 participants were eligible for inclusion, and were

randomized for study intervention. Group A consisted of 20

participants who received 12 consecutive session of HILT twice a

weekly over 6 weeks in addition to therapeutic exercises. Group B

consisted of 20 participants who received therapeutic exercises

alone three sessions per week for 6 weeks. All randomized

participants completed the trial. The groups were similar at

baseline (p > 0.05) with regard to age, height, weight and BMI

, 8 and 12 weeks of therapy. At baseline. Overall, the HILT group

(table 1). The interaction effect between type of intervention and

had three and eight weeks of clinically lower pain VAS ratings.

Within 12 weeks, there was no significant difference in pain.

Together, the HILT group had VAS scores of 3 and 8 weeks of

clinically lower pain. There was no significant difference in pain

within 12 weeks of this. No relevant effect or detectable harm was

associated with the addition of high-intensity laser therapy to

standard exercise therapy [10]. These findings are not in line with

the findings of recent research work done by Javier et al [22] who

stated that an intervention lasted for threeꢀweeks and comprised a

total of 15 sessions (five sessions/week). During each session,

participants received high-intensity laser therapy (experimental

group) or sham-laser intervention (sham-controlled group);

thereafter, all subjects received the same purpose-designed

exercise therapy protocol for subacromial syndrome, consisting of

stretching and strengthening exercises. They concluded that effect

of high-intensity laser therapy plus exercise is not higher than

exercise alone to reduce pain and improve functionality in patients

with subacromial syndrome. [22]. The long-term effect of pulsed

HILT in the treatment of post mastectomy pain syndrome was

evaluated by Ebid and El-sodany [23] who reported that after 12

weeks of follow-up, HILT is an effective physical therapy

modality for patients with PMPS. In fact, the HILT program is

superior and has a more prolonged effect than a sham laser in pain

reduction, increasing shoulder ROM, and improving and quality

of life [23].

measuring period on the combined dependent variables was

statistically significant, F= 452.606, p = 0.001, Wilks' Λ = 0.04,

partial η2 = 0.96. There was statistically significant effect of

intervention on the combined dependent variables, F= 279.93, p =

. 001, Wilks' Λ = .063, partial η2 = 0.937. While, there was a

statistically significant main effect of measuring periods on the

combined dependent variables, F= 1575.497, p = 0.001, Wilks' Λ

(

0.012, partial η2 = 0.988. Multiple pairwise comparison tests

Post hoc tests) showed that the Ultrasonography of supraspinatus

tendon thickness and VAS showed a significant reduction (p <

.05) within both groups, while the ROM of shoulder flexion and

abduction showed a significant increase (p < 0.05) within both

groups. Comparing both groups post-program revealed

statistically significant reduction in Ultrasonography of

supraspinatus tendon thickness and VAS and significant increase

in ROM of shoulder flexion and abduction in favor to group A in

compared to group B (p > 0.05) (Table 2).

Discussion

The current research was conducted to investigate the impact

of high-level laser therapy in subacromial impingement syndrome

on shoulder mobility. The mean value of VAS, electro goniometer,

and Ultrasonography between groups prior to and after treatment

was significantly different. The high intensity pulsed laser used in

Table 1: General characteristics of subjects

Study group(A)

Control group(B)

(n = 20)

P value

(n = 20)

Age (yrs.)

37.35 ±11.22

10 / 10

36.85 ±11.33

10 / 10

0.79^N^S

Gender Male/ female

Weight (Kg)

1.00 ^N^S

0.347^N^S

0.415 ^N^S

0.532^N^S

59.73 ±9.46

157.80 ±10.80

19.48 ±4.41

63.20 ±10.36

165.80 ±11.70

20.54 ±2.72

Height (Cm)

BMI (Kg/m²)

P > 0.05 = non-significant, P = Probability. BMI: body mass index.

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2020, Volume 8, Issue 3, Pages: 1157-1162

Table 2: Descriptive statistics and 2x2 mixed design Multivariate Analysis of Variance (MANOVA) for all dependent variables at different

measuring periods at both groups

Group A (n = 40)

Group B (n = 40)

P value*

Ultrasonography of supraspinatus

tendon thickness

Pre-program

6.44 ±0.61

6.45 ± 0.62

0.98 ^N^S

Post-program

P value**

3.93 ± 0.31

5.16 ± 0.4

0.001 ^H^S

0.001

VAS

Pre-program

Post-program

P value**

6.74 ±0.59

1.51 ± 0.42

0.001

6.51 ± 0.62

3.73 ± 0.66

0.001

0.091 ^N^S

0.001

ROM of Shoulder Flexion

ROM of Shoulder Abduction

Pre-program

Post-program

P value**

105.1 ±3.19

104.67 ± 3.4

0.567 ^N^S

0.001

157.75 ± 4.56

121.17 ± 15.71

0.001

Pre-program

Post-program

P value**

105.1 ±3.19

105.1 ± 3.2

0.99^N^S

152.45 ± 2.87

116.27 ± 3.74

0.001

Inter-group comparison; ** intra-group comparison of the results pre- and post-program.

P > 0.05 = non-significant, HS P < 0.01 = highly significant, P = Probability, ROM: range of motion.

Kujawa J et al [24] reported that uses of a specific waveform

with frequent peaks of elevated amplitude values and distances (in

time) between them to minimize thermal accumulation

phenomena and can quickly cause photochemical and

photothermic effects in the deep tissue that increase blood flow,

vascular permeability, and cease blood flow Vascular

permeability, and cell metabolism [24]. HILT had an analgesic

effect on nerve endings, but no evidence of decrease inflammation

was found [25, 26]. Rotator cuff injuries are common issues

although the individual affected may remain grossly asymptomatic

until large muscle injury has already occurred. The incidence of

partial-or full-thickness tears increases markedly after 50 years of

age as rotator-cuff lesions are a natural correlation of ageing and

are frequently present with no clinical signs [27]. In addition,

HILT is the other recently experienced physiotherapy agent in

clinical use. HILT effectiveness was compared with that of LILT

in Bell's palsy treatment and HILT was found to be more effective.

Its effectiveness was evaluated in two different studies on back

pain compared to ultrasound; in one study it was found to be

Effective pain and disability treatment; however, no difference

was detected in the other study. [28, 29, 30] Furthermore, Kheshie

AR et al [31] stated in their study that, HILT was found to be more

effective than LILT in the treatment of knee osteoarthritis.

Competing interests

The authors declare that there is no conflict of interest that

would prejudice the impartiality of this scientific work.

Authors’ contribution

We are three authors for this work, and we did all requirement

to accomplish this work, there is no other researchers participate

in this work.

References

De witted PB, NageLST, vanarkel ER, et al. study protocol

subacromial impingement syndrome; The Identification of

pathophysiologic mechanisms (SISTIM). BMC Musculo skeletal

Disorder 20ll; 12:282.

2. Leyes M and Forriol F. La rotura del manguito rotu-dor: etiologic.

Exploration y tratamientc. trauma2012; 23 (suppl.1):39 - 56.

3. Santamato A, solfrizzi V, Panza F, et al: Randomized clinical trial

people with subacromial impingement syndrome: versus ultrasound

therapy in the treatment of short-term effects of high-intensity laser

therapy. Phys Ther2009,89: 643-652. [Medline] [CrossRef].

Husni EM and Donohue JP. Painful Shoulder and Reflex Sympathetic

Dystrophy Syndrome. Arthritis and Allied condition, 15 ed.

Philadelphia: Lippincott Williams Wilkins, 2005, PP 2133-2151.

Abd Elhamed HB, Koura GM., Hamada HA., Mohamed YE, & Abbas

R. Effect of strengthening lower trapezius muscle on scapular tipping

in patients with diabetic frozen shoulder: A randomized controlled

study. Biomedical Research, 2018: 29(3).

Conclusions

HILT was shown to be superior in short term effect for

decreasing pain and improving mobility in patient with stage 1

and 2 SAIS, however, perhaps clinicians would be more willing

to use HILT if the effectiveness of therapy were investigated, and

favorable result obtained, in future studies outcome measure.

Dorrestijn O, Stevens M, Winters JC, van der Meer K & Diercks RL.

Conservative or surgical treatment for subacromial impingement

syndrome? A systematic review. Journal of shoulder and elbow

surgery (2009). 18(4), 652-660.

Basfrd TR. low intending laser therapy. Still not an established clinical

tool. laser sugar med 1995, 16-33-3-2

Zati A, Valente A. laser terrapin in medicine, terraria elision remove

endodermic in medicine riabiltaintre, Edizioni Minervamesica, 2006:

Ethical issue

Authors are aware of, and comply with, best practice in

publication ethics specifically with regard to authorship

62 -185

(avoidance of guest authorship), dual submission, manipulation of

Neer CS .2nd Impingement lesions. Clin Orthop Relat Res. 1983;

figures, competing interests and compliance with policies on

research ethics. Authors adhere to publication requirements that

submitted work is original and has not been published elsewhere

in any language.

(173):70–7.

10. Sae Hoon Kim, Yeon Ho Kim, Hwa-Ryeong Lee, Young Eun Choi.

shor-term effects of high-intensity laser therapy on frozen shoulder: A

prospective randomized control study, Manual therapy, volume 20,

Issue 6 ,2015, Pages 751-757.

161

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 3, Pages: 1157-1162

1. Parisa Nejati, Armita Ghahremaninia, Farrokh Naderi,Safoora

Gharibzadeh and Ali Mazaherinezhad .Treatment of Subacromial

Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy?

A Randomized Controlled Trial. The Orthopedic Journal of Sports

Medicine May 19, 2017.

2. price DD, Bush FM, long S, et al. A comparison of pain measurement

characteristics of mechanical visual analogue and simple numerical

rating scales. pain. 1994; 56:217-226.

3. Norkin Cynthia C and D Joyce White. "Measurement of joint motion."

A guide to goniometry.2 (2003): 181-98

4. Goodwin J,mClark C, Deakes J,mBurdon D and Lawrence C.Clinical

methods of goniometry

rehabil.1992,14 (1): 10-15.

a comparative study. Disabil and

5. Norkin C and DJ White. Joint Measurement. A Guide to Goniometry.

Philadelphia: FA Davis.1985, pp: 56-93.

6. Farin PU, Jorama H, Harju A, Soimakallio S. Shoulder impingement

syndrome: Sonographic evaluation. Radiology.1990;176: 845-8.

[

PubMed][Google Scholar]

7. Kyeongwon Kim, Hong Geum Kim, Daeheon Song, Jung Yoon

Yoon,and Myung Eun Chung. Ultrasound Dimensions of the Rotator

Cuff and Other Associated Structures in Korean Healthy

Adults.Korean Med Sci 2016; 31: 1472-1478

8. 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 PhysRehabil Med, 2011,

7:375-380.

9. karaca B. Effectiveness of high-intensity laser therapy in subacromial

impingement syndrome. Photo med laser Surge 2016;34(6):223-228.

0. pekyavas NO and Baltaci G. short-term effects of high intensity laser

therapy, manual therapy, and Kinesio taping in patients with

subacromial impingement syndrome. Lasers Med Sci 2016; (6): 1133-

141.

1. Santamato A, Solfrizzi V, Panza F, Tondi G, Frisardi V, Leggin BG

Fiore P. Short-term effects of high-intensity laser therapy versus

ultrasound therapy in the treatment of people with subacromial

impingement syndrome: a randomized clinical trial. Physical Therapy.

July 2009, Volume 89, Issue 7, 1, Pages 643–652.

2. Javier Aceituno-go`mez, Juan Avenda`no-Coy, Julio Go`mez-

Soriano. Efficacy of high-intensity laser therapy in subacromial

impingement syndrome: a three-month follow-up controlled clinical

trial. Clinical Rehabilitation. 2019, Vol.33(5):894-903.

3. Ebid AA and El-Sodany AM. Long-term effect of pulsed high-

intensity laser therapy in the treatment of post-mastectomy pain

syndrome: A double blind, placebo-control, randomized study. Lasers

Med Sci 2015; 30:1747-1755.

4. Kujawa J, Zavodnik L, Zavodnik I, Buko V, Lapshyna A, &

Bryszewska M. Effect of low-intensity (3.75-25 J/cm2) near-infrared

(810 nm) laser radiation on red blood cell ATPase activities and

membrane structure. Journal of clinical laser medicine

surgery,2004; 22(2), 111-117.

5. Tsukya K, Kawatani M, Takeshige c, et al. laser irradiation abates

neuronal responses to nociceptive stimulation of rat-paw skin. Brain

Res Bull.1994;34:369-374.

6. Nicolau RA, Martinez MS, Rigau J Tomas. Neurotransmitter release

changes induced by low power 830 nm diode laser irradiation on

neuromuscular junctions of the mouse. Lasers Surge Med.2004;

5:236-241.

7. Milgrom M, Schafflery, Gilbert M, Van Holsbeeck. Rotator-cuff

changes in asymptomatic adults: the effect of age, hand dominance

and gender. Journal of bone and Joint surgery.1995;77(2):296-8.

8. Alayat MS, Elsodany AM, El Fiky AA. Efficacy of high- and low-

level laser therapy in the treatment of Bell`s palsy: a randomized

double-blind placebo-controlled trial. Lasers Med Sci2014; 29:335-

42.

9. Fiore P, Panza F, Cassatella G, Russo A, Frisardi V, Solfrizzi V &

Santamato A. Short-term effects of high-intensity laser therapy versus

ultrasound therapy in the treatment of low back pain: a randomized

controlled trial. Eur J Phys Rehabil Med, 2011: 47(3), 367-73.

0. Boyraz I, Yildiz A, Koc B, Sarman H. Comparison of high intensity

laser therapy and ultrasound treatment in the patients with lumbar

discopathy. Biomed Res Int; 2015; 2015:304328.

1. Kheshie AR, Alayat MS, Ali MM. High-intensity versus low-level

laser therapy in the treatment of patients with Knee osteoarthritis: a

randomized controlled trial. Lasers Med Sci 2014; 29:1371-1376.

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