***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose Subacromial decompression is the st and ard surgical treatment of subacromial impingement syndrome . Unsatisfactory results have been reported for concomitant lesions as well as inadequate diagnosis . We sought to determine the predictive value of the preoperative examination for the results of arthroscopic subacromial decompression in impingement syndrome . Methods Forty-nine shoulder joints in 47 patients receiving arthroscopic subacromial decompression were prospect ively followed for a mean 3.7 ± 0.4 years . Prior to surgery , the impingement tests according to Neer , Hawkins – Kennedy ( in the neutral as well as abducted position ) , and the Jobe test ( empty can position ) were evaluated as well as the presence of a painful arc . The association between the presence of these sings , success of the operation , and improvement in Constant scores as well as WORC indices was analysed . Results Pre- to postoperative improvement in Constant scores as well as WORC indices was greater in case of a positive test result for every test studied . With the numbers available , significant greater improvements in Constant scores were observed only for patients with a positive Hawkins – Kennedy sign in the neutral position , Neer and Jobe tests , compared to patients with negative signs , respectively . No significant differences were observed for the improvement in WORC indices . Patients with at least four positive tests out of the five studied had greater improvement in Constant scores than patients with three or less positive test results . Five patients went on to receive subsequent shoulder surgery . There was no association between the necessity for revision surgery and the presence or absence of impingement signs . Conclusion The impingement tests according to Hawkins – Kennedy , Neer , and Jobe are valid predictors of outcome after subacromial decompression , as is the presence of multiple impingement tests . This study may aid in improving patient outcome and especially patient selection for subacromial decompression . Level of evidence Prognostic , Level Background Although arthroscopic subacromial decompression ( ASD ) is a common procedure for treatment of shoulder impingement , few long term results have been published . In this prospect i ve study , we determined whether the high degree of patient satisfaction at 6 months postoperatively reported by us earlier remained at the 6-year follow-up . Patients and methods We originally reported high patient satisfaction 6 months after  ASD for shoulder impingement in 50 prospect ively studied patients using the Disability of the Arm Shoulder and H and question naire ( DASH ) and the  Visual Analog Scale ( VAS ) .  Patients with associated shoulder disorders were excluded . The surgeons were experienced shoulder arthroscopists . 6 years after surgery , the  DASH question naire and the  VAS  were sent to these 50 patients . 2 patients had other medical problems of the upper extremity that affected the DASH and VAS scores , 1 patient was lost to follow-up , and another refused to participate . Thus , 46 patients with a mean age of 55 ( 33–78 ) years were included in this 6-year evaluation . Results The considerable improvement in both the DASH score and the VAS that was observed 6 months after surgery persisted or had even improved 6 years after surgery . Interpretation Properly selected patients with shoulder impingement treated with ASD remain satisfied 6 years after surgery Subacromial impingement syndrome ( SAIS ) , which is associated with pain and a loss of function , has a high occurrence in the physically active population . Not all patients respond positively to treatment . Classifying patients can improve decision-making . The scapular kinematic and clinical impairments can aid in classifying the patients who are more likely to respond to physical therapy treatment . Thirty-three subjects ( males , 20 - 33 years ) presenting SAIS were studied to determine altered scapular kinematics and clinical impairments . Three measurements were collected : ( 1 ) three-dimensional scapular kinematics during performing functional tasks ; ( 2 ) impairment outcomes of range of motion and muscle force ; and ( 3 ) self-reported measurements of pain , satisfaction , and function . All patients received 6-week ( 2 times per week ) physical therapy treatment . Improvement with treatment was determined using the Global Rating of Change Scale . Scapular kinematics and clinical impairments were first identified by t-test in predicting improvement and then combined into a multivariate prediction method . A prediction method with three variables ( Flexilevel Scale of Shoulder Function score < 41 , muscle power of serratus anterior < 27.4 % body weight , degree of scapular internal rotation at 30 ° shoulder elevation during descending arm phase in unloaded condition<0.7 ° ) were identified . It appears that scapular kinematics and impairment features can be used to classify subjects with SAIS in addition to self-report . Prospect i ve validation of the proposed prediction method requires further investigation The aim of this case series was to investigate changes in pain and pressure pain sensitivity after manual treatment of active trigger points ( TrPs ) in the shoulder muscles in individuals with unilateral shoulder impingement . Twelve patients ( 7 men , 5 women , age : 25 ± 9 years ) diagnosed with unilateral shoulder impingement attended 4 sessions for 2 weeks ( 2 sessions/week ) . They received TrP pressure release and neuromuscular interventions over each active TrP that was found . The outcome measures were pain during arm elevation ( visual analogue scale , VAS ) and pressure pain thresholds ( PPT ) over levator scapulae , supraspinatus infraspinatus , pectoralis major , and tibialis anterior muscles . Pain was captured pre-intervention and at a 1-month follow-up , whereas PPT were assessed pre- and post-treatment , and at a 1-month follow-up . Patients experienced a significant ( P < 0.001 ) reduction in pain after treatment ( mean ± SD : 1.3 ± 0.5 ) with a large effect size ( d > 1 ) . In addition , patients also experienced a significant increase in PPT immediate after the treatment ( P < 0.05 ) and one month after discharge ( P < 0.01 ) , with effect sizes ranging from moderate ( d = 0.4 ) to large ( d > 1).A significant negative association ( r(s ) = -0.525 ; P = 0.049 ) between the increase in PPT over the supraspinatus muscle and the decrease in pain was found : the greater the decrease in pain , the greater the increase in PPT . This case series has shown that manual treatment of active muscle TrPs can help to reduce shoulder pain and pressure sensitivity in shoulder impingement . Current findings suggest that active TrPs in the shoulder musculature may contribute directly to shoulder complaint and sensitization in patients with shoulder impingement syndrome , although future r and omized controlled trials are required Background Shoulder complaints , and especially the outlet-impingement syndrome , are a common condition . Among other things , poor posture has been discussed as a cause . A correlation between impingement syndrome and restricted mobility of the thoracic spine ( T ) has been described earlier , but there has been no motion analysis of the thoracic spine to show these correlations . In the present prospect i ve study , we intended to find out whether there is a significant difference in the thoracic sagittal range of motion ( ROM ) between patients with a shoulder outlet impingement syndrome and a group of patients who had no shoulder pathology . Secondly , we wanted to clarify whether Ott 's sign correlates with ultrasound topometric measurements . Methods Two sex- and age-matched groups ( 2 × n = 39 ) underwent a clinical and an ultrasound topometric examination . The postures examined were sitting up straight , sitting in maximal flexion and sitting in maximal extension . The disabilities of the arm , shoulder and h and ( DASH ) score ( obtained by means of a self- assessment question naire ) and the Constant score were calculated . Lengthening and shortening of the dorsal projections of the spine in functional positions was measured by tape with Ott 's sign . Results On examination of the thoracic kyphosis in the erect seated posture there were no significant differences between the two groups ( p = 0.66 ) . With  ultrasound topometric measurement it was possible to show a significantly restricted segmental mobility of the thoracic spine in the study group compared with the control group ( p = 0.01 ) . An in-depth look at the mobility of the subsegments T1 - 4 , T5 - 8 and T9 - 12 revealed that differences between the groups in the mobility in the lower two sections of the thoracic spine were significant ( T5 - 8 : p = 0.03 ; T9 - 12 : p = 0.02 ) . The study group had an average Constant score of 35.1 points and the control group , 85.5 ( p < 0.001 ) . On the DASH score the patient group reached 34.2 points and the control group , 1.4 ( p < 0.001 ) . The results of Ott 's sign differed significantly between the two collectives ( p = 0.0018 ) , but showed a weak correlation with the ultrasound topometric measurements ( study group flexion/extension : r = 0.36/0.43 , control group flexion/extension : r = 0.29/0.26 ) . Conclusion The mobility of the thoracic spine should receive more attention in the diagnosis and therapy of patients with shoulder outlet impingement syndrome OBJECTIVES : Conflicting results were reported about the effectiveness of Low level laser therapy on musculoskeletal disorders . The aim of this study was to investigate the effectiveness of 850‐nm gallium arsenide aluminum ( Ga‐As‐Al ) laser therapy on pain , range of motion and disability in subacromial impingement syndrome . METHODS : A total of 52 patients ( 33 females and 19 males with a mean age of 53.59±11.34 years ) with subacromial impingement syndrome were included . The patients were r and omly assigned into two groups . Group I ( n = 30 , laser group ) received laser therapy ( 5 joule/cm2 at each point over maximum 5‐6 painful points for 1 minute ) . Group II ( n = 22 , placebo laser group ) received placebo laser therapy . Initially cold pack ( 10 minutes ) was applied to all of the patients . Also patients were given an exercise program including range of motion , stretching and progressive resistive exercises . The therapy program was applied 5 times a week for 14 sessions . Pain severity was assessed by using visual analogue scale . Range of motion was measured by goniometer . Disability was evaluated by using Shoulder Pain and Disability Index . RESULTS : In group I , statistically significant improvements in pain severity , range of motion except internal and external rotation and SPADI scores were observed compared to baseline scores after the therapy ( p<0.05 ) . In Group II , all parameters except range of motion of external rotation were improved ( p<0.05 ) . However , no significant differences were recorded between the groups ( p>0.05 ) . CONCLUSIONS : The Low level laser therapy seems to have no superiority over placebo laser therapy in reducing pain severity , range of motion and functional disability Background Diagnosing impingement syndrome without rotator cuff tear usually depends on the physical examination and roentgenography , and obtaining objective evidence for this condition is at best difficult . The purpose of this study was to ascertain whether quantitatively assessing this condition with using single photon emission computerized tomography ( SPECT ) can diagnose impingement syndrome and predict the postoperative results . Methods Before executing arthroscopic or open treatment , SPECT was performed on 73 patients and 24 volunteers and these people were followed up for 2 years . Any increased uptake on SPECT  was investigated by using the axial view , which demonstrated the greatest uptake for the acromion , distal clavicle , greater tuberosity , lesser tuberosity and the coracoid process of the operated and non-operated sides . Results The patients who were diagnosed as having impingement syndrome with or without rotator cuff tear showed increased uptake on the operative side compared to the non-operated side in the assessed locations . The greater tuberosity of the humerus could be used for quantitative measurement as a postoperative prognostic factor . Conclusions The bone SPECT method is useful for making the diagnosis of patients with impingement sydrome , and the results of quantitative assessment at the greater tuberosity can be used for evaluating the prognosis following the operation OBJECTIVE The aim of this study was to determine the effectiveness of Kinesio taping ( KT ) application added to the exercise treatment of subacromial impingement syndrome ( SIS ) . METHODS Thirty-eight ( 25 female , 13 male ) patients with SIS were r and omly divided into therapeutic KT ( n=19 ) and sham KT ( n=19 ) groups . All patients received the same exercise therapy in addition to therapeutic or sham KT at 3-day intervals for 12 days . The groups were compared according to pain , range of motion ( ROM ) , muscle strength and DASH and Constant scores before treatment and at the 5th and 12th treatment days . RESULTS Within group comparisons showed significant improvements in both groups at the 5th and 12th day evaluations ( p<0.05 ) . In comparisons between the groups , pain with movement and DASH scores in the therapeutic group were significantly lower at the 5th day ( p<0.01 ) . There were significant improvements in night pain , pain with movement , DASH score , shoulder external rotation muscle strength , and pain free shoulder abduction ROM in the therapeutic group at the 12th day ( p<0.05 ) . Passive shoulder flexion ROM increased more in the sham group at the 12th day ( p<0.05 ) . CONCLUSION The addition of KT application to the exercise program appears to be more effective than the exercise program alone for the treatment of SIS HYPOTHESIS We prospect ively studied patients with impingement syndrome to look at outcomes of nonoperative treatment on a temporal basis . MATERIAL S AND METHODS Temporal outcomes of 100 consecutive patients treated for impingement syndrome were prospect ively evaluated . All patients began a st and 
    Output:
    
Conclusions This systematic review has illustrated that studies investigating SIS test for various signs and symptoms , which is in keeping with describing the condition as a ‘ syndrome ’ .