The Effect of Thoracic Mulligan Mobilization on Sub-acromial Impingement Syndrome

Shoulder Impingement Syndrome Clinical Trial

— SAIS  

Official title:

The Effect of Mulligan Thoracic Sustained Natural Apophyseal Glides on Sub-acromial Impingement Syndrome.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04801732
• Other study ID #: Basic Science PT
• Secondary ID: faculty of physi
• Status: Completed
• Phase: N/A
• Start date: August 1, 2022
• Est. completion date: November 30, 2022

Study information

• Verified date: March 2023
• Source: Cairo University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study was conducted to investigate the effect of mulligan thoracic sustained natural apophyseal glide on patients diagnosed as sub acromial impingement syndrome and its effect on shoulder range of motion, pain, function and disability of affected shoulder joint and size of sub acromial space, Half of the patients will treated with traditional treatment and mulligan thoracic SNAGS technique, while the other half will treated with traditional treatment only.

Description:

Forty patients with sub-acromial impingement syndrome will participate in this study. Intervention for the both group consisted of 12 session (3 times per week ) for one month. Subjects will be divided randomly and allocated into two groups , study group will received supervised exercise and mulligan thoracic SNAGS technique and the control group will received supervised exercise (stretching and strengthening exercises). both group will assessed by x ray to measure sub-acromial space , visual analogue scale for pain , The Shoulder Pain and Disability Index for shoulder function and goniometer for shoulder flexion, abduction ,external and internal rotation range of motion before and after treatment.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 74
• Est. completion date: November 30, 2022
• Est. primary completion date: November 30, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 25 Years to 40 Years

Eligibility

Inclusion Criteria:

1. Patients referred as sub-acromial impingement syndrome (stage 2) according to neer's classification.

2. Have +ve Neer's sign, +ve Hawkins and Kennedy test and +ve Empty and full can tests.

3. selected from both genders.

4. Aged from 25 to 40 years old.

5. Have restricted thoracic extension motion ( +ve occiput to wall test).

Exclusion Criteria:

1. History of shoulder adhesive capsulitis

2. Rotator cuff tendon tear/rupture (stage 3).

3. Shoulder dislocation, subluxation and fractures.

4. History of cervical, shoulder, upper back surgery.

5. Any spinal deformities such as scoliosis, kyphosis and rounded shoulder.

6. Diabetes mellitus.

7. Radiculopathy.

8. History of breast cancer.

9. Previous stroke or Shoulder hand syndrome.

10. Ligamentous Laxity.

Related Conditions & MeSH terms

• Rotator Cuff Injuries
• Shoulder Impingement Syndrome
• Syndrome

Intervention

Other:
• mulligan thoracic Sustained Natural Apophyseal Glides
Extension Thoracic Sustained Natural Apophyseal Glides : Patient position: The patient sits astride the end of the table with hands placed behind the neck to protract the scapulae allowing access to the mid thoracic spine for the therapist's hand. Therapist position: Therapist stands on their most efficient side for a centrally applied Sustained Natural Apophyseal Glides. Therapist grasp: The therapist's mobilizing hand (ulnar border) will apply a cephalad glide in line with the facet joint plane of the involved spinal level and the other arm holds the thoracic wall above the level to be mobilized. Traction is applied prior to glide, which is achieved by therapist knee extension Repetitions: Three sets of ten repetitions will be done after a trial for the patient to be familial with the technique. and traditional treatment.
• traditional treatments
includes: Ice pack and Pendulum exercise and shoulder range of motion (elevation, depression, flexion, abduction, rotations).Stretching exercise for internal rotators and posterior capsule. Strengthening exercise will be isometric in nature include external shoulder rotators, internal rotators, biceps, deltoid, and scapular stabilizers (rhomboids, trapezius, serratus anterior, Latissimus Dorsi , and pectoralis major muscles).

Locations

Country	Name	City	State
Egypt	faculty of physical therapy - Cairo university	Cairo

Sponsors (1)

Lead Sponsor	Collaborator
Cairo University

Country where clinical trial is conducted

Egypt, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Pain by Visual analogue scale	the patient asked to choose from scale from zero (no pain) to 10 (worst pain) to detect his/her intensity of pain.	changes from baseline to before treatment and changes before treatment to immediately after treatment
Primary	Range of motion of shoulder joint by universal goniometer.	for flexion stationary Arm of the goniometer was aligned with the lateral border of the scapula (mid axillary arm), and the moving arm was aligned with the humerus.; for abduction the fulcrum was placed at the mid point of the posterior aspect of the glenohumeral joint, stationary arm was parallel to the trunk, and the moving arm was parallel to the longitudinal axis of the humerus. for internal and external rotation patient was in supine with the hips and knees flexed approximately 45°.The tested arm was supported on the table in 90° of abduction, elbow flexed 90°, and the wrist in neutral position.; the fulcrum was placed on the olecranon, stationary arm Placed perpendicular to the floor, and the moving arm parallel with the forearm.	changes from baseline to before treatment and changes before treatment to immediately after treatment
Primary	Shoulder pain and disability index	the patients will asked to answer the questions on index . And then creating a percentage of pain and disability with higher scores indicating more severe limitation. The means of the two subscales are averaged to produce a total score ranging from 0 (best) to 100 (worst).; Minimum Detectable Change (90% confidence) = 13 points	changes from baseline to before treatment and changes before treatment to immediately after treatment
Primary	The sub-acromial space by radiograph X ray	measure the size of sub-acromial space	changes from baseline to before treatment and changes before treatment to immediately after treatment