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

Not Applicable

Completed

• Conditions: Shoulder Impingement Syndrome
• Interventions: Other: mulligan thoracic Sustained Natural Apophyseal Glides; Other: traditional treatments

• Registration Number: NCT04801732
• Lead Sponsor: Cairo University

Brief 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.

Detailed 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.

Study Timeline

• Study First Submitted: 2021-03-07
• Study First Submitted QC: 2021-03-13
• Study First Posted: 2021-03-17
• Study Start: 2022-08-01
• Primary Completion: 2022-11-30
• Study Completion: 2022-11-30
• Status Verified: 2023-03
• Last Update Submitted: 2023-03-04
• Last Update Posted: 2023-03-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 74

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.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
mulligan group	mulligan thoracic Sustained Natural Apophyseal Glides	Patients in the study group will treated with SNAGS techniques on thoracic spine with traditional treatment consist of ice application, supervised exercises (stretching and strengthening exercise) for 3 times/week for one month.
exercising group	traditional treatments	will receive only traditional treatment (ice application and supervised exercise ) for 3 times/week for one month.

Primary Outcome Measures

Name	Time	Method
Shoulder pain and disability index	changes from baseline to before treatment and changes before treatment to immediately after treatment	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
Pain by Visual analogue scale	changes from baseline to before treatment and changes before treatment to immediately after treatment	the patient asked to choose from scale from zero (no pain) to 10 (worst pain) to detect his/her intensity of pain.
Range of motion of shoulder joint by universal goniometer.	changes from baseline to before treatment and changes before treatment to immediately after treatment	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.
The sub-acromial space by radiograph X ray	changes from baseline to before treatment and changes before treatment to immediately after treatment	measure the size of sub-acromial space

Trial Locations

Locations (1)

faculty of physical therapy - Cairo university; 🇪🇬 Cairo, Egypt