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

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

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.

Study Overview

• Status: Completed
• Conditions: Shoulder Impingement Syndrome
• Intervention / Treatment: Other: mulligan thoracic Sustained Natural Apophyseal Glides; Other: traditional treatments

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 Type: Interventional
• Enrollment (Actual): 74
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Fatma AL-Zahraa A Abo-oof, BSc; Phone Number: 00201282200450; Email: fatma.abooof@gmail.com

Study Locations

• Egypt
  • Cairo, Egypt
    • Faculty of Physical Therapy - Cairo University
    • Contact: Fatma AL-Zahraa A Abo-oof, BSc; Phone Number: 00201282200450; Email: fatma.abooof@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years to 40 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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 Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: mulligan group; 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.	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.
Active Comparator: exercising group; will receive only traditional treatment (ice application and supervised exercise ) for 3 times/week for one month.	Other: 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).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
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
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
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
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

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2022
• Primary Completion (Actual): November 30, 2022
• Study Completion (Actual): November 30, 2022

Study Registration Dates

• First Submitted: March 7, 2021
• First Submitted That Met QC Criteria: March 13, 2021
• First Posted (Actual): March 17, 2021

Study Record Updates

• Last Update Posted (Estimate): March 7, 2023
• Last Update Submitted That Met QC Criteria: March 4, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: SUBACROMIAL IMPINGEMENT SYNDROME; mulligan thoracic sustained natural apophyseal glides; Acromiohumeral distance or subacromial space
• Additional Relevant MeSH Terms: Pathologic Processes; Wounds and Injuries; Disease; Joint Diseases; Musculoskeletal Diseases; Rupture; Shoulder Injuries; Tendon Injuries; Syndrome; Rotator Cuff Injuries; Shoulder Impingement Syndrome
• Other Study ID Numbers: Basic Science PT; faculty of physical therapy (Cairo University)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: These data are case sensitive and considered confidential regarding my supervisors' and study directors' opinion, So, upon their request i prefer to not share individual participant data with other researchers

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No