Ultrasonographic Response to Cervical and Upper Thoracic SNAG in Medial Epicondylitis

Ultrasonographic Response to Cervical and Upper Thoracic SNAG in Treatment of Chronic Medial Epicondylitis, a Randomized Controlled Trial

Aim of the work :

1. To detect if there is any change would occur in the neovascularity and echogenicity after using cervical and upper thoracic SNAG or not in ME patients.
2. To find the effect of cervical and upper thoracic SNAG on pain, function of upper extremities, grip strength in ME comparing with traditional treatment alone

Study Overview

• Status: Completed
• Conditions: Medial Epicondylitis
• Intervention / Treatment: Other: SNAG ( sustained natural apopheseal glide ); Other: (Conventional Physical Therapy)

Detailed Description

medial epicondylitis(ME) of the elbow is a condition characterized by aggravation of pain in the outer part of the elbow during active wrist flexion , and presentation of pain on direct palpation of the medial epicondyle, or proximal muscle belly . Biomechanical and sensorimotor deficits can occur and adversely impact upper extremity function .These functional deficits may interfere with occupational tasks and activities of daily living The study's results: Measuring the changes that will be produced by using therapeutic growth of the cervical and thoracic vertebrae on the pathological changes that persist in the tendons of the tens of the tibialis cruciate ligaments in detecting excess weight resulting from the disease of the middle epicondyle, such as increased blood vessels in the tendon and decreased echogenicity of the tendon, in addition to measuring the changes that occurred in the extent of pain sensation and the extent of functional performance of the shoulder and elbow joints. Patients will be directly selected jointly according to the patient's specifications for the research and written consent will be obtained from the patient after a detailed explanation of the research steps and what is required of him. The vocal function of the tendon will be evaluated, with the exception of functional pain of the successful upper extremity and the strength of the hand muscles before and after the experiment.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Banī Suwayf, Egypt
    • Faculty of Physical Therapy, Beni-Suef University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ranges from 35 to 50 years old in both sexes.
• Patients with LE that diagnosed by orthopedist.
• Pain onset is more than 3 months appear primarily with use or rest or in both, also , it appear with deep palpation of the medial epicondyle .

Exclusion Criteria:

• • Rheumatoid Arthritis .

  • Skin infection.
  • History of previous elbow surgery.
  • Any pathology in the shoulder joint.
  • Neurologic deficit in upper extremity.
  • Cervical disc prolapse and radiculopathy C5,6.
  • Dislocation of elbow joint.
  • Recent fractures of upper extremity.
  • Arthrosis of the radiohumeral joint.
  • Osteochondritis dissecans.
  • Osteonecrosis.
  • Plica synovialis.
  • Participants receiving other treatment, in the form of physical therapy or medication, for the duration of the study that may interfere with the results of this study.

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: Experimental group	Other: SNAG ( sustained natural apopheseal glide ); A postero-anterior glide was applied to the spinous process of the C6-7 cervical. Ten repetitions were held for 10 seconds each, followed by a 30-second rest period. The patient sat comfortably with their back resting on a straight seat and their head and neck in a relaxed neutral position. After identifying the hypomobile segment, the clinician administered a single sub-therapeutic dose of thoracic SNAG at the specified treatment level. This technique involved performing one thoracic SNAG with a cephalad glide, applied parallel to the facet joint plane, aiming towards the patient's eyes. The clinician then positioned one arm around the patient's chest, just above the designated treatment level, ensuring that the ulnar border of the mobilizing hand was placed over the thoracic spinous process of the targeted level. Over four weeks, each patient had three therapy sessions per week, with a maximum of 12 sessions total.; Other: (Conventional Physical Therapy); Conventional treatment, includes five sets of 30-second self-wrist flexor stretching; a total of 5 minutes of ultrasound therapy at a frequency of 3.3 MHz and a duty cycle of 1.2 W/cm²; five minutes of cross-friction massage focused on the most painful area; and fifteen minutes of heat application. Over four weeks, each patient had three therapy sessions per week, with a maximum of 12 sessions total.
Other: control group	Other: (Conventional Physical Therapy); Conventional treatment, includes five sets of 30-second self-wrist flexor stretching; a total of 5 minutes of ultrasound therapy at a frequency of 3.3 MHz and a duty cycle of 1.2 W/cm²; five minutes of cross-friction massage focused on the most painful area; and fifteen minutes of heat application. Over four weeks, each patient had three therapy sessions per week, with a maximum of 12 sessions total.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Colour Ultrasonography	Change in hypervascularity and hypoechogencity measured by colour sonography ( grade 1: grade 4) include: hypo-echoic variations within the common flexor tendon, tendon sheath thickening, ruptures of varying thickness, neovascularization as seen by Doppler, and cortical damage at the medial epicondyle	Baseline and after one month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire	30-question outcome measure provided by patients to assess upper-limb function. For those involved in sports and occupational assessments, an additional eight questions are available. The questionnaire employs a Likert scale ranging from one to five (where one indicates no difficulty and five signifies incapacity). The cumulative DASH rating runs between 0 and 100, with higher numbers reflecting bigger disability.	Baseline and after one month
A Patient-Rated Elbow Evaluation (PREE) questionnaire.	A questionnaire consisting of 20 items designed to assess pain and impairment associated with elbow conditions. It is divided into two main sections: function and pain. The pain category contains 5 items, while the function category includes 15 aspects. Within the functional section, there exist other subdivisions: Eleven items concentrate on specific activities, while four items relate to routine activities. Every item is evaluated on a scale from 0 to 10. The final ratingrelies on a 100-point scale, with impairment and pain weighted similarly. Pain and disability increase with a higher PREE total score	Baseline and after one month
The hydraulic hand dynamometer.	It is the most often utilized tool in research, has undergone extensive validation, and is the standard by which other tools are evaluated. Participants were positioned upright, either sitting with their knees and hips at a 90-degree angle and, if back support was available, in an elevated long-sitting position, or in bed. The dominant arm was positioned laterally, with the elbow extended at 90° and unsupported, while the wrist remained in neutral posture. Individuals were advised to use their main hand to force the dynamometer as strong as possible. For each device, three trials were recorded, and the one with the greatest score was maintained for review. Following the initial set of measurements, the volunteers took a 30-minute break before repeating the process with the second device.	Baseline and after one month
Visual analog scale	Pain intensity for the elbow was measured using a ten-centimeter straight visual analogue scale (VAS), with 0 reflecting painlessness and 10 meaning the highest discomfort ever experienced.	Baseline and after one month

Collaborators and Investigators

• Sponsor: Beni-Suef University
• Collaborators: Benha University

Study record dates

Study Major Dates

• Study Start (Actual): September 8, 2025
• Primary Completion (Actual): March 25, 2026
• Study Completion (Actual): March 25, 2026

Study Registration Dates

• First Submitted: September 15, 2025
• First Submitted That Met QC Criteria: September 15, 2025
• First Posted (Actual): September 22, 2025

Study Record Updates

• Last Update Posted (Actual): March 30, 2026
• Last Update Submitted That Met QC Criteria: March 25, 2026
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Ultrasonography; DASH; Mobilization; sympathetic activity; SNAGs; PRTEE; Medial Epicondylitis
• Additional Relevant MeSH Terms: Elbow Injuries; Musculoskeletal Diseases; Muscular Diseases; Wounds and Injuries; Tendon Injuries; Arm Injuries; Tendinopathy; Elbow Tendinopathy
• Other Study ID Numbers: FMBSUREC/07092025/Ahmed

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: "No, there is no plan to make individual participant data (IPD) available to other researchers due to privacy concerns and institutional restrictions."

Drug and device information, study documents

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