Pectoralis Minor Release in Patients With Subacromial Impingement Syndrome

Efficacy of Pectoralis Minor Release on Subacromial Space in Patients With Subacromial Impingement Syndrome

To investigate the effect of PMI release on subacromial space, pectoralis minor length, shoulders ROM, shoulder joint pain, and functional ability in patients with SAIS.

Study Overview

• Status: Active, not recruiting
• Conditions: Subacromial Impingement Syndrome
• Intervention / Treatment: Other: conventional physical therapy; Other: Experimental group therapy

Detailed Description

Statement of the problem:

This study will be designed to answer the following question Does PMI release have an effect on subacromial space in patients with SAIS?

The purposes of the study:

1. To investigate the effect of PMI release on subacromial space in patients with SAIS.
2. To investigate the effect of PMI release on pectoralis minor length in patients with SAIS.
3. To investigate the effect of PMI release on shoulders ROM (flexion, abduction, internal and external rotation) in patients with SAIS.
4. To investigate the effect of PMI release on shoulder joint pain in patients with SAIS.
5. To investigate the effect of PMI release on functional ability in patients with SAIS.

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

Contacts and Locations

Study Locations

• Egypt
  • Dokki
    • Giza, Dokki, Egypt, 12612
      • Faculty of Physical Therapy Cairo University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

1. Patients with chronic unilateral SAIS.
2. Patient age average 40- 60 years old from both sexes (Michael and Gail 2000).
3. Decreased AHD less than 10mm by x-ray image (Mean AHD in absence of rotator cuff tear is 10.5mm (Goutallier et al., 2011)).
4. Decreased of active shoulder ROM.
5. Presence of unilateral shoulder joint pain.
6. Reliable patients.

Exclusion Criteria:

All patients who have any of the following will be excluded from the study (Lewis and Valentine 2007)

1. Intra articular injection.
2. Arthroscopic intervention.
3. Previous shoulder fracture.
4. Shoulder subluxation.
5. Adhesive capsulitis.
6. Shoulder osteoarthritis.
7. Any previous operation on cervical and shoulder region.
8. Mastectomy on the same side of shoulder impingement.
9. Patients with neurological disorder that may contribute performance the procedure instructions.
10. Osteoporosis.
11. Pregnant and lactating woman.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Sham Comparator: traditional group; Thirty patients will receive traditional physical therapy treatment (Postural correction exercises and scapular stabilization exercises) at the painful shoulder, Treatment sessions will be two times per week for six weeks	Other: conventional physical therapy; Physiotherapy treatment included passive manual joint mobilization, home-based strengthening exercises and advice on posture, twice a week. So, we will apply this conventional physical therapy to control group; Postural correction exercisePatient can apply this exercise on prone lie position for against a wall as in figure 10.patient will start with chin in exercise, will asked to pull his chine in and push the wall, then hold for 15 seconds and repeat for 3 times.Patient will try to touch both shoulders to the wall and hold for 15 seconds.Patient will be asked to straight all spine against the wall and hold for 15 seconds.; Scapular stabilization exercise Patient will lie prone with elbow extended, start to move his arm away from his body (horizontal abduction), with wait or without according to Lafayette muscle test results. Apply 2 cycle and each cycle will have 10 times repetitions
Experimental: Experimental Group; Thirty patients will receive traditional treatment plus pectoralis minor stretching and release, Treatment sessions will be two times per week for six weeks.	Other: conventional physical therapy; Physiotherapy treatment included passive manual joint mobilization, home-based strengthening exercises and advice on posture, twice a week. So, we will apply this conventional physical therapy to control group; Postural correction exercisePatient can apply this exercise on prone lie position for against a wall as in figure 10.patient will start with chin in exercise, will asked to pull his chine in and push the wall, then hold for 15 seconds and repeat for 3 times.Patient will try to touch both shoulders to the wall and hold for 15 seconds.Patient will be asked to straight all spine against the wall and hold for 15 seconds.; Scapular stabilization exercise Patient will lie prone with elbow extended, start to move his arm away from his body (horizontal abduction), with wait or without according to Lafayette muscle test results. Apply 2 cycle and each cycle will have 10 times repetitions; Other: Experimental group therapy; Treatment will be conventional treatment with pectoralis minor release and stretch.; Pectoralis minor stretch The subject lying in a supine position with a towel roll running the length of the thoracic spine. The subject's shoulder at 90° of abduction and external rotation and the elbow at 90° flexion while therapist applying a posterior force to the coracoid process, in this study stretch will be performed for two sequential repetitions, holding the stretches for 30 seconds with 30 second break; Pectoralis minor release the subject in a supine position with the test arm at his side while the therapist palpated medially into the proximal axilla, followed by proceeding superiorly towards the coracoid process then applied pressure in the anterior direction, similar to attempting to lift the muscle, therapist applying tensile force directly to the pectoralis minor. The opposite therapist hand will stabilize the scapula and humeral head maintain for 30 seconds and repeat 2 times

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Subacromial space will be measured by X-ray image	The radiograph will be done to measure acromio-humeral distance, which is considered the shortest distance between the inferior cortex of acromion and the top of humeral head. In normal shoulders, the sub acromial space was between 9 and 10 mm. The space was significantly greater in men, with a slight reduction with age. In middle age, a sub-acromial space less than 6 mm is pathological	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pectoralis minor length will be measured by tape measurement	Participants will be asked to remain in a relaxed posture with the arms at the side in a neutral position, avoid postural correction, and exhale just before the measurement. A tape measure was used to measure the linear distance between the origin and insertion of the muscle. The primary investigator of the study performed all measurements. The origin was defined as the inferior aspect of the 4th rib, which was one finger width lateral to the sternum, just lateral to the sternocostal junction. The insertion was defined as the medial-inferior aspect of the coracoid process .	6 month
Shoulder joint ROM (flexion, abduction, internal and external rotation) will be measured by inclinometer	Shoulder flexion, abduction, internal and external rotation movements will be measured with the individual seated upright on a non-reclining high-back chair, to limit trunk compensation. The chair was the same for all movements performed by one individual, but different for each individual, to provide support up to the middle of the scapula. Shoulder movements will be actively and passively evaluated for flexion in supine and seated positions, abduction, external rotation in a neutral position with 0° abduction (ERN), external rotation with the arm at 90° of abduction (ER90), and internal rotation with the arm at 90° of abduction (IR90) using an Acumar digital inclinometer .	6 month
Pain intensity will be measured by using VAS ( visual analog scale)	The patients' pain severity will be evaluated using a visual analog scale (VAS). The visual analog scale (VAS) is a validated, subjective measure for acute and chronic pain. Scores are recorded by making a handwritten mark on a 10-cm line that represents a continuum between 0 "no pain" and 10 "worst pain	6 month
Identification of Functional Ability of the shoulder joint using Q-DASH questionnaire with Arabic version	The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper extremity disability and symptoms The use of the DASH questionnaire as an outcomes instrument in patients with upper-extremity complaints. The main part of the Quick-DASH is a 14-item disability/symptom scale concerning the patient's health status during the preceding week. The items ask about the degree of difficulty in performing different physical activities as well as the problem's impact on social activities, work, sleep, and self-image. Each item has five response options. The scores for all items are then used to calculate a scale score ranging from 1 (no difficulty) to 5 ( unable).	6 month

Collaborators and Investigators

• Sponsor: Cairo University

Publications and helpful links

General Publications

• Abu EL Kasem Sh., Alaa F., Abd EL-Raoof N. et al., (2024):" Efficacy of Mulligan thoracic sustained natural apophyseal glides on sub-acromial pain in patients with sub-acromial impingement syndrome: a single-blinded randomized controlled trial "journal of manual & manipulative therapy 10.1080/10669817.2024.2341453 Amado A., Marques A., Maiorino R. et al., (2006):" An Anatomical Study of The Subcoracoid Space" CLINICS 2006;61(5):467-72 Ann Sisto S. and Dyson-Hudson T. (2007):" Dynamometry testing in spinal cord injury" Journal of Rehabilitation Research & Development, Volume 44, Number 1 Anne T., Herrington L., Horlsey I. et al. (2015):" An evidence-based review of current perceptions with regard to the subacromial space in shoulder impingement syndromes: Is it important and what influences it?" Clinical Biomechanics , Volume 30, Issue 7, August 2015, Pages 641-648

Study record dates

Study Major Dates

• Study Start (Actual): May 11, 2026
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): January 12, 2027

Study Registration Dates

• First Submitted: May 10, 2026
• First Submitted That Met QC Criteria: May 15, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 22, 2026
• Last Update Submitted That Met QC Criteria: May 15, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Shoulder Joint; Pectoralis Minor; Subacromial Space
• Additional Relevant MeSH Terms: Shoulder Injuries; Musculoskeletal Diseases; Wounds and Injuries; Joint Diseases; Shoulder Impingement Syndrome
• Other Study ID Numbers: P.T.REC/012/005809

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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