The Effect of Thoracic Mulligan Mobilization on Sub-acromial Impingement Syndrome
Condition: Shoulder Impingement Syndrome
MeSH terms: Shoulder Impingement Syndrome; Syndrome; Rotator Cuff Injuries
Study type: Interventional

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.
    

Intervention name(s): mulligan thoracic Sustained Natural Apophyseal Glides; traditional treatments
Intervention type(s): Other; Other
Intervention description(s): 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.; 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).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized controlled study design were the recruited patients will randomly allocated into two groups control group and study group by Closed Envelope method of randomization. The treatment for all patients in both groups will conducted 3 times per week for one month .The study group (A): will receive SNAGS techniques on thoracic spine with traditional treatment consist of ice application, supervised exercises (stretching and strengthening exercise) and the study group(B) will receive only traditional treatment (ice or application and supervised exercise). All patients will be diagnosed as stage II according to Neer's classification recruited from orthopedic clinic from both sexes who met all the inclusion criteria and will be informed about the study procedure and signed the informed consent prepared for this study.
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: SUBACROMIAL IMPINGEMENT SYNDROME; mulligan thoracic sustained natural apophyseal glides; Acromiohumeral distance or subacromial space