Investigation of the Effects of Mulligan Mobilization and Corticosteroid Injection in Rotator Cuff Lesions
Condition: Rotator Cuff Tears
MeSH terms: Rotator Cuff Injuries
Study type: Interventional

Summary: 
      Chronic shoulder pain, predominantly caused by rotator cuff disorders represents one of the
      most frequently encountered musculoskeletal issues within the community. Rotator cuff tears
      are a crucial pathophysiological contributor to shoulder pain. Individuals afflicted with
      this condition frequently report nocturnal intensification of pain and movement-specific
      aggravation, especially during overhead activities. The condition is frequently correlated
      with functional impairment, with many patients noting a sensation of weakness. Conservative
      treatment of the rotator cuff tear consists of a wide range of procedures such as exercise
      therapy; and/or local anesthetic, ice/heat therapy, electrotherapy, various types of manual
      therapy and joint mobilization procedures. Corticosteroid injection approach is an
      alternative method to these applications The subacromial corticosteroid injection is an
      intervention technique that has been utilized for short-term relief over numerous years.Given
      the restricted self-repair capabilities of tendons the consideration of novel biological
      treatment strategies for tendinopathies has gained prominence in recent times. Nonetheless,
      there remains a lack of sufficient scientific evidence to substantiate their
      efficacy.Mulligan mobilization techniques are manual therapy techniques that aim to increase
      normal joint movement and reduce pain levels by correcting the biomechanical structure of
      joint surfaces to provide a pain-free range of motion. A review of the literature reveals no
      studies comparing the Mulligan mobilization technique and corticosteroid injections in
      rotator cuff tears. The aim of our study is to examine the effects of the Mulligan
      mobilization technique and corticosteroid injections on pain, range of motion, functionality
      and proprioception in individuals with rotator cuff tears.
    

Detailed description: 
      Individuals diagnosed with rotator cuff rupture presenting at Medipol Esenler Hospital will
      be included in the study. Participants will be randomly divided into 2 groups. A conventional
      treatment program will be applied to individuals in both groups 5 days a week for 3 weeks.
      The conventional exercise program will consist of wand exercises, Codman exercises,
      stretching exercises for all ranges of motion, and TENS (100Hz, 15 minutes). A corticosteroid
      injection will be administered to the shoulder region of the first group prior to treatment.
      For the second group, in addition to the conventional treatment program, a mobilization
      technique with movement will be applied twice a week, with 10 repetitions. Inclusion
      Criteria:

        -  Being between the ages of 40 and 60

        -  Not having had any shoulder surgery before

        -  Having been diagnosed with a rotator cuff lesion

        -  Not having any orthopedic or cardiac problems that could hinder participation in the
           study and evaluation

      Exclusion Criteria:

        -  Having a pathology affecting the shoulder area

        -  Having had any shoulder surgery

        -  Individuals who are non-cooperative or have mental problems

        -  Individuals with neurological, cardiac, and vascular problems

        -  Individuals who have participated in any physiotherapy program directed towards the
           shoulder in the last three months

      Evaluation Scales to be Used:

        -  Visual Analog Scale - VAS

        -  Joint Range of Motion - Becure extremity ROM

        -  Joint Position Sense - Becure extremity ROM

        -  Disability of the Arm, Shoulder and Hand Questionnaire - DASH

      Evaluation Methods:

        1. Visual Analog Scale (VAS) The Visual Analog Scale is a commonly preferred evaluation
           method in the clinic and literature studies for measuring pain intensity. Patients' pain
           levels are determined by numbering 0-10. 0 indicates no pain, and 10 represents the most
           severe pain experienced.

        2. Joint Range of Motion The normal joint range of motion was evaluated with the Becure
           Extremity ROM. Becure Extremity ROM is a system that allows for the objective
           measurement of joint range of motion by using its camera and sensors to detect reference
           points during extremity movements. In the Becure Extremity ROM system, the patient is
           expected to stand in front of the camera and perform the movement to be measured. In our
           study, the shoulder joint's flexion, extension, abduction, internal and external
           rotation ranges of motion were evaluated in degrees with Becure Extremity ROM.

        3. Joint Position Sense The joint position sense measurements of the individuals
           participating in the study will be evaluated with a goniometer. Individuals will be
           asked to lift their shoulder to a certain degree, and then bring it back to the same
           angle value with their eyes closed. The angle value formed when eyes are open and closed
           will be recorded, and the difference between shoulder angles will be calculated. Joint
           position sense will be applied at 30 and 60 degrees of flexion and abduction movements.

        4. Disability of the Arm, Shoulder, and Hand Questionnaire (DASH) The DASH, developed as a
           result of the collaboration of the American Academy of Orthopedic Surgeons and other
           groups, is a scale that evaluates physical restrictions and function in upper extremity
           lesions[18]. The DASH questionnaire consists of three subsections. The first part
           contains 30 questions; 21 questions evaluate the difficulties encountered in the
           patient's daily life functions, 5 questions are about symptoms, and the other 4
           questions assess social life, work, sleep, and the individual's self-confidence. The
           part with 4 questions (optional Work Module (DASH- FS)) measures the difficulties
           encountered in the individual's work life.
    

Intervention name(s): Corticosteroid Group; Mulligan Group
Intervention type(s): Other; Other
Intervention description(s): Conventional exercise and corticosteroid injection; Conventional exercise and mulligan mobilization
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Mobilization with movement; Rotator cuff; Corticosteroid