Effect of Mulligan on Sub-acromial Space in Patients With Shoulder Impingement Syndrome

Study Overview
=================
Brief Summary
-----------------
the aim of this study is to investigate the Effect of mulligan technique on sub-acromial space in patients with shoulder impingement syndrome

Detailed Description
-----------------
Shoulder Impingement Syndrome (SIS) is defined as the mechanical entrapment of the rotator cuff (mainly the supraspinatus tendon) or the sub-acromial bursa in the sub-acromial space between the humeral head and the acromion or coracohumeral ligament .It is typically exacerbate when the arm is elevated or when overhead throwing activities are performed . Mulligan technique is a type of manual therapy with hypoalgesic effects, increases joint ROM, enhances muscle function and treats specific pathologies. Mobilization with movement (MWM) can be defined as the application of a sustained passive accessory force / glide to a joint while the patient actively performs a task that was previously identified as being problem.

Official Title
-----------------
Effect of Mulligan on Sub-acromial Space in Patients With Shoulder Impingement Syndrome

Conditions
-----------------
Shoulder Impingement

Intervention / Treatment
-----------------
* Other: mulligan technique
* Other: conventional therapy


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: age of patients from 30- 55 years old . Both Male and female. Shoulder pain and two out of four specified objective signs and symptoms: Positive Neer impingement test. Positive Hawkins-Kennedy impingement test. Painful or limitation of active shoulder elevation (flexion, abduction, scaption). Pain or limitation with the functional movement patterns of hand-behind-back or hand-behind-head. Exclusion Criteria: Systemic or neurological disorder. Adhesive capsulitis. Cervical radiculopathy. History of shoulder surgery. Corticosteroid injection within the past month Subjects who had received physical therapy treatment for their shoulder within the past three months.

Ages Eligible for Study
-----------------
Minimum Age: 30 Years
Maximum Age: 55 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: mulligan and conventional therapy
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A<br>the patient will receive Shoulder complex mobilization with movement three time a week for two weeks | Other: mulligan technique<br>* The patient will be in sitting and the therapist stands on the contralateral side of pain, stabilizing the scapula posteriorly with one hand. The head of the humerus is translated posteriorly and laterally with the other hand, along the plane of the glenoid fossa. While the glide is sustained, the patient actively elevates their arm through the plane of abduction or scaption (elevation). Apply 6-10 repetitions in a set, with 3-5 sets in a treatment session the perform mobilization on acromioclavicular and sternoclavicular joint<br>Other: conventional therapy<br>* Flexibility exercises: enhance flexibility of the glenohumeral Posterior capsule, pectoralis muscle, and upper thoracic spine. Strengthen the rotator cuff and scapular stabilizers. Improve upper-quarter postural awareness<br>|
| Active Comparator: Group B<br>will receive Conventional therapy three times a week for two weeks. | Other: conventional therapy<br>* Flexibility exercises: enhance flexibility of the glenohumeral Posterior capsule, pectoralis muscle, and upper thoracic spine. Strengthen the rotator cuff and scapular stabilizers. Improve upper-quarter postural awareness<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| sub-acromial space | sub-acromial space will be measured by ultrasonography | up to two weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| shoulder range of movement | shoulder range of motion will be measured by digital goniometer | up to two weeks | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
mulligan technique, sub-acromial space