Comparative Effects of Cervicothoracic Junction Mobilization and Thoracic Manipulation in Subachromial Impinegment Syndrome

Study Overview
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Brief Summary
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The aim of this study is to investigate the comparative effects of high velocity low amplitude thrust manipulation of upper thoracic spine and spinal mobilization with arm movement on the subjects with the subacromial impingement syndrome.

Detailed Description
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Subacromial impingement is the condition, in which the tissue underlying subacromial spaces are compressed between the head of the humerus and the acromion, is one ofthe main diagnoses of shoulder pain. Subjects frequently experience pain when engaging in anyoverhead activity.In general, medical practice, pain in the glenohumeral region is commonmusculoskeletal problem has almost 48% prevalence. Cervicothoracic junction refers to atherapeutic technique or manual therapy approaches that focuses on improving mobility andfunction in this area where the cervical neck and upper back spine meet. Upper thoracic manipulation refers to a manual technique used to address dysfunctions or restrictions in the upper portion of the thoracic vertebral region, which is the area of the thoracic vertebrae located between the cervical and mid back regions.Previously, studies were conducted individually to determine effectiveness of upper thoracic mobilization and cervico-thoracic mobilization with arm movement for treatment of subacromial bursitis. However, fewer studies were previously conducted to compare the effects of both treatment methods (mobilization and manipulation). This study specifically focuses on the comparative effects of upper thoracic and cervico-thoracic mobilization.

Official Title
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Comparative Effects of Cervicothoracic Junction Mobilization With Arm Movements and Upper Thoracic Manipulation in Patients With Subachromial Impinegment Syndrome

Conditions
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Subacromial Impingement Syndrome

Intervention / Treatment
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* Other: Cervicothoracic Junction Mobilization
* Other: Upper Thoracic Spine Manipulation:


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ranging from 18-40 Both males and Females Positive Hawkins and Neer's impingement test positive The subjects primarily report unilateral shoulder pain. Exclusion Criteria: Patients with diagnosed case of co morbidities such as malignancies, RA, or fracture, that causes bilateral shoulder discomfort. Diagnosed case of cervical radiculopathy, glenohumeral osteoarthritis, and adhesive capsulitis

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group 1: Cervicothoracic junction mobilization with arm movement along with baseline treatment<br> | Other: Cervicothoracic Junction Mobilization<br>* The therapist stood in back of the subject, who was seated straight on a chair. The therapist positioned the medial side of one hand's thumb. The desired level of vertebra can be strengthened by placing the index finger of the opposite hand on the spinous process. A pure transverse glide was executed from the affected side to the unaffected side.<br>|
| Experimental: Group 2: upper thoracic manipulation woth baseline treatment<br> | Other: Upper Thoracic Spine Manipulation:<br>* The therapist placed one hand on the patient's head and the hypothenar or thenar eminence of the other hand was placed over the T1 transverse process (the therapist's left hand was used for thrusting and vice versa for treating the left T1 Transverse process). As the tissue deficiency is taken up localizing the forces, the patient was urged to breathe in and out multiple times. While holding the hand on the head steady, a minor relative rotation in the opposite direction was caused, which led to the introduction of the postero-anterior force on the transverse process of T1(29). Patients will receive three sessions a week on alternate days for three weeks and follow up data will be taken once after completion of all three sessions using data collection tools<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Numeric Pain Rating Scale (NPRS) | NPRS scale will be used to quantify pain intensity levels. The scale ranges from '0' for the least amount of pain no pain to '10' for the most extreme levels of pain pain as severe as you can imagine. It is convenient to use NPRS for patients. Its score ranges between 0-10 (19). It is a valid and reliable tool (20). Reliability ranges from .67-.96 and validity ranges from 0.79-0.95 | 6 weeks | 
| Shoulder pain and disability index SPADI | To quantify the degree to which patients affected with shoulder pain may have disability the Shoulder Pain and Disability Index (SPADI) was created. The SPADI's 13 components are split between a pain scale of five items and a disability scale of eight items. The numerical rating scale variant was created to facilitate its use and scoring (23). Reliability of SPADI is 0.92 and validity is 0.79 | 6 weeks | 
| imagej software | It can calculate area and pixel value statistics of user-defined selections. It can measure distances and angles. It can create density histograms and line profile plots. It supports standard image processing functions such as contrast manipulation, sharpening, smoothing, edge detection and median filtering.. It has been introduced as a reliable assessment tool. | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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shoulder pain, NECK PAIN, UPPER THORACIC MOBILIZATION, CERVICOTHORACIC MOBILIZATION, SUBACROMIAL IMPIGEMENT SYNDROME