Pragmatic Set of Interventions Versus Scapular Strengthening Exercises on Scapular Dyskinesia in Adhesive Capsulitis

Study Overview
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Brief Summary
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The aim of this study is to determine the Effects of pragmatic set of interventions versus scapular strengthening exercises on scapular dyskinesia in adhesive capsulitis.

Detailed Description
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Scapular dyskinesia (SD) is a term that describes a physical impairment in which the scapula's position and motion are altered.Symptoms of SD can be one or a combination of the anterior shoulder pain, Postero-superior scapular pain, superior shoulder pain, proximal lateral arm pain. scapular dyskinesia is commonly found in adhesive capsulitis patients. To determine the scapular dyskinesia with shoulder pain two tests that apply manual assistance to the scapula are lateral scapular slide test and wall push up test. Pragmatic set of interventions are an important element in rehabilitation, and has improved the treatment of many musculoskeletal and neurological conditions. Scapular strengthening exercises, which aims to improve abnormal scapular movements that commonly occur in people with adhesive capsulitis. The purpose of this study is to explore the effect of scapular focused exercises on the rehabilitation of adhesive capsulitis, patient with scapular dyskinesia. The importance of scapular rehabilitation in the treatment of scapular dyskinesia and to examine the comparative effect of pragmatic set of intervention with scapular strengthening protocol on scapular dyskinesia. My study on the effect of a pragmatic set of intervention versus scapular strengthening exercises on scapular dyskinesia in adhesive capsulitis is important because it addresses a gap in the current literature. While both interventions have been shown to improve scapular dyskinesia in patients with adhesive capsulitis, there is a lack of studies comparing the two methods. My study will help determine which intervention is more effective in treating scapular dyskinesia, which will be valuable information for healthcare providers working with patients with adhesive capsulitis

Official Title
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Effects of Pragmatic Set of Interventions Versus Scapular Strengthening Exercises on Scapular Dyskinesia in Adhesive Capsulitis

Conditions
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Scapular Dyskinesis, Adhesive Capsulitis

Intervention / Treatment
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* Other: pragmatic set of interventipons
* Other: scapular strengthening exercise.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Both male and females with age range b/w 25-45 People with adhesive capsulitis (having pain, stiffness, and decrease movements of - external rotation, forward flexion and abduction) Scapular dyskinesia (positive lateral scapular slide with difference of 1.5cm when measurements are compared bilaterally) Exclusion Criteria: History of shoulder surgery or other significant shoulder injury, neurological or musculoskeletal conditions that may affect shoulder function. History of significant medical conditions (e.g., heart disease, cancer) that may affect their ability to participate in the study. Pregnant or breast feeder, as the exercise program may not be safe or appropriate for them.

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 45 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
Interventional Model Description: Participants are divided into two groups. Group A assigned to pragmatic group of interventions and group B assigned with scapular strengthening exercises at the beginning of the trial and continue that throughout the length of the trial.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: pragmatic set of interventions<br>The pragmatic set included 6 interventions as follows. Pragmatic posterior capsular stretch (PPCS) Serratus anterior stretch (SAS) Rotator cuff facilitation (RCF) Acromioclavicular joint mobilization Pectoralis minor stretch Thoracic manipulation | Other: pragmatic set of interventipons<br>* The pragmatic set included 6 interventions as follows. Pragmatic posterior capsular stretch (PPCS) Serratus anterior stretch (SAS) Rotator cuff facilitation (RCF) Acromioclavicular joint mobilization. Pectoralis minor stretch Thoracic manipulation Five to ten sweeps per minute are administered three to four times. The applied force is combined with deep breathing. The subject is asked to report discomfort and the applied force is adjusted.<br>|
| Placebo Comparator: scapular strengthening exercises<br>Scapular strengthening exercises will be individualised focusing on Serratus anterior, trapezius, Levator scapulae, Rhomboids. Serratus anterior; Dynamic hug Scaption with external rotation Diagonal PNF (shoulder flexion, horizontal flexion, external rotation), Trapezius - Upper trapezius: Unilateral shoulder shrug, Rowing, Forward shoulder flexion, Shoulder abduction in scapular plane above 120 degrees. Middle trapezius: Prone shoulder horizontal abduction Scaption, horizontal abduction with external rotation Lower trapezius: Unilateral scapular retraction, Prone bilateral shoulder external rotation at 90 degrees of abduction, Prone shoulder abduction. Levator Scapulae: Horizontal abduction with shrug, Horizontal abduction with ER, Prone shoulder extension. Rhomboids: ER at 90° of abduction, ER at 0° of abduction, Horizontal abduction, Shoulder extension, | Other: scapular strengthening exercise.<br>* • Subjects in Group B receive strengthening exercises (exercise will perform with 15 repetitions for each set- 3sets/day, 3 days /week for 6 weeks. In Scapular strengthening exercises, treatment protocol will involve the individualized for focus muscle Serratus anterior (Dynamic hug, Scaption with external rotation, Diagonal PNF (shoulder flexion horizontal flexion, external rotation),Trapezius - Upper trapezius (unilateral shoulder shrug, rowing, forward shoulder flexion, shoulder abduction in scapular plane above 120 degrees, Middle trapezius (prone shoulder horizontal abduction, scaption, horizontal abduction with external rotation), Lower trapezius (Unilateral scapular retraction, prone bilateral shoulder external rotation at 90 degrees of abduction, prone shoulder abduction), Levator Scapulae (horizontal abduction with shrug, horizontal abduction with ER, prone shoulder extension, Rhomboids (ER at 90° of abduction, ER at 0° of abduction, Horizontal abduction, Shoulder extension)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Shoulder Pain and Disability Index (SPADI) | The Shoulder Pain and Disability Index (SPADI) was developed to measure current shoulder pain and disability in an outpatient setting. The SPADI contains 13 items that assess two domains; a 5-item subscale that measures pain and an 8-item subscale that measures disability. SPADI was found to have reliability coefficients of ICC ≥ 0.89 in a variety of patient populations.Internal consistency is high with Cronbach α typically exceeding 0.90. The SPADI demonstrates good construct validity, correlating well with other region-specific shoulder questionnaires. | 4th week | 
| Scapulometer | is a reliable tool to measure scapular medial border and inferior angle prominence. It is used to measure the distance from the root of the spine (ROS) and the inferior angle (INF) of the scapula to the thorax wall. The novel scapulometer has excellent reliability and fair validity to quantify medial border and inferior angle prominence of the scapula. Further research utilizing this instrument is recommended. | 4th week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual analogue scale: | This VAS will be used in this study to measure Pain. Patients were instructed to assess the severity of shoulder pain experienced last week on a 0-10 cm horizontal line (0 = painless and 10 = worst pain imaginable). The VAS has been shown to have excellent test-retest reliability (ICC = 0.97) and high validity (r with a 5-point verbal descriptive scale = 0.71-0.78) to evaluate pain perception. | 4th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Scapular Dyskinesis, Adhesive Capsulitis, Pragmatic set of interventions, strengthening exercise