Maitland Thoracic Mobilization Versus Mulligan Thoracic Mobilization in Kyphotic Patients With Shoulder Impingement Syndrome

Cairo University (CU)

Status

Completed

Conditions

Kyphosis Thoracic

Shoulder Impingement Syndrome

Treatments

Other: Mulligan thoracic sustained natural apophyseal glide (SNAGS)

Other: Traditional exercise management

Other: Maitland mobilization for thoracic spine

Study type

Interventional

Funder types

Other

Identifiers

NCT05605730

P.T.REC/012/003447

Details and patient eligibility

About

In recent years the management of shoulder impingement syndrome (SIS) included the thoracic spine as it was proved that it's highly correlated to pathologies in shoulder joint. SIS is proved to be associated with kyphotic posture. Also, It was proved that changing sitting posture affects the measured ROM of shoulder joint and this implicates the influence of changing thoracic position on shoulder mechanics. Explanations were made regarding the role of thoracic spine in affecting the shoulder joint through two ways. Firstly, through affecting the mechanics of scapular movements and secondly through altering the length tension relationship of shoulder musculature. This study would aim at studying the most effective thoracic mobilization in the treatment of SIS.

Enrollment

45 patients

Sex

Male

Ages

20 to 45 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Shoulder impingement syndrome SIS clinically diagnosed by using Hawkins-Kennedy test, the painful arc test, and the infraspinatus muscle strength test; and for a rotator cuff tear, the infraspinatus and the drop-arm test and supraspinatus muscle strength tests.
Subjects will be diagnosed of having postural kyphosis proved by a physician referral or modified Cobb's angle of more than 40 degrees (x-ray).

Exclusion criteria

The participants with any musculoskeletal abnormalities eg. Glenohumeral instability.
Neurological abnormalities.
Surgical operation of the last 4 months will be excluded from the study.
Shoulder corticosteroid injection at any time in the past.
Engaging in any athletic physical activities.

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Single Blind

45 participants in 3 patient groups

Traditional exercise management

Active Comparator group

Description:

1. Prone back extension. 2. Shoulder external rotation starting in 45° of internal rotation, with the arm by the side and the elbow flexed to 90 °. 3. Shoulder internal rotation starting in 45 ° of external rotation, with the arm by the side and the elbow flexed to 90 °.. 4. Shoulder abduction (scapular plane) through a 0- to 60-° with the elbow flexed 90 ° and the shoulder in neutral rotation. 5. Shoulder flexion (sagittal plane) through a 0- to 60-°starting with the elbow flexed 90 ° and the shoulder in neutral rotation and punching forward, simultaneously extending the elbow and flexing the shoulder. 6. Internal rotation towel stretch: Subjects will be instructed to sit or stand while holding a towel with the affected arm behind the back and to use the other arm to pull the affected arm up the back.

Treatment:

Other: Traditional exercise management

Maitland mobilization for thoracic spine

Experimental group

Description:

This group will receive the previously mentioned exercises protocol targeting shoulder joint in addition to Maitland mobilization for thoracic spine.

Treatment:

Other: Traditional exercise management

Other: Maitland mobilization for thoracic spine

Mulligan thoracic sustained natural apophyseal glide (SNAGS)

Experimental group

Description: