Participants will be divided into two groups, with both receiving conventional physical therapy along with their respective thoracic intervention. One group will receive thoracic manipulation at the identified T1-T7 segment using a controlled High-Velocity, Low-Amplitude thrust in the prone position at the end of full exhalation, while the other group will receive central PosterioAnterior thoracic mobilization in the prone position for 30 repetitions with a 1-minute rest between two sets. The most painful or stiffest segment will be identified using the Passive Accessory Intervertebral Movement (PAIVM) test; if no joint sign is present, mobilization will be performed at T6-T7.
Age range between 40 and 60 years.
Both male and female patients with unilateral or bilateral shoulder pain.
Pain persisting for at least 3 months.
Decreased shoulder ROM, including external rotation, abduction, internal rotation, and flexion, with both active and passive ROM reduced by more than 50%.
History of fracture, surgery, or dislocation in the affected shoulder.
Shoulder pain resulting from systemic diseases such as rheumatoid arthritis, infection, or tumors, or conditions such as myelopathy (positive Hoffman's sign).
Neurological conditions such as stroke or cervical radiculopathy (positive Spurling's test).
Thoracic Outlet Syndrome (positive Roos test).
Parallel
Thoracic Manipulation
Procedure/SurgeryGroup A will receive thoracic thrust manipulation in addition to the conventional treatment program. The target thoracic segment (T1-T7) will be identified through posterior-to-anterior (PA) assessment. With the patient in a prone position, the therapist will position and preload the tissues at the identified segment and deliver a quick, controlled, high-velocity, low-amplitude (HVLA) thrust at the end of the patient's full expiration.
Thoracic mobilization
Procedure/SurgeryThoracic mobilization will be performed as an adjunct to the conventional physical therapy program. Central posterior-to-anterior oscillatory mobilization will be performed in the prone position. The treatment segment will be identified using the Passive Accessory Intervertebral Motion (PAIVM) test, with the most painful or stiffest segment selected; if no joint sign is present, mobilization will be applied at T6-T7.
Shoulder Pain Intensity
Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), an 11-point scale ranging from 0 to 10, where 0 = no pain, 1-3 = mild pain, 4-6 = moderate pain, and 7-10 = severe pain.
Shoulder range of motion
Shoulder range of motion will be measured using a universal goniometer. Shoulder flexion, abduction, internal rotation, and external rotation will be assessed and recorded in degrees.
Functional disability
Functional disability will be assessed using the Shoulder Pain and Disability Index (SPADI), consisting of 13 items assessing shoulder pain and functional limitations. with 5 items assessing pain and 8 items evaluating functional limitations. Each item is scored ranging from 0 (no pain/no difficulty) to 10 (worst pain imaginable/so difficult required help).
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