This study will be conducted to investigate the difference between high-intensity laser and extracorporeal shock wave on supraspinatus tendon thickness, subacromial space, occupation ratio, shoulder pain intensity, shoulder range of motion (ROM), hand strength, and functional disability in patients with chronic supraspinatus tendinopathy.
Patients from 18 to 50 years old of both genders.
Unilateral Chronic Supraspinatus Tendinitis in dominant side
BMI 18.5-24.9
Tenderness is found over the supraspinatus as it passes subacromial and anterolateral The patient will report pain with active shoulder elevation in the scapular plane (eg: welders, plate workers, slaughterhouse workers and overhead playing athletes)
Post shoulder surgery, traumatic incidents
Partial tears at surgery
Massive retracted tears at surgery
Frozen shoulder Rotator cuff tear
Parallel
High-intensity Laser Therapy
Other interventionthe patients will receive HILT with peak power 3kW, intensity 15000W/cm and energy per pulse 350 mj) at supraspinatus tendenopathy.The treatment consisted of 3 phases in each session. the initial phase will be rapid manual scanning (100 cm2/30s) of the anterior joint line of the shoulder with one shot of 850 mj at frequency of 30 Hz. The scanning will be performed parallel to the joint line, with the patient arm internally rotated on the posterior scan and externally rotated on the anterior scan. the intermediate phase will be a fixed scan phase , with one -shot emission of 350mj at a frequency of 20-25Hz. plus conventional therapy
Extracorporeal Shock Wave
Other interventionpatients will be sitting with shoulder abduction at 45 and elbow flexed and the forearm rested on flat surface and shock wave applicator directed in the most tender point near the insertion at the greater tubrosity under acromion with 2000 impulses, and energy flex density of 0.22mj/mm , pulse rate 10/sec and frequency 1-15 Hz plus conventional therapy
conventional therapy
Other interventionwill receive Conventional physical therapy in form of stretching exercise of posterior shoulder capsule, passive stretching exercise, will be done only 3 times with holding time 30 sec and 10 sec rest period between repetitions , strengthing exercise consists of 3 exercises all have been recommended as essential for any shoulder rehabilitation program. These exercise include shoulder flexion, scaption and horizontal extension. for each exercise, a 10-repetition maximum for 3 sets with 60 sec rest between every set + TENS and hot back.
supraspinatous tendon thickness
supraspinatus tendon thickness will be assess by ultrasonography.The tendon often appears swollen or thickened (frequently \> 6 to 7 mm)
supracromial space
supracromial space will be measured by ultrasonography. A normal resting subacromial space generally ranges from 9 to 11 mm. A measurement of less than 6 mm is often pathological
occupation ratio of subacromial space
The ratio comparing the thickness of the supraspinatus tendon to the overall acromiohumeral distance. An increased occupation ratio (i.e., a thickened tendon taking up too much of the space) indicates a higher risk of impingement
pain intensity
visuala analogue scale will be used to assess pain intesity. it is a line of 100 mm.The ends are labeled with extremes, such as "No pain" at 0 mm and "Worst pain imaginable" at 100 mm.
shoulder range of motion
the range of motion will be measured by electrogoniometer
upper limb disability
The QuickDASH will be used to assess upper limb function.the QuickDASH is an 11-item questionnaire used to measure physical function and symptoms in people with upper limb disorders. Scores range from 0 (no disability) to 100 (most severe disability).
supraspinatus muscle strength
supraspinatus muscle strength will be measured by handheld dynamometer
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