This study will be conducted to investigate the combined effect of thoracic manipulation and instrument-assisted soft tissue mobilization in patients with shoulder impingement syndrome
Patients with shoulder impingement syndrome from both genders their age from 18-55 years.
History of shoulder pain for one month.
Positive Neer's impingement test and Hawkin's Kennedy test.
Painful arc sign.
History of Shoulder girdle fracture, dislocation and surgery
Diagnosed with frozen shoulder or rotator cuff tear
History of cervicobrachial pain
Any neuromuscular pain in upper limb and use of corticosteroids or pain subsiding medication.
Parallel
conventional physical therapy
Other interventionthe patients will receive conventional physical therapy in the form of transcutaneous electrical nerve stimulation, ultrasound, and therapeutic exercise. The exercise includes range of motion exercises, stretching, scapular stabilization exercises, and rotator cuff strengthening.
thoracic manibulation
Other interventionWith the participant in a prone position, the therapist will apply a high-velocity, short-lever, posterior-to-anterior (P-A) thrust. The thrust will be directed toward the spinous or transverse processes of the hypomobile thoracic vertebrae. Thoracic thrust manipulation demonstrated to manipulate specific thoracic segment mainly the mid-thoracic, plus conventional physical therapy.
instrument assisted soft tissue mobilization
Other interventionThe IASTM technique will be performed for 20 seconds parallel to the muscle fibers, followed by 20 seconds perpendicular to the muscle fibers, with the instrument held at a 45° angle to the skin. The beveled side of the M2T blade will be in contact with the skin. Stroke pressure and speed will be modified according to the participant's tolerance to avoid causing pain and according to the depth of the treated muscle plus conventional physical therapy.The technique will be applied to the pectoral muscles, shoulder rotator cuff musculature, and periscapular musculature, including the upper, middle, and lower fibers of the trapezius, rhomboids major and minor, teres major, and latissimus dorsi
thoracic manipulation and instrument-assisted soft tissue mobilization
Other interventionthe patients will receive The IASTM technique will be performed for 20 seconds parallel to the muscle fibers followed by 20 seconds perpendicular to the muscle fibers, with the instrument held at a 45° angle to the skin plus thoracic manibulation in which the therapist will apply a high-velocity, short-lever, posterior-to-anterior (P-A) thrust. The thrust will be directed toward the spinous or transverse processes of the hypomobile thoracic vertebrae. Thoracic thrust manipulation demonstrated to manipulate specific thoracic segments, mainly the mid-thoracic, plus conventional physical therapy. finally, the pateitns will recieve conventional physical therapy
upper limb disability
Disabilities of the arm, shoulder and hand (Quick DASH) questionnaire will be used toassess upper limb diability.the QuickDASH only contains 11 items .It is a questionnaire that measures an individual's ability to complete tasks, absorb forces, and severity of symptoms.The QuickDASH tool uses a 5-point Likert scale from which the patient can select an appropriate number corresponding to his/her severity/function level.The QuickDASH outcome measure is designed to be used on patients presenting with one or more disabilities of the arm, shoulder, and hand. Scoring with 100 is more severe disability, and zero mean no disability.
pain intensity
neumerical pain rating scale will be used to assess pain. It consists of a line, often 10 cm long (100mm); its ends are generally labelled with verbal pain anchors (e.g., "no pain" and "pain as bad as it could be"). Patients are asked to indicate the point along the line from 0-10 cm marked in 1 cm increments where 0 cm represents no pain and 10 cm the most severe pain imaginable
shoulder range of motion
The Digital goniometer will be used to assess shoulder range of motion.
shoulder proprioception (joint position error)
shoulder joint position error will be assessed by a smartphone clinometer application. Proprioception test was done by moving the participant's arms from the starting position (0 degrees) to the target angles. The arm remained at each target angle for 5 seconds, allowing the subjects to memorize the position before returning to the starting position. Subsequently, the subjects were instructed to independently move their arms towards each target angle.
life disability
World Health Organization Quality of Life BREF will be used to assess life disability. The WHOQOL-BREF is a 26-item instrument that assesses quality of life across four domains: physical health (items 3, 4, 10, 15, 16, 17, and 18), psychological health (items 5, 6, 7, 11, 19, and 26), social relationships (items 20, 21, and 22), and environment (items 8, 9, 12, 13, 14, 23, 24, and 25). Items 1 and 2 assess overall quality of life and general health, respectively. Each item is rated on a 5-point Likert scale from 1 to 5. Items 3 and 4 are reverse-scored. For each domain, the item scores are averaged and multiplied by 4, producing a domain score ranging from 4 to 20, with higher scores indicating better quality of life.
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