Rotator Cuff Injuries
Conditions
Keywords
Rotator cuff injuries, Manual therapy, Exercise, Shoulder joint, Thoracic Vertebrae
Brief summary
Rotator cuff pathology is defined as the degeneration or tear of one or more of the muscles or tendons of the rotator cuff, namely the supraspinatus, infraspinatus, teres minor, and subscapularis. Shoulder girdle biomechanics are not solely comprised of the glenohumeral joint but are built upon a kinetic chain involving the synchronized movement of the scapula, clavicle, and thoracic spine. In this context, the concept described in the literature as the "Regional Dependence" model argues that functional impairment in a distal segment like the shoulder may stem from or exacerbate limitations in a more proximal region like the thoracic spine. Conventional treatment approaches that focus solely on the shoulder joint may have limited clinical outcomes due to neglecting the fundamental link in the kinetic chain. Maintained natural apophyseal glides (SNAGs), a cornerstone of Mulligan's Concept in spinal rehabilitation, are a dynamic manual therapy technique aimed at correcting microscopic misalignments in facet joints during active movement. The aim of this randomized controlled trial is to investigate the effects of thoracic mobilization added to the Mulligan movement shoulder mobilization technique on pain intensity, range of motion, proprioception, and upper extremity functionality in individuals with rotator cuff pathology, and to evaluate the superiority of this combined approach over shoulder mobilization alone. Assessments will be performed before treatment and at the end of the 3-week intervention. Rest and activity pain intensity will be assessed using the Pain Numerical Rating Scale (PMR), shoulder range of motion using a digital goniometer, thoracic kyphosis degrees using a smartphone with the 'Angle Meter' software installed and calibrated gyroscope and accelerometer sensors, functionality using the Shoulder Pain and Disability Index (SPAI), and proprioception using a laser pointer and target device. The obtained data will be compared using appropriate statistical analysis methods. This study is expected to provide scientific evidence regarding the clinical effectiveness of thoracic mobilization technique added to shoulder mobilization technique applied in conjunction with conventional treatment in individuals with rotator cuff pathology, and to contribute to filling the methodological gap mentioned in the literature.
Interventions
PROCEDUREMulligan Mobilization with Movement
Mobilization with Movement technique applied to the shoulder joint according to Mulligan concept to improve pain and range of motion.
PROCEDUREThoracic Spine Mobilization
Manual mobilization techniques applied to thoracic spine segments to improve thoracic mobility and contribute to shoulder function.
Conventional physiotherapy program including hot pack application (20 minutes), TENS (80-100 Hz frequency, 50-100 µs impulse duration, 20 minutes), therapeutic ultrasound (1-3 MHz frequency, 1.0-1.5 W/cm² intensity, continuous mode, 7 minutes), and supervised exercise program consisting of pendulum exercises, stick exercises for range of motion, scapular stabilization exercises (retraction, Y-W-T), and progressive strengthening exercises (isometric and dynamic) for rotator cuff muscles.
Sponsors
Yuzuncu Yil University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Having been diagnosed with unilateral rotator cuff pathology (impingement syndrome, tendinopathy, or partial tear) by a specialist physician through clinical examination and/or radiological imaging (USG/MR); * Being between 18 and 65 years of age; * Having shoulder pain that has persisted for at least 3 months; * Having a positive result on at least two of the Neer, Hawkins-Kennedy, and Empty Can tests; * Having a pain intensity of at least 3/10 on the Pain Numerical Rating Scale (NPRS) during rest or activity; * Having sufficient cognitive ability to follow simple instructions and administer the tests; * Having a Mini Mental State Test score ≥24; * Having the ability to provide signed informed consent and agreeing to participate in the study voluntarily.
Exclusion criteria
* Having undergone previous surgery on the shoulder or thoracic region; * Having full-thickness rotator cuff tears requiring surgical indication; * Having adhesive capsulitis, shoulder instability, labrum tears, or calcific tendinitis; * Having cervical radiculopathy or neurological diseases affecting the upper extremity; * Having uncontrolled diabetes, inflammatory rheumatic diseases (rheumatoid arthritis, etc.), or malignancy; * Having severe osteoporosis, unstable vertebral fractures, or active infection in the thoracic region; having received steroid (cortisone) or PRP injections to the shoulder region within the last 3 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Thoracic kyphosis angle | From enrollment to the end of treatment at 3 weeks | Participants' thoracic kyphosis degrees will be measured via a smartphone equipped with 'Angle Meter' software, a digital inclinometer. |
| Proprioception | "From enrollment to the end of treatment at 3 weeks | Proprioception will be assessed using a laser pointer and millimeter graph paper. The laser pointer will be secured to the participant's arm just above the lateral epicondyle, parallel to the arm, using an elastic bandage. The participant will be positioned in a seated position 1 meter away from the millimeter graph paper. The amount of linear deviation on the millimeter graph paper will be converted into angular error using a trigonometric formula based on the distance between the center of the shoulder joint and the paper. |
| Range of motion | "From enrollment to the end of treatment at 3 weeks | Range of motion will be assessed using a universal goniometer. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Shoulder pain | From enrollment to the end of treatment at 3 weeks | Shoulder pain will be assessed with Numerical Pain Rating Scale. Pain intensity is assessed on a numerical scale of 0-10; 0 = no pain, 5 = moderate pain, 10 = unbearable pain. |
| Shoulder Functionality | From enrollment to the end of treatment at 3 weeks | Functionality will be assessed with Shoulder Pain Disability Index. |
Countries
Turkey (Türkiye)
Contacts
CONTACTAyşe Merve Tat, Assistant Professor
Outcome results
None listed