Rotator Cuff Syndrome
Conditions
Brief summary
This randomized controlled trial aims to investigate the effects of Mobilization With Movement (MWM) combined with exercise therapy on tendon morphology, pain, and functional outcomes in individuals with rotator cuff tendinopathy. A total of approximately 60 participants diagnosed with supraspinatus tendinopathy will be randomly assigned to either an exercise-only group or an exercise plus MWM group. All participants will undergo a standardized rehabilitation program for 8 weeks. Clinical outcomes, including pain intensity (Visual Analog Scale), shoulder function (SPADI and QuickDASH), range of motion, muscle strength, proprioception, and psychosocial status (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, and Central Sensitization Inventory), will be assessed at baseline and post-intervention. In addition, ultrasound imaging will be used to evaluate tendon morphology, including tendon thickness, subacromial bursa thickness, acromiohumeral distance, echogenicity, and vascularity. The primary objective is to determine whether MWM produces superior improvements in clinical outcomes and whether it is associated with measurable changes in tendon structure as assessed by ultrasound. The findings are expected to contribute to a better understanding of the biomechanical and neurophysiological mechanisms underlying manual therapy in rotator cuff tendinopathy and to provide evidence for its role in musculoskeletal rehabilitation.
Detailed description
Rotator cuff tendinopathy is one of the most common causes of shoulder pain and functional limitation, often resulting in reduced quality of life and impaired upper extremity performance. Although exercise therapy is widely accepted as the cornerstone of conservative management, the additional benefit of manual therapy techniques, particularly Mobilization With Movement (MWM), remains an area of ongoing investigation. Furthermore, the potential effects of manual therapy on tendon morphology assessed via ultrasound imaging are not yet fully understood. This randomized controlled trial will examine whether the addition of MWM to a standardized exercise program provides superior outcomes compared to exercise alone in individuals with supraspinatus tendinopathy. Participants will be randomly allocated into two groups: an exercise-only group and an exercise plus MWM group. Both interventions will be delivered over an 8-week period. The study will focus on both clinical and imaging-based outcomes. Clinical outcomes include pain intensity, shoulder function, range of motion, muscle strength, proprioception, and psychosocial factors such as fear of movement, pain catastrophizing, and central sensitization. Imaging outcomes will be assessed using musculoskeletal ultrasound to evaluate tendon thickness, subacromial bursa thickness, acromiohumeral distance, echogenicity, and vascularity. The primary aim is to determine whether MWM induces superior improvements in pain and function and whether these changes are accompanied by measurable alterations in tendon morphology. Secondary aims include exploring the relationship between ultrasound-based structural changes and clinical outcomes, as well as evaluating the potential role of psychosocial factors in treatment response. This study is expected to provide new evidence regarding the structural and functional effects of manual therapy in rotator cuff tendinopathy and to clarify whether improvements in clinical symptoms are associated with objective changes in tendon morphology.
Interventions
BEHAVIORALExercise Therapy
A standardized physiotherapy program including rotator cuff strengthening exercises, scapular stabilization exercises, posterior capsule stretching, pectoralis minor stretching, and active range of motion exercises for the shoulder.3 sessions per week for 8 weeks (supervised and/or home-based depending on protocol design)
PROCEDUREMobilization With Movement (MWM)
Glenohumeral joint Mobilization With Movement techniques (Mulligan concept), including posterior glide and inferior glide techniques applied during active shoulder movement, aimed at improving pain-free range of motion and function. Application Details: Grade: Sustained glide during active movement Techniques: Posterior glide, inferior glide Dosage: 2 sessions per week for 8 weeks Performed by licensed physiotherapist
Sponsors
Kirsehir Ahi Evran Universitesi
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Due to the nature of the interventions, participants and care providers cannot be blinded to group allocation. However, outcome assessments will be performed by an independent assessor who is blinded to group assignment. The assessor will not be involved in the treatment process or randomization procedures. This single-blind design is used to minimize assessment bias in both clinical and ultrasound-based outcome measures.
Intervention model description
This study is designed as a two-arm, parallel-group, randomized controlled interventional trial. Participants diagnosed with rotator cuff tendinopathy will be randomly allocated into either an exercise-only group or an exercise plus Mobilization With Movement (MWM) group. The intervention will be delivered over an 8-week period, and both groups will receive standardized exercise therapy. The experimental group will additionally receive MWM techniques applied to the glenohumeral joint. Outcomes will be assessed at baseline and immediately after the intervention period. The study follows a superiority framework, aiming to determine whether the addition of MWM provides greater improvements in tendon morphology (as assessed by ultrasound imaging), pain intensity, shoulder function, range of motion, muscle strength, proprioception, and psychosocial variables compared to exercise therapy alone. Randomization will be performed using a computer-generated sequence, and outcome assessors will
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 65 years * Clinical diagnosis of rotator cuff tendinopathy (supraspinatus involvement) confirmed by musculoskeletal ultrasound * Shoulder pain duration of at least 3 months * Pain intensity ≥ 3/10 on the Visual Analog Scale (VAS) * Ability to understand and follow instructions and complete questionnaires
Exclusion criteria
* Full-thickness or large rotator cuff tear confirmed by ultrasound or MRI * History of shoulder surgery on the affected side * Diagnosis of adhesive capsulitis (frozen shoulder) * Shoulder instability or dislocation history * Cervical radiculopathy or referred neck-related shoulder pain * Inflammatory rheumatic diseases (e.g., rheumatoid arthritis, ankylosing spondylitis) * Neurological disorders affecting upper extremity function * Corticosteroid injection in the shoulder within the last 6 months * Ongoing physiotherapy or manual therapy treatment for shoulder pain in the last 3 months * Severe systemic or psychiatric conditions that may interfere with participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Supraspinatus Tendon Thickness | Baseline (Week 0) and post-intervention (Week 8) | Supraspinatus tendon thickness will be measured using musculoskeletal ultrasound imaging. Measurements will be obtained at the tendon footprint in the longitudinal plane using a high-frequency linear transducer. Tendon thickness will be recorded in millimeters (mm). This variable is selected as the primary structural outcome to evaluate morphological changes associated with the intervention. Increased or decreased tendon thickness will be interpreted in relation to clinical improvement and tissue remodeling. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity | Baseline (Week 0) and post-intervention (Week 8) | Pain intensity will be assessed using a 10-cm Visual Analog Scale (VAS). Participants will rate their pain at rest, during activity, and at night. Scores range from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate greater pain intensity. |
| Shoulder Pain and Disability Index (SPADI) | Baseline (Week 0) and post-intervention (Week 8) | SPADI will be used to evaluate shoulder pain and functional disability. The questionnaire consists of pain and disability subscales, with total scores ranging from 0 to 100. Higher scores indicate greater disability. |
| QuickDASH Score | Baseline (Week 0) and post-intervention (Week 8) | QuickDASH will assess upper limb disability and symptoms. It consists of 11 items scored from 1 to 5, converted to a scale from 0 to 100. Higher scores indicate greater functional limitation. |
| Shoulder Range of Motion (ROM) | Baseline (Week 0) and post-intervention (Week 8) | Active shoulder flexion, abduction, internal rotation, and external rotation will be measured using a goniometer or digital inclinometer in degrees. |
| Shoulder Muscle Strength | Baseline (Week 0) and post-intervention (Week 8) | Isometric muscle strength of shoulder abductors and external rotators will be measured using a handheld dynamometer. Results will be recorded in Newtons (N). |
| Joint Position Sense (JPS) | Baseline (Week 0) and post-intervention (Week 8) | Shoulder proprioception will be assessed using a laser pointer method. The participant will attempt to reproduce a target shoulder flexion position with eyes closed. Deviation from the target position will be recorded in centimeters. Higher values indicate poorer proprioception. |
| Tampa Scale of Kinesiophobia (TSK) | Baseline (Week 0) and post-intervention (Week 8) | TSK will be used to assess fear of movement and reinjury. The scale consists of 17 items scored on a 4-point Likert scale. Total scores range from 17 to 68, with higher scores indicating greater fear of movement. |
| Pain Catastrophizing Scale (PCS) | Baseline (Week 0) and post-intervention (Week 8) | PCS measures exaggerated negative cognitive responses to pain, including rumination, magnification, and helplessness. It consists of 13 items with a total score ranging from 0 to 52. Higher scores indicate greater catastrophizing. |
| Central Sensitization Inventory (CSI) | Baseline (Week 0) and post-intervention (Week 8) | CSI is a 25-item questionnaire assessing symptoms related to central sensitization. Total scores range from 0 to 100, with higher scores indicating greater central sensitization-related symptom severity. |
Contacts
STUDY_DIRECTORÖmer ÖZÇELEP, Assist. Prof.
Kirsehir Ahi Evran Universitesi
Outcome results
None listed