The Effect of Thoracic Mulligan Mobilization on Sub-acromial Impingement Syndrome

The Effect of Mulligan Thoracic Sustained Natural Apophyseal Glides on Sub-acromial Impingement Syndrome.

This study was conducted to investigate the effect of mulligan thoracic sustained natural apophyseal glide on patients diagnosed as sub acromial impingement syndrome and its effect on shoulder range of motion, pain, function and disability of affected shoulder joint and size of sub acromial space, Half of the patients will treated with traditional treatment and mulligan thoracic SNAGS technique, while the other half will treated with traditional treatment only.

Forty patients with sub-acromial impingement syndrome will participate in this study. Intervention for the both group consisted of 12 session (3 times per week ) for one month. Subjects will be divided randomly and allocated into two groups , study group will received supervised exercise and mulligan thoracic SNAGS technique and the control group will received supervised exercise (stretching and strengthening exercises). both group will assessed by x ray to measure sub-acromial space , visual analogue scale for pain , The Shoulder Pain and Disability Index for shoulder function and goniometer for shoulder flexion, abduction ,external and internal rotation range of motion before and after treatment.

Inclusion Criteria:

1. Patients referred as sub-acromial impingement syndrome (stage 2) according to neer's classification.
2. Have +ve Neer's sign, +ve Hawkins and Kennedy test and +ve Empty and full can tests.
3. selected from both genders.
4. Aged from 25 to 40 years old.
5. Have restricted thoracic extension motion ( +ve occiput to wall test).

Exclusion Criteria:

1. History of shoulder adhesive capsulitis
2. Rotator cuff tendon tear/rupture (stage 3).
3. Shoulder dislocation, subluxation and fractures.
4. History of cervical, shoulder, upper back surgery.
5. Any spinal deformities such as scoliosis, kyphosis and rounded shoulder.
6. Diabetes mellitus.
7. Radiculopathy.
8. History of breast cancer.
9. Previous stroke or Shoulder hand syndrome.
10. Ligamentous Laxity.