forty patients will be assigned randomly into 2 equal groups Study group (n=23) will receive "closed-chain shoulder girdle scapular depression exercise" in addition to Stretching for posterior capsule & pectoralis minor, Eccentric exercise for external rotators and Strength exercises for serrates anterior and low intensity ultrasound Control group B (n=23) will receive "shoulder girdle depression against manual resistance exercise" in addition to stretching for posterior capsule & pectoralis minor, eccentric exercise for external rotators and Strength exercises for serrates anterior and low intensity ultrasound .

The exercise program will consist of 3 sessions / week for 5 weeks

BACKGROUND:

Patients with shoulder impingment syndrome report disability, especially during overhead movements, which may hinder activities of daily living .

Muscular strengthening training influences the resting position and scapular movement pattern of subjects with shoulder impingement syndrome and improve function of the affected shoulder.

Therefore, the focus of treatment for the syndrome is on performing exercises, including stretching, strengthening, and neuromuscular control exercises.

Although multiple types of exercise, such as scapular stability exercises, strengthening of the rotator cuff through range, and flexibility exercises for the anterior and posterior shoulder exercise is effective in the management of patients with shoulder impingement syndrome, there is not enough evidence to say whether one mode of exercise is superior to another.

RESEARCH QUESTION:

Are there any difference between closed-chain shoulder girdle scapular depression exercise and shoulder girdle depression against manual resistance exercise on patients with shoulder impingement syndrome

METHODS:

forty patients will be assigned randomly into 2 equal groups Study group (n=23) will receive "closed-chain shoulder girdle scapular depression exercise" in addition to Stretching for posterior capsule & pectoralis minor, Eccentric exercise for external rotators and Strength exercises for serrates anterior and low intensity ultrasound Control group B (n=23) will receive "shoulder girdle depression against manual resistance exercise" in addition to stretching for posterior capsule & pectoralis minor, eccentric exercise for external rotators and Strength exercises for serrates anterior and low intensity ultrasound .

The exercise program will consist of 3 sessions / week for 5 weeks

Inclusion Criteria:

• Patients aged from 25 to 45 years old.
• Patients with shoulder impingement stage I &II as judged by criteria of neer classification.
• Patients diagnosed by orthopedic surgeon with shoulder impingement, the diagnosis will be confirmed by positive Neer and Hawkins tests.

Exclusion Criteria:

• History of cardiac diseases or dyspnea on exertion
• Patients with cervical radiculopathy.
• Patients with shoulder instability.
• Patients with frozen shoulder.
• Acute shoulder trauma.