Treatment for shoulder impingement is conservative initially, Rehabilitation programs generally consist of exercise therapy and manual therapy that provide relief from symptoms of impingement. High-intensity laser therapy used recently and was found to be effective in the short term in the treatment of pain and disability in patients with impingement.

This study aims to

• Investigate the effect of high intensity power laser therapy on sonographic measurement in the adolescent suffering from shoulder impingement syndrome.
• Investigate the effect of high intensity power laser therapy on pain in the adolescent suffering from shoulder impingement syndrome.
• Investigate the effect of high intensity power laser therapy on shoulder function in the adolescent suffering from shoulder impingement syndrome.

RESEARCH QUESTION:

Does using high intensity power laser affects shoulder dysfunction in adolescent with shoulder impingement syndrome?

Shoulder symptoms are often persistent and recurrent and represents approximately one fifth of all musculoskeletal disability payment. One of the most common causes of shoulder pain is the occurrence of tendinopathy resulting from the impingement of rotator cuff tendons under the coracoacromial arch which refer to impingement syndrome.

Treatment for shoulder impingement is conservative initially, Rehabilitation programs generally consist of exercise therapy that provide relief from symptoms of impingement, Exercise therapy has been shown to be effective in the reducing pain and improving function also it was stated that the exercise therapy lead to improving shoulder musculoskeletal risk factors in competitive athletes with Specific exercise was superior to non-specific exercise. Strong recommendation may be made to include manual therapy as an adjunct intervention with exercise.

The manual therapy technique of joint mobilizations which are commonly used by physiotherapists for reducing pain and disability in patients with shoulder musculoskeletal disorders, Manual therapy which involves realigning collagen, enhancing fiber slip, reducing adhesion, and re-establishing correct gleno-humeral joint kinematics, can relieve pain by stimulating peripheral mechanical receptors, suppressing nociceptors, boosting synovial fluid nutrition, and reducing adhesion. It has been stated that impingement patients treated with manual therapy in combination with supervised exercise showed improvement in pain and function.

High-intensity laser therapy (HILT) is a treatment method that added to therapeutic interventions recently. HILT improves the microcirculation and tissue regeneration with photomechanic effects in deep tissues. Biostimulation, anti-inflammatory, and analgesic properties contribute to an effective improvement in painful bone-muscle-joint pathologies, including shoulder problems. Adding therapeutic interventions to laser therapy is usual in clinical practice. HILT was found to be effective in the short term in the treatment of pain and disability in patients with Sub-acromial pain syndrome.

Ultrasonography is recommended as the first line imaging tool to evaluate sports injuries; it has been used as the preferred technique for evaluating the subacromial space.

Algometers are devices that can be used to identify the pressure and/or force eliciting a pressure-pain threshold. . This technique is a well-known and well-validated method to induce acute experimental pain.

Null Hypothesis:

High intensity laser therapy will not affect the sonographic measurement in adolescents with shoulder impingement syndrome.

High intensity laser therapy will not affect the pain in adolescents with shoulder impingement syndrome.

High intensity power laser therapy will not affect the shoulder function in adolescents suffering from shoulder impingement syndrome.

Basic assumptions:

It will be assumed that:

• All evaluation and treatment procedures will be performed in the same environment for all patients
• All volunteers will attend the treatment program regularly.
• All volunteers will be cooperative, following the instructions given to them, and exert their maximum effort during the study.
• The results of the study will be helpful for physical therapists dealing with similar cases.

Inclusion Criteria:

1. Age was ranged between 12-18 years old.
2. Unilateral pain in the anterolateral region of the shoulder.
3. Has painful arc.
4. 2 out of 3 impingement tests positive (Hawkins, Jobe and Neer).
5. Pain with palpation of the supraspinatus tendon insertion.

Exclusion Criteria:

1. Previous shoulder complex, cervical and thoracic fractures, or surgeries.
2. Either cervical pain or arm radiculopathy.
3. History of shoulder dislocation.
4. Traumatic onset of the pain.
5. No corticosteroid injections could have been received within 2 months prior to the study