Fascial Manipulation on Scapulohumeral Rhythm and Proprioception in Patients With Rotator Cuff Tendinitis.

Riphah International University32 enrolled

Overview

The aim of this randomized controlled trial is to find the effectiveness of Fascial Manipulation on Scapulohumeral Rhythm and Proprioception in Patients with Rotator cuff tendinitis

Rotator cuff is a collection of four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) which hold the shoulder joint and provide movement any injury to the tendon of these muscles cause rotator cuff tendinitis among all of these the supraspinatus tendon is more prone to injury because of its blood supply pattern the head of the humerus put pressure on supraspinatus tendon and hence degenerative changes started. Rotator cuff tendinopathy typically presents with dull, aching pain around the shoulder joint, particularly over the areas of the four rotator cuff tendons. This discomfort is often aggravated by activities such as reaching overhead, reaching behind the back, lifting, or sleeping on the affected side. Pain is especially noticeable during shoulder elevation and abduction, often limiting the range of motion to less than 90° in abduction and forward flexion (anteflexion). Activities of daily living (ADLs) can become increasingly painful. The onset of pain is gradual rather than sudden and tends to persist over time The manual technique itself consists in creating localized heat by friction by using the elbow, knuckle, or fingertips on the abovementioned points. The mechanical and chemical stress effects on connective tissue are well known and a local rise in temperature could affect the ground substance of the deep fascia in these specific points. Tensional adaptation can then propagate along an entire MF sequence, diagonal, or spiral, re-establishing a physiological balance. Fascial manipulation aims to release fascial restrictions, improve blood flow, and restore neuromuscular function. Unlike conventional treatments, FM addresses the underlying fascial adhesions that contribute to the disruption of scapulohumeral rhythm and proprioception, offering a more integrated and holistic solution to these problems. In my study, we will investigate how fascial manipulation affects proprioception and scapulohumeral rhythm in patients with rotator cuff impingement syndrome The concept that proprioception is mainly work on the mechanoreceptors which convert mechanical energy to electrical nerve impulse which give signals to central nervous system about the joint position and orientation. * This study aims to determine if fascial manipulation can enhance the effectiveness of conventional physiotherapy by addressing myofascial restrictions that contribute to chronic tendinitis. Unlike many studies that focus on acute rotator cuff injuries, this study targets chronic cases where long-term inflammation and dysfunction persist. The research will assess long-term functional improvements rather than short-term symptom relief. While most studies focus primarily on pain reduction, this study will investigate how fascial manipulation affects scapular movement coordination and proprioceptive control, which are critical for shoulder rehabilitation.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Rotator Cuff Tendinitis

Interventions

Fascial manipulation techniqueOTHER

In initially step the patient in prone position and therapist approach on the same side of the treatment limb. Use the thumb by applying the pressure on the side of the target muscle. The treatment sequence will begin with thumb gradually involve the finger. A single treatment consists of a series of specific sequences of these moves with frequent pauses 2 to 5 minutes. Treatment session duration 15-30 minutes occur 2 days per week, for 4 weeks. Week 1(Fascial Manipulation on the targeted muscle for 5 minutes) week 2(Fascial Manipulation on the targeted muscle for 10 minutes) week 3(Fascial Manipulation on the targeted muscle for 15 minutes) week 4 (Fascial Manipulation on the targeted muscle for 20 minutes) Conventional PT including 1- hot pack (for 15 minutes)2- Periscapular exercises, a. shoulder shrug exercise (3 sets of 10 reps.) b. prone arm hangs (3 sets of 10 reps) 3- shoulder proprioception exercises a. Ball throws (30 reps) six times

Conventional PTOTHER

Conventional PT including 1- hot pack (for 15 minutes)2- Periscapular exercises, a. shoulder shrug exercise (3 sets of 10 reps.) b. prone arm hangs (3 sets of 10 reps) 3- shoulder proprioception exercises a. Ball throws (30 reps) six times b. abc's on wall exercise 4- Shoulder stability exercises a. Ts Ys exercise (3 sets) b. side-lying external rotations (3 sets of 10 reps.) Total duration is 3 sessions per week for 4 consecutive weeks.

Eligibility

Sex: ALLMin age: 20 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Participants falling in this category would be recruited into the study. 2. Participants aged 20-45 years. 3. Gender: Male and female 4. A confirmed diagnosis of rotator cuff tendinitis based on clinical evaluation. (positive Hawkin's test, Jobe test, Empty can test, Hornblower test) 5. Persistent shoulder pain for at least 3 months. 6. Willingness to provide informed consent and adhere to the study protocol. Exclusion Criteria: * Participants falling in this category would be excluded from the study. 1. History of shoulder surgery or severe structural deformities affecting the shoulder joint. 2. Recent fracture in the upper limb. 3. Recent dislocation in the upper limb. 4. Uncontrolled or severe comorbidities (e.g., advanced osteoporosis, cardiovascular disease, uncontrolled diabetes). 5. Signs or symptoms of serious underlying pathology such as infection or malignancy

Locations (1)

Life care Physiotherapy Clinic, Shahmansoor, Swabi

Swabi, Khyber Pakhunkhwa, Pakistan

Outcomes

Primary Outcomes

Lateral scapular slide test (LSST)

In the LSSTs, the distance from the inferior angle of the scapula to thoracic vertebral spinous process T8 was measured in three positions (shoulder joint 0°, 45°, and 90° abduction) using tape measures

Time frame: 4 weeks

Joint position sense test.

A laser-pointer attached to the index finger during an ART allowed measurement (mm) of JPS by measuring the distance between the target and relocated position. Participants were blindfolded and stood an arm's length (approximately 1 m) away from the wall. Whilst keeping the wrist in neutral and elbow extended, the participant actively moved to the target position (90° glenohumeral flexion), held for 5 seconds, returned their arm to their side and actively returned to the target position. A mean was calculated from three trials to provide an ART score

Time frame: 4 weeks

Goniometer

Participants will be assessed in a standardized supine position to minimize compensatory trunk or scapular movements. Bony landmarks (acromion, humeral epicondyle, mid-axillary line, olecranon process, and ulnar styloid) will be palpated for goniometer alignment. The fulcrum will be placed at the joint axis, the stationary arm aligned with the proximal reference (thorax/sternum), and the moving arm aligned with the distal segment (humerus/ulna).

Time frame: 4 weeks

Data from ClinicalTrials.gov

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