This study will be conducted to investigate the difference between high-intensity laser and extracorporeal shock wave on supraspinatus tendon thickness, subacromial space, occupation ratio, shoulder pain intensity, shoulder range of motion (ROM), hand strength, and functional disability in patients with chronic supraspinatus tendinopathy.
Supraspinatus tendinopathy is a common cause of shoulder pain and dysfunction due to irritation, inflammation, or degeneration of the supraspinatus tendon in the rotator cuff. It is caused by repetitive overhead movements and is characterized by pain, weakness, and a limited range of motion, especially when reaching or lifting the arm. Recently, studies have demonstrated that HILT is useful for treating a variety of shoulder impairments, including subacromial impingement syndrome, rotator cuff tendinopathy, and adhesive capsulitis.Shock wave is an effective and noninvasive method of reducing pain and increasing ROM and functional status without the need for surgery; it has been successfully utilized to treat tendinopathy over the past 20 years.There is a gap in available literature about comparing the high-intensity laser and extracorporeal shock wave in patients withchronic supraspinatus tendonitis. So this study may add a piece of information to the physiotherapists in the government hospitals and the private clinics about showing the difference between the application of High Intensity laser and extracorporeal shock wave in patients with chronic supraspinatus tendinitis
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
69
the patients will receive HILT with peak power 3kW, intensity 15000W/cm and energy per pulse 350 mj) at supraspinatus tendenopathy.The treatment consisted of 3 phases in each session. the initial phase will be rapid manual scanning (100 cm2/30s) of the anterior joint line of the shoulder with one shot of 850 mj at frequency of 30 Hz. The scanning will be performed parallel to the joint line, with the patient arm internally rotated on the posterior scan and externally rotated on the anterior scan. the intermediate phase will be a fixed scan phase , with one -shot emission of 350mj at a frequency of 20-25Hz. plus conventional therapy
patients will be sitting with shoulder abduction at 45 and elbow flexed and the forearm rested on flat surface and shock wave applicator directed in the most tender point near the insertion at the greater tubrosity under acromion with 2000 impulses, and energy flex density of 0.22mj/mm , pulse rate 10/sec and frequency 1-15 Hz plus conventional therapy
supraspinatous tendon thickness
supraspinatus tendon thickness will be assess by ultrasonography.The tendon often appears swollen or thickened (frequently \> 6 to 7 mm)
Time frame: up to 6 weeks
supracromial space
supracromial space will be measured by ultrasonography. A normal resting subacromial space generally ranges from 9 to 11 mm. A measurement of less than 6 mm is often pathological
Time frame: up to 6 weeks
occupation ratio of subacromial space
The ratio comparing the thickness of the supraspinatus tendon to the overall acromiohumeral distance. An increased occupation ratio (i.e., a thickened tendon taking up too much of the space) indicates a higher risk of impingement
Time frame: up to 6 weeks
pain intensity
visuala analogue scale will be used to assess pain intesity. it is a line of 100 mm.The ends are labeled with extremes, such as "No pain" at 0 mm and "Worst pain imaginable" at 100 mm.
Time frame: up to 6 weeks
shoulder range of motion
the range of motion will be measured by electrogoniometer
Time frame: up to six weeks
upper limb disability
The QuickDASH will be used to assess upper limb function.the QuickDASH is an 11-item questionnaire used to measure physical function and symptoms in people with upper limb disorders. Scores range from 0 (no disability) to 100 (most severe disability).
Time frame: up to six weeks
supraspinatus muscle strength
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will receive Conventional physical therapy in form of stretching exercise of posterior shoulder capsule, passive stretching exercise, will be done only 3 times with holding time 30 sec and 10 sec rest period between repetitions , strengthing exercise consists of 3 exercises all have been recommended as essential for any shoulder rehabilitation program. These exercise include shoulder flexion, scaption and horizontal extension. for each exercise, a 10-repetition maximum for 3 sets with 60 sec rest between every set + TENS and hot back.
supraspinatus muscle strength will be measured by handheld dynamometer
Time frame: up to six weeks