RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FORDISSERTATION

1.

Name of the Candidate And

Address

(in block letters):

SANJEEV.K.PRABHUKRISHNAKRIPA,KALAPPURA KOVILAKAM,KODUNGALLUR (P.O),THRISSUR (DIST), KERALA – 680 664

2.

Name of the Institute :

LAXMI MEMORIAL COLLEGE OF PHYSIOTHERAPY, MANGALORE.

3.

Course of study and subject :

MASTERS OF PHYSIOTHERAPY (MPT)2 YEARS DEGREE COURSE

MUSCULOSKELETAL AND SPORTS

4.

Date of Admission to Course:

14th JULY, 2010

5.

Title of the topic:

IMMEDIATE EFFECTS OF SCAPULAR MOBILIZATION

IN SHOULDER DYSFUNCTION : A COMPARATIVE STUDY BETWEEN THREE GROUPS

6.Brief Resume of the Intended Work:

6.1 NEED FOR THE STUDY

Shoulder dysfunction can affect an individual’s ability to function independently, consequently decreasing quality of life.4

Teys et al6 also reported applying manual therapy to participants with painful restriction of shoulder movement produced significant improvement in range of motion (ROM) and pain.6

Recently, clinicians10,11 and investigators12,13 have focused increased attention on the role of the scapula in the pathogenesis of shoulder pain and movement in general and impingement symptoms.

Elevation of the upper extremity(about 180degree with trunk rotation) refers to combination of scapular, clavicular and humeral motion that occurs during arm movement32.

The scapular upward rotation linearly varies with humeral angle and contributes to approximately 30% to 40% of the overall arm elevation in adults, classically described as the scapulohumeral rhythm.14

The abnormal scapular biomechanics that occur as a result of dysfunction create abnormal scapular positions that decrease normal shoulder function.11,14,16.

Therefore, treatment of shoulder dysfunction should include scapular-mobility exercises, or scapular-mobilization (SM) techniques.

Scapular mobilization is the treatment technique widely used in the management of musculoskeletal disorders of the shoulder. It involves the manual application of a sustained mobilization (in 4 directions) by a therapist to a scapulothoracic joint.

Hence the aim of this study was to evaluate the acute effects of SM on shoulder ROM, scapular positions, pain, and function or disability.

HYPOTHESES

NULL HYPOTHESIS (HO):

There will be not be any immediate effects of scapular mobilization in subjects with shoulder dysfunction

ALTERNATE HYPOTHESIS(H1) :

There will be immediate effects of scapular mobilization in subjects with shoulder dysfunction

6.2 REVIEW OF LITERATURE

The findings of the study are consistent with studies conducted on other joints of the body that showed similar effects with different mobilization techniques.6,7,18

Joint-mobilization techniques are assumed to induce various beneficial effects.

The mechanical changes may include breaking up adhesions, realigning collagen, or increasing fiber glide.24

There is a curvi –linear relationship between scapular & humeral movement.25,26

It is accepted that the glenohumeral and scapulothoracic joints are in the closed kinetic chain. So I assume that if glenohumeral mobilization improves shoulder movements6 and normalizes the scapulohumeral rhythm,11,18, scapular mobilization should improve shoulder movements; this is related with my study, because of the relation between shoulder and scapula.

In agreement with the result of previous studies, the current study demonstrated that when scapular and shoulder movements are improved, shoulder functional status gets better.30

Jiu Jeng et al31 found that scapular kinematics would be important in reflecting functional disabilities in patients with shoulder dysfunction.

These findings are especially noteworthy because scapular mobilization may help to decrease functional disabilities in patients with shoulder dysfunction.

6.3 OBJECTIVES OF STUDY

The objectives of this study is to evaluate the immediate effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular malpositions, pain, and function.

7.MATERIALS AND METHODS:

7.1 STUDY DESIGN:

Pretest-posttest for 3 groups –Group1, Group2 and Group3.

SOURCE OF DATA:

The study will be conducted on 39 patients at

a. Laxmi Memorial College of Physiotherapy Mangalore. Out patient department

b. A.J. Institute of Medical Sciences Mangalore Physiotherapy out patient department.

7.2 METHOD OF COLLECTION OF DATA

A total of 39 patients between age group 20-77, from both sexes are going to be selected. They will be divided into 3 groups of 13 numbers in each, namely,

a) Group1 b) Group2 c) Group3

INCLUSION CRITERIA

1. The primary inclusion criterion of Teys et al6 is the inability to elevate the arm more than 100° in the scapular plane because of pain.

2. Subjects with painful restriction of shoulder movement that has been persisting for at least 4 weeks are considered for this study.

3. Subjects referred with diagnosis of tendinitis, impingement, tenosynovitis and frozen shoulder.

4. Both males and females between age group 20-77 years.

EXCLUSION CRITERIA

1. Subjects with diagnosis of cervical symptoms(numbness or tingling in the upper extremity)

2. Subjects with history of onset of symptoms because of a traumatic injury, shoulder surgery, carcinoma, nerve injuries.

3. Subjects who are uncooperative.

Materials

(a) Visual Analogue Scale

(b) Constant Shoulder Score

(c) Universal goniometer

(d) Bubble goniometer

TECHNIQUE OF APPLICATION

METHOD

Sampling technique will be used to evaluate the immediate effects of scapular mobilization and ultrasound on shoulder range of motion, scapular malposition, pain and function,between three groups. This design has to be used to reduce the effects of individual variation.

a) Group1 – consists of application of supero inferior gliding, rotations and distraction of scapula, with ultrasound therapy to affected shoulder joint after mobilization. Here scapula has to be mobilized with therapist’s one hand over upper border of scapula and other over inferior angle of scapula, patient lying on unaffected shoulder,with therapist standing infront of patient.

b) Group2 – condition replicates the treatment condition of Test group except for hand positioning (patient lying on unaffected shoulder, therapist’s one hand over affected shoulder and other over scapula), ultrasound therapy is also given after mobilization to affected shoulder joint.

c) Group3 – Will receive only ultrasound therapy to affected shoulder joint.

STUDY DURATION:

3-4 Weeks duration, single sitting : Sets of 10 repetitions of scapular mobilization will be applied with rest interval of 30 seconds between sets19,followed by ultrasound therapy for 3 minutes.

OUTCOME MEASURES:

Pain - Severity of pain will be assessed with a 100-mm visual analog scale (VAS).

Range of Motion - A universal goniometer will be used to measure active shoulder

flexion and abduction.

Scapular Position - All scapular motions will be involved if shoulder motion is limited, Scapular lateral deviation, dropping and abductionwill be measured using a bubble goniometer33.

Function - Constant Shoulder Score will be used to measure shoulder function.

STATISTICAL ANALYSIS

The Kruskal -Wallis test will be used to establish differences between groups. The Bonferroni-corrected Mann–Whitney U test will be used to establish intergroup comparisons.

RESEARCH QUESTION

Will there be any immediate effects of scapular mobilization in patients with shoulder dysfunctions?

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes , I do only scapular mobilization and ultrasound on patients with shoulder dysfunction.

7.4 Has ethical clearance been obtained from your institutions In case of 7.3.

Yes

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