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Pragmatic Posterior Capsular Stretch Versus Sleeper Stretch in Subject With Shoulder Pathologies

Primary Purpose

Shoulder Impingement, Shoulder Arthritis, Shoulder Injuries

Status
Unknown status
Phase
Not Applicable
Locations
Pakistan
Study Type
Interventional
Intervention
Pragmatic Set of intervention and posterior capsular stretch
Pragmatic Set of intervention and Sleeper Stretch
Sponsored by
Helping Hand Institute of Rehabilitation Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Shoulder Impingement focused on measuring sleeper stretch, shoulder pathologies, Posterior capsular tightness, shoulder range of motion, pragmatic posterior capsular stretch, pragmatic intervention

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

-Limitation in range of motion abduction or internal rotation or external rotation or reaching up behind the back or reaching behind down the neck are only one of the limitations in comparison with the unaffected joint.

A patient who fall in grade 1 and grade 2 of the shoulder mobility test of functional movement screening.

Exclusion Criteria:

-Patient with shoulder ligamentous instability Functional movement Screening score 0 or 3. Cancerous growth around the shoulder girdle Rheumatoid arthritis patients The patient has a recent fracture of less than the 6th-week duration or shoulder dislocation.

Long term use of steroids Cervical joint dysfunction, radicular pain. Systemic diseases.

Sites / Locations

  • HHIRSTRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

GROUP A

GROUP B

Arm Description

Pragmatic Set of intervention and posterior capsular stretch

Pragmatic Set of intervention and Sleeper Stretch

Outcomes

Primary Outcome Measures

shoulder range of motion
shoulder range of motion will be measured in degrees by using digital inclinometer
shoulder pain
shoulder pain will be measured by numeric pain rating scale

Secondary Outcome Measures

Shoulder related quality of life
quality of life will be measured by using HHIRS quality of life questionnaire
Shoulder disability
Shoulder disability will be measured by Shoulder Pain And Disability Index Urdu (SPADI-U)
satisfaction level of patient
satisfaction level of patient will be measured by Questionnaire for satisfaction level of patient receving this intervention

Full Information

First Posted
September 29, 2021
Last Updated
September 29, 2021
Sponsor
Helping Hand Institute of Rehabilitation Sciences
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1. Study Identification

Unique Protocol Identification Number
NCT05064033
Brief Title
Pragmatic Posterior Capsular Stretch Versus Sleeper Stretch in Subject With Shoulder Pathologies
Official Title
Pragmatic Posterior Capsular Stretch Versus Sleeper Stretch in Subject With Shoulder Pathologies: a Randomized Control Trial (RCT)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Unknown status
Study Start Date
May 24, 2021 (Actual)
Primary Completion Date
December 24, 2021 (Anticipated)
Study Completion Date
March 24, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Helping Hand Institute of Rehabilitation Sciences

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The glenohumeral joint is an articulation between the glenoid of the scapula and the head of the humerus that is enclosed by a synovial capsule divided into three main components: anterior, posterior, and the axillary pouch. Symptoms of posterior capsule tightness are linked to altered shoulder biomechanics and impairments which includes glenohumeral internal rotation deficit, incomplete glenohumeral adduction, impaired inferior glenohumeral ligament (IGHL) function, and increased risk of impingement symptoms. In the literature the two techniques available for stretching posterior capsule are pragmatic posterior capsular stretch and sleeper stretch. Pragmatic posterior capsular stretch is therapist administered and sleeper stretch is patient-administered. The work on the pragmatic posterior capsular stretch is more specified and rational to mark the tightness in the posterior capsule.
Detailed Description
Shoulder pathologies have been reported as the third most popular musculoskeletal problem after knee and back problems and are relatively common in 1 in 3 individuals in their lifetime and reported shoulder pain once a year. The Popular shoulder complex disorders are tendinopathies, rotator cuff lesions, serratus anterior paralysis, subacromial impingement syndrome, and adhesive capsulitis among these 44-65 percent shoulder disorders, contributing to subacromial impingement syndrome. Posterior capsular tightness is more common in overhead activities which increases the force on shoulder joint which may cause posterior capsular tightness along with rotator cuff tear. The active stabilizer for shoulder is rotator cuff which avoid the superior translation of humeral head during shoulder abduction due to weakness of rotator cuff along with posterior inferior capsular tightness the humeral head may translate superiorly and ultimately lead to SAIS in which rotator cuff tendon long head of biceps and subacromial bursa impinge between acromion superiorly and greater tubercle of humeral head inferiorly. Tears of the subscapularis tendon are mostly the result of a degenerative process, but less commonly, traumatic injury can result in acute subscapularis tearing. The most common mechanisms of subscapularis injury are hyperextension and external rotation of the shoulder.6 The infraspinatus (ISP) muscle, one of the rotator cuff muscles. Pain in the infraspinatus is most likely caused by repetitive motion involving the shoulder. Swimmers, tennis players, painters, and carpenters get it more frequently. It also becomes more likely as you get older. The serratus anterior play an important role in prevention of shoulder impingement by lifting the acromion process in overhead activities. The most common pathologies of serratus anterior is serratus anterior dysfunction which may cause scapula winging.8 In GHIRD glenohumeral internal rotation deficit there is 18 to 20 degree of limitation along with glenohumeral horizontal adduction and incomplete humeral rotation can lead to posterior capsular tightness. Therefore, posterior capsular stretch is more effective intervention for posterior capsular tightness.AC joint is responsible for shoulder disability and pain in inactive patient and athletic activities including skiing, cycling and mostly in contact sports which contribute 9 percent approximately of AC joint damage with shoulder injuries. Impairment of AC joint effects range of motion, pain and weakness along with poor posture and these leads to restriction in overhead activities. The most frequent causes are posterior capsular tightness and rotator cuff tear involve overhead movements such as swimming and volleyball and basketball, which have high-velocity pressures on the joint shoulder. In non-operative management of subacromial impingement, anti-inflammatory mediction,subacromial injection of steriods, ultrasound, lifestyle changes, and physical therapy management is normally given. Physical therapy is used to reduce the pain and enhance the functioning of the SIS. Patients should attempt to discontinue overhead movements unless symptoms diminish. A pragmatic posterior capsular stretch (PPCS) is designed to stretch the posterior capsule when it is in torsion.Pragmatic Posterior capsular stretch can effectively improve the functional movements and shoulder ROM of healthy young adults.16 Another popular stretch is the "sleeper stretch". There is a significant increase in posterior shoulder flexibility by sleeper stretch.Scapular movement is restricted while performing the sleeper stretch and accomplished by lying on the side to be stretched, elevating the humerus to 90° on the support surface, then passively internally rotating the shoulder with the opposite arm.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Shoulder Impingement, Shoulder Arthritis, Shoulder Injuries, Shoulder Capsulitis, Shoulder Bursitis, Shoulder Pain Chronic
Keywords
sleeper stretch, shoulder pathologies, Posterior capsular tightness, shoulder range of motion, pragmatic posterior capsular stretch, pragmatic intervention

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Randomized control trial(double-blind)
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
GROUP A
Arm Type
Experimental
Arm Description
Pragmatic Set of intervention and posterior capsular stretch
Arm Title
GROUP B
Arm Type
Active Comparator
Arm Description
Pragmatic Set of intervention and Sleeper Stretch
Intervention Type
Other
Intervention Name(s)
Pragmatic Set of intervention and posterior capsular stretch
Intervention Description
Group 1 will receive a pragmatic set of interventions, including Serratus Anterior Stretch,Rotator Cuff Facilitation,Acromilcalavicular joint Mobilization,Stretch of Pectoralis Major and Minor,Thoracic Manipulation and posterior capsular stretch.
Intervention Type
Other
Intervention Name(s)
Pragmatic Set of intervention and Sleeper Stretch
Intervention Description
Group 2 will receive a pragmatic set of interventions, including Serratus Anterior Stretch, Rotator Cuff Facilitation, Acromilcalavicular joint Mobilization, Stretch of Pectoralis Major and Minor, Thoracic Manipulation and sleeper stretch.
Primary Outcome Measure Information:
Title
shoulder range of motion
Description
shoulder range of motion will be measured in degrees by using digital inclinometer
Time Frame
6 weeks
Title
shoulder pain
Description
shoulder pain will be measured by numeric pain rating scale
Time Frame
6 weeks
Secondary Outcome Measure Information:
Title
Shoulder related quality of life
Description
quality of life will be measured by using HHIRS quality of life questionnaire
Time Frame
6 weeks
Title
Shoulder disability
Description
Shoulder disability will be measured by Shoulder Pain And Disability Index Urdu (SPADI-U)
Time Frame
6 weeks
Title
satisfaction level of patient
Description
satisfaction level of patient will be measured by Questionnaire for satisfaction level of patient receving this intervention
Time Frame
6 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: -Limitation in range of motion abduction or internal rotation or external rotation or reaching up behind the back or reaching behind down the neck are only one of the limitations in comparison with the unaffected joint. A patient who fall in grade 1 and grade 2 of the shoulder mobility test of functional movement screening. Exclusion Criteria: -Patient with shoulder ligamentous instability Functional movement Screening score 0 or 3. Cancerous growth around the shoulder girdle Rheumatoid arthritis patients The patient has a recent fracture of less than the 6th-week duration or shoulder dislocation. Long term use of steroids Cervical joint dysfunction, radicular pain. Systemic diseases.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
keramat ullah karamat, Ph.D.*
Phone
+923330927670
Email
karamatjee@yahoo.com
First Name & Middle Initial & Last Name or Official Title & Degree
Abdul Haseeb Bhutta, M.Phil
Phone
+923479470947
Email
abdul.haseeb@hhirs.edu.pk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
keramat ullah karamat, Ph.D.*
Organizational Affiliation
HHIRST
Official's Role
Principal Investigator
Facility Information:
Facility Name
HHIRST
City
Mansehra
State/Province
Khyber Pakhtunkhwa
ZIP/Postal Code
213000
Country
Pakistan
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
keramat ullah keramat, Ph.D*
Phone
+923330927670
Email
karamatjee@yahoo.com
First Name & Middle Initial & Last Name & Degree
Abdul Haseeb Bhutta, M.phil
Phone
+923479470947
Email
abdul.haseeb@hhirs.edu.pk

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
As per the decision of the research ethics committee.
Citations:
PubMed Identifier
12763431
Citation
Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon). 2003 Jun;18(5):369-79. doi: 10.1016/s0268-0033(03)00047-0.
Results Reference
background
PubMed Identifier
22802986
Citation
Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia). 2012 May 9;4(2):e18. doi: 10.4081/or.2012.e18. Epub 2012 May 31.
Results Reference
background
PubMed Identifier
26537804
Citation
Cools AM, Johansson FR, Borms D, Maenhout A. Prevention of shoulder injuries in overhead athletes: a science-based approach. Braz J Phys Ther. 2015 Sep-Oct;19(5):331-9. doi: 10.1590/bjpt-rbf.2014.0109. Epub 2015 Sep 1.
Results Reference
background
PubMed Identifier
16148361
Citation
Lyons RP, Green A. Subscapularis tendon tears. J Am Acad Orthop Surg. 2005 Sep;13(5):353-63. doi: 10.5435/00124635-200509000-00009.
Results Reference
background
PubMed Identifier
29845083
Citation
Johnson JE, Fullmer JA, Nielsen CM, Johnson JK, Moorman CT 3rd. Glenohumeral Internal Rotation Deficit and Injuries: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2018 May 22;6(5):2325967118773322. doi: 10.1177/2325967118773322. eCollection 2018 May.
Results Reference
background
PubMed Identifier
33062302
Citation
Keramat KU, Naveed Babur M. Pragmatic posterior capsular stretch and its effects on shoulder joint range of motion. BMJ Open Sport Exerc Med. 2020 Sep 9;6(1):e000805. doi: 10.1136/bmjsem-2020-000805. eCollection 2020.
Results Reference
background
PubMed Identifier
18668168
Citation
Laudner KG, Sipes RC, Wilson JT. The acute effects of sleeper stretches on shoulder range of motion. J Athl Train. 2008 Jul-Aug;43(4):359-63. doi: 10.4085/1062-6050-43.4.359.
Results Reference
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Pragmatic Posterior Capsular Stretch Versus Sleeper Stretch in Subject With Shoulder Pathologies

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