Symptoms and General Pathology

All Conditions

Musculoskeletal Diseases

Nervous System Diseases

Syndrome

Mobility Limitation

Pain

Shoulder Pain

Arthralgia

Joint Diseases

Neurologic Manifestations

This group includes 15 patients who received muscle energy technique post-surgery in addition to traditional shoulder exercise, 3 sessions/week for four weeks.

This group includes 15 patients who received mobilization in addition to traditional shoulder exercise, 3 sessions/week for four weeks.

It was applied on the shoulder flexion and the external rotation. An isometric contraction of the agonist muscle (the muscle which requires stretching) for 7 seconds with gentle muscle contraction to avoid the risk of increasing the muscle tone. This contraction started just short of the restrictive barrier. After that, the patient is asked to relax for 2-3 seconds and then the therapist stretches the contracted muscle in the opposite direction for 30 seconds. This is repeated three repetitions for each muscle.

Muscle energy technique

At the start of each session, the physical therapist examined the patient's ROM in all directions to obtain information about the end-range position and the end feel of the glenohumeral joint. Start with rhythmic mid-range mobilization with the patient in a supine position. The therapist's hands are placed close to the glenohumeral joint, and the humerus is brought into a position of maximal flexion in the sagittal plane. After 10 to 15 repetitions of intensive mobilization techniques in this end-range position, the direction of mobilization will be altered by varying the plane of elevation or by varying the degree of rotation. When alternating the direction of mobilization, other movements such as gliding techniques and distraction in that joint position were (inferior gliding, anterior gliding, and posterior gliding).

Maitland mobilization

Traditional shoulder exercises in the form of shoulder range of motion exercises, stretching exercises and, scapular stabilization.

Traditional shoulder exercise

Shaimaa MA El Sayeh, PhD

The purpose of this study was to investigate the effect of muscle energy technique versus Maitland's mobilization on shoulder pain and disability after neck dissection surgeries.

Thirty patients with shoulder pain and limited ROM post-neck dissection surgeries participated in this study. Patients were subdivided into two groups, fifteen patients in each group. Group A received the muscle energy technique and group B received Maitland's mobilization.

Data obtained from both groups regarding the Visual Analogue Scale, it has a 100-mm-long horizontal line labeled ''no pain' (with or without related facial expressions) at one extreme and ''worst pain ever' at the other. Pain intensity is determined by the length of the line as measured from the left-hand side to the point marked, The Shoulder Pain and Disability Index, it has two subscales; The pain subscale includes five questions about pain intensity. The disability subscale includes eight questions about difficulty in different orders. Each question of both pain and disability subscale was scaled in numeric ratings ranging from 0 to 10. Each score was summed up and transformed into percentages. Finally, the average score between pain and disability subscale comprised the total SPADI scores ranging from 0 (the best) to 100 (the worst), and shoulder flexion, abduction, and external ROM were statistically analyzed and compared.

Patients were subdivided into two groups, fifteen patients in each group. Group A received the muscle energy technique and group B received Maitland's mobilization.

Muscle Energy Technique Versus Maitland Mobilization on Shoulder Pain and Disability

Muscle Energy Technique Versus Maitland Mobilization on Shoulder Pain and Disability After Neck Dissection Surgeries.

A Visual Analogue Scale (VAS) is one of the pain rating scales used for the first time in 1921 by Hayes and Patterson. It is often used in epidemiology and clinical research to measure the intensity or frequency of various symptoms. It has a 100-mm-long horizontal line labeled ''no pain' (with or without related facial expressions) at one extreme and ''worst pain ever' at the other. Pain intensity is determined by the length of the line as measured from the left-hand side to the point marked.

It is a self-reported questionnaire consisting of 13 items divided in two parts: pain and disability sub-scale. The pain subscale includes five questions about pain intensity. The disability subscale includes eight questions about difficulty in different orders. Each question of both pain and disability subscale was scaled in numeric ratings ranging from 0 to 10. Each score was summed up and transformed into percentages. Finally, the average score between pain and disability subscale comprised the total SPADI scores ranging from 0 (the best) to 100 (the worst).

Through using the universal goniometer to measure the shoulder flexion, abduction and, external rotation.

Cairo University

Lecturer of Physical Therapy

Neoplasms

Head and Neck Neoplasms

Mulligan Mobilization Technique in addition to traditional physical therapy program (myofascial release, capsular stretching ex. strengthening ex. and ROM ex.) 3 sessions per week for 6 weeks. The therapist applied passive accessory glide to increase shoulder flexion, abduction, external rotation as the patient moved the arm actively in the desired direction with in a pain free range with dosage: 3 sets for 10 repetitions with 1 minute rest between sets. 3 times a week for 6 weeks.

Traditional physical therapy will include chin tucks, shoulder shrugs, shoulder circle, scapular retraction/adduction and shoulder ROM exercises, including shoulder flexion and abduction to improve glenohumeral \& scapulothoracic motion and shoulder extension \& adduction with moderate resistance and shoulder internal/external rotation with approximately two sets of 15 repetitions.

Traditional physical therapy program (myofascial release, capsular stretching ex. strengthening ex. and ROM ex.) 3 sessions per week for 6 weeks. Traditional physical therapy will include chin tucks, shoulder shrugs, shoulder circle, scapular retraction/adduction and shoulder ROM exercises, including shoulder flexion and abduction to improve glenohumeral \& scapulothoracic motion and shoulder extension \& adduction with moderate resistance and shoulder internal/external rotation with approximately two sets of 15 repetitions.

The therapist applied passive accessory glide to increase shoulder flexion, abduction, external rotation as the patient moved the arm actively in the desired direction with in a pain free range with dosage: 3 sets for 10 repetitions with 1 minute rest between sets. 3 times a week for 6 weeks.

Traditional physical therapy will include chin tucks, shoulder shrugs, shoulder circle, scapular retraction/adduction and shoulder ROM exercises, including shoulder flexion and abduction to improve glenohumeral \& scapulothoracic motion and shoulder extension \& adduction with moderate resistance and shoulder internal/external rotation with approximately two sets of 15 repetitions.

Mulligan Mobilization Technique

Myofascial release, capsular stretching ex. strengthening ex. and ROM ex. 3 sessions per week for 6 weeks. Traditional physical therapy will include chin tucks, shoulder shrugs, shoulder circle, scapular retraction/adduction and shoulder ROM exercises, including shoulder flexion and abduction to improve glenohumeral \& scapulothoracic motion and shoulder extension \& adduction with moderate resistance and shoulder internal/external rotation with approximately two sets of 15 repetitions.

Traditional Physical Therapy Program

Mona Amin, Master

Research Ethical Committee Faculty of Physical Therapy

Faculty of Physical Therapy

Seventy six patients of both genders with age 30 - 50 year old suffering from shoulder dysfunction after neck dissection surgeries will participate in this study. The participants will be selected from Damanhur Oncology Center and randomly will be distributed into two groups equal in number.

Group (A): 38 patients will receive mulligan mobilization technique in addition to traditional physical therapy program (myofascial release, capsular stretching ex. strengthening ex. and ROM ex.) 3 sessions per week for 6 weeks.

Group (B): 38 patients will receive traditional physical therapy program (myofascial release, capsular stretching ex. strengthening ex. and ROM ex.) 3 sessions per week for 6 weeks.

1. Subjects:

   Seventy six patients of both genders with age 30 - 50 year old suffering from shoulder dysfunction after neck dissection surgeries will participate in this study. The participants will be selected from Damanhur Oncology Center and randomly will be distributed into two groups equal in number.

   Group (A): 38 patients will receive mulligan mobilization technique in addition to traditional physical therapy program (myofascial release, capsular stretching ex. strengthening ex. and ROM ex.) 3 sessions per week for 6 weeks.

   Group (B): 38 patients will receive traditional physical therapy program (myofascial release, capsular stretching ex. strengthening ex. and ROM ex.) 3 sessions per week for 6 weeks.
2. Equipment:

Therapeutic equipment:

* Mulligan Mobilization Technique: the therapist applied passive accessory glide to increase shoulder flexion, abduction, external rotation as the patient moved the arm actively in the desired direction with in a pain free range with dosage: 3 sets for 10 repetitions with 1 minute rest between sets. 3 times a week for 6 weeks.
* Traditional physical therapy program: (myofascial release, capsular stretching ex. Strengthening ex. And ROM ex.) 3 sessions per week for 6 weeks. Traditional physical therapy will include chin tucks, shoulder shrugs, shoulder circle, scapular retraction/adduction and shoulder ROM exercises, including shoulder flexion and abduction to improve glenohumeral \& scapulothoracic motion and shoulder extension \& adduction with moderate resistance and shoulder internal/external rotation with approximately two sets of 15 repetitions.

Measurement equipment:

* Digital Goniometer: It's a device which measures joint ranges, together with velocity and acceleration variables, with a high level of precision and at a relatively low-cost, practically similar to current analogical tools. The digital goniometer is a device specifically designed for the measurement of angles of movement of the human body with a resolution of 1°, representing an ideal substitute to traditional goniometers, which are usually based on a scale of 5° increments. For measuring the selected shoulder movements (flexion, abduction, external rotation), the position used as the supine position, in which the participant was asked to lie down restfully on his back.
* Shoulder Pain and Disability Index: The SPADI is a self-reported questionnaire consisting of 13 items divided in two parts: pain and disability subscale. The pain subscale includes five questions about pain intensity at its worst and when lying on the involved side, reaching for something on a high shelf, touching the back of the neck and pushing with the involved arm. The disability subscale includes eight questions about difficulty when washing the hair, washing the back, putting on an undershirt or jumper, putting on a shirt that buttons down the front, putting on your pants, placing an object on a high shelf, carrying an object of 10 pounds (4.5 kilograms) and removing something from your back pocket. Each question of both pain and disability subscale was scaled in 11-numeric ratings ranging from 0 to 10. Each score was summed and transformed to percentage. Finally, the average score between pain and disability subscale comprised the total SPADI scores ranging from 0 (the best) to 100 (the worst).

Mulligan Technique on Shoulder Dysfunction

Effect of Mulligan Technique on Shoulder Dysfunction Post Neck Dissection Surgeries

Digital Goniometer is a device which measures joint ranges, together with velocity and acceleration variables, with a high level of precision and at a relatively low-cost, practically similar to current analogical tools. The digital goniometer is a device specifically designed for the measurement of angles of movement of the human body with a resolution of 1°, representing an ideal substitute to traditional goniometers, which are usually based on a scale of 5° increments. For measuring the selected shoulder movements (flexion, abduction, external rotation), the position used as the supine position, in which the participant was asked to lie down restfully on his back.

The SPADI is a self-reported questionnaire consisting of 13 items divided in two parts: pain and disability subscale. The pain subscale includes five questions about pain intensity at its worst and when lying on the involved side, reaching for something on a high shelf, touching the back of the neck and pushing with the involved arm. The disability subscale includes eight questions about difficulty when washing the hair, washing the back, putting on an undershirt or jumper, putting on a shirt that buttons down the front, putting on your pants, placing an object on a high shelf, carrying an object of 10 pounds (4.5 kilograms) and removing something from your back pocket. Each question of both pain and disability subscale was scaled in 11-numeric ratings ranging from 0 to 10. Each score was summed and transformed to percentage. Finally, the average score between pain and disability subscale comprised the total SPADI scores ranging from 0 (the best) to 100 (the worst).

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Muscle Energy Technique Versus Maitland Mobilization on Shoulder Pain and Disability	NCT06010381	Neck Cancer Mobility Limita... Pain Syndrome Shoulder Pain Surgery	Muscle energy t... Maitland mobili... Traditional sho...	25 Years - 70 Years	Cairo University
Mulligan Technique on Shoulder Dysfunction	NCT05915572	Head and Neck C...	Mulligan Mobili... Traditional Phy...	30 Years - 50 Years	Cairo University

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