Rajiv Gandhi University of Health Sciences s52

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE- II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1. NAME OF THE CANDIDATE RITU MISHRA AND ADDRESS D/O Mr. Rakesh Misra 111/297, HARSH NAGAR, BEHIND 80 FEET ROAD PETROL PUMP, KANPUR- 208012 U.P.2. NAME OF THE INSTITUTION THE OXFORD COLLEGE OF PHYSIOTHERAPY, No.6/9, 1ST CROSS, BEGUR ROAD, HONGASANDRA,BANGALORE-5600683. COURSE OF THE STUDY AND MASTERS IN PHYSIOTHERAPY SUBJECT (PHYSIOTHERAPY IN MUSCULOSKELETAL DISORDERS AND SPORTS)4. DATE OF THE ADMISSION 18-JUNE-2011 TO THE COURSE5. TITLE OF THE STUDY:“A STUDY TO FIND OUT THE EFFECTIVENESS OF CLAVICULAR MOBILIZATION IN IMPROVING THE SUBACROMIAL IMPINGEMENT SYNDROME” 6. BRIEF RESUME OF THE INTENDED WORK :6.1. NEED OF THE STUDY : Subacromial impingement syndrome (SAIS) of the shoulder is the most common disorder of the shoulder, accounting for 44-65% of all the complaints of shoulder pain.1Shoulder pain is second only to low back pain in occurrence, affecting approximately 16-21% of the population.2,3,4 Moreover, approximately one-fifth of all disability payments for musculoskeletal disorders are for patients with shoulder disorders.5Pain and dysfunction occurs when the shoulder is placed in positions of elevations6 with overhead activities7, 8 in impingement syndrome and is common in younger adults. (25-40 years).Subacromial impingement syndrome is also seen in the athletes and swimmers and the young individuals who usually participate in sports and also who require repetitive overhead motion.9The shoulder complex consists of humerus, scapula and clavicle, which forms glenohumeral, acromioclavicular, scapulothoracic and sternoclavicular joints which are joined by several interconnecting ligaments and layers of muscles.The subacromial space is defined by the humeral head inferiorly, the anterior edge and under surface of the anterior third of the acromion, coracoacromial ligament and acromioclavicular joint superiorly.10 This syndrome is associated with pathology of one or more of the contents of the subacromial space.6SAIS is a mechanical impingement of the rotator cuff tendons beneath the anterior-inferior portion of the acromion occurring when the shoulder is placed in the forwardly flexed and internally rotated position.11This disorder can be present from inflammation to degeneration of the bursa and rotator cuff tendons of the subacromial space.12 Typically external rotation, flexion and abduction of the shoulder are weak and painful. Night pain due to which inability to sleep on the painful shoulder are the main features.13Approximately 20° of motion occurs at the AC joint during arm abduction with 10° occurring during the last 45° of the normal range (180°) of arm elevation. At both the AC and SC joints, the clavicle posteriorly rotates approximately 45° during arm elevation. This motion is allowed by the planar configuration at the AC joint and the fibro-cartilaginous articulating disc between the sternum and the proximal clavicle. The most common three restrictions the AC joint involve limited internal and external rotation and abduction.14A functional AC joint is mandatory for normal shoulder function since clavicular rotation is essential for the abduction of this complex joint to move more than 90° of the glenohumeral joint.15But AC and SC joints being small joints, the contribution of clavicle is been ignored in the movement of shoulder joint in the previous studies, and hence my study will be focusing on the importance of the mobilization of AC and SC joints in Subacromial Impingement Syndrome.Studies show that Joint mobilization techniques in combination with therapeutic exercise should be favored over exercise alone in the patients with SAIS.16 This study will thus be intended to do the importance of clavicular mobilization in subacromial impingement syndrome.6.2. REVIEW OF LITERATURE : Prevalence:1. Van Der Windt et al (1995)1 stated that SAIS of the shoulder is the most common disorder accounting for 44-65% of all complaints of shoulder pain during a physician’s office visit.2. Pope DP et al (1997)4 stated that shoulder pain comes second only to low back pain in occurrence and affects approximately 16-21% of population.3. Masten and Arntz (1990)17 stated that more than a third of painful shoulder diagnoses are related to disorders of the rotator cuff that are often related to Shoulder impingement syndrome.AC and SC joint Mobilization:4. Gaunt BW18 has demonstrated that the direct mobilization of AC and SC joint can efficiently and effectively result in a marked immediate increase in shoulder elevation.5. Hakan et al (1998)15 said that a functional AC joint is mandatory for normal shoulder function since clavicular rotation is essential for the abduction of the shoulder to move more than 90°.Scapular stabilization exercises:6. Baskurt Z et al (2011)19 suggested that scapular stabilization exercises when given with stretching and strengthening exercises can be more effective in increasing muscle strength.7. Ashim Bakshi (2008)20 stated the importance of scapular stabilization exercises because of posterior capsular tightness in the impingement syndrome.8. Jason Brumitt (2006)21 said about the importance of the scapular stabilization exercises as scapula plays a vital role in the shoulder functions.9. Farhad O. Moola22 stated that scapular stabilization refers to a set of exercises that strengthen the shoulder girdle muscles to restore the normal scapular motion and correct dyskinesia.Stretching: 10. Baskurt Z.19 stated the importance of stretching in relieving the tightness of the muscles in the impingement shoulder syndrome.Cryotherapy:11. David Edell23 stated that ice, preferably ice massage, before and after range of motion and strength exercises and following any activity which produces pain is beneficial.Special tests: 12. Michener LA(2008)24 conducted a study stating that out of Neer impingement test, Hawkins- Kennedy test, Painful arc test, Empty can (Jobe) test, External rotation resistance test, cut point of 3 or more positive of 5 tests can confirm the diagnosis of SAIS, while less than 3 positive of 5 rules out SAIS.13. Hegedus EJ(2006)25 revealed that the pooled sensitivity and specificity for the Neer test was 79% and 53%, respectively, and for the Hawkins-Kennedy test was 79% and 59% respectively.Outcome Measures :Shoulder pain and disability index (SPADI):14. Catherine L Hill et al (2011)26 stated that SPADI has a bi-dimensional factor structure representing pain and stability, with adequate internal consistency and construct validity for the use in population studies of shoulder symptoms.15. Roach KE et al (1991)27 stated that SPADI is the only reliable and valid region-specific measure for the shoulder.Range of Motion (ROM):16. Marx RG et al (1999)28 have stated that standardized goniometric measurements of the shoulder have been shown to have a good intra rater reliability and validity.17. Mag. Kathie Musil (2006)29 stated that range of motion is limited in the patients with SAIS due to the capsular tightness.6.3. OBJECTIVES OF THE STUDY: To find out the effectiveness of clavicular mobilization in improving range of motion (ROM) and activities of daily living (ADL) in subjects with subacromial impingement syndrome (SAIS).6.4. HYPOTHESES : a). Research hypothesis :  There is a significant effect of clavicular mobilization in improving the ADL and ROM in patients with subacromial impingement syndrome. b). Null hypothesis :  There is no significant effect of clavicular mobilization in improving the ADL and ROM in patients with subacromial impingement syndrome.MATERIALS AND METHODS : 7.1. STUDY DESIGN AND SETTING:7.1.1. STUDY DESIGN : 7. Randomized Control Trial.7.1.2. SOURCE OF DATA :Subjects with Subacromial Impingement Syndrome from:  The oxford college of physiotherapy and rehabilitation center. Hospitals and clinics in and around Bangalore.7.2. METHODOLOGY :7.2.1. POPULATION :Both Males and Females who satisfy the selection criteria from the population of the study.7.2.2. SELECTION CRITERIA :1. INCLUSION CRITERIA6 : Both males and Females. Age 30-40 years. Subjects diagnosed with Subacromial impingement syndrome. Subjects who are willing to give their consent in the study. Unilateral shoulder pain of more than 1 week. Pain produced or increased during flexion and/or abduction of the symptomatic shoulder. At least 3 positive tests from the following:  Neer impingement Test. Hawkins Kennedy Test. Painful Arc Test.  Empty Can (Jobe) Test. External Rotation Resistance Test. Painful arc of movement between 60° to 120°.2. EXCLUSION CRITERIA6 : Fractured shoulder joint. History of spinal or upper limb sugeries and fractures. Subjects having recent shoulder injuries and falls on shoulder. Pregnancy Systemic illness Reproduction of shoulder symptoms during cervical movements. Post traumatic onset of symptoms. Presence of positive sulcus sign, load and shift test. Presence of clinical signs of acromioclavicular pathology. Scoliotic patients.7.2.3. SAMPLING METHOD AND SAMPLE SIZE : a) Sampling method : Random sampling method b) Sample size: 30 subjects. 15 subjects in each group.7.2.4. PROCEDURE : Subjects will be screened on the basis of the selection criteria and the informed consent will be obtained from them. Study sample consists of 15 in each group based on the random sampling. Participants will be explained about the whole procedure and if needed task will be demonstrated. The components of SPADI (Shoulder pain and disability index) are explained properly in detail before the questionnaire is asked to them.Group A: (Experimental Group)The experimental group will be treated with the following treatmemts:. Cryotherapy. Stretching. Shoulder stabilization exercises. Clavicular mobilizationClavicular Mobilization: Upward Rotation, AP Glide and Superior Glide for AC joint, AP and PA glide for SC joint will be given to improve the subacromial space. Each set consists of 3-5 repititions and 3 sets will be given for each session of the treatment. Group B: (Control Group)The control group will be treated with the following treatments:. Cryotherapy . Stretching. Shoulder stabilization exercises.Both the groups will be treated for 5 days in a week for 2 weeks.Both the groups will be assessed with Range Of Motion of the shoulder and SPADI before the first session and after the last session of the treatment.Description of Exercises:Both the groups will be treated with the following exercises:Cryotherapy (Ice therapy): Cold should be used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates the symptoms.Stretching: Stretching exercises are required to reduce the tightness in the muscles present due to the subacromial impingement syndrome. Stretching also increases the range of motion of the shoulder capsule due to the tightness. Each stretch should be held for 10 seconds and a gentle stretching should be felt by the subjects. Over-Stretching can tear muscles. Patient will be asked to breathe normally during the stretching exercises and not to hold the breathing. Following exercises should be performed 2-3 times per day, through pain free movements: Codman’s Pendulum Swings Horizontal Adduction Stretch Triceps Stretch Corner Stretch Standing Adduction Stretch Chicken stretchShoulder Stabilizing Exercises: Stabilizing the shoulder muscles is important to strengthen the shoulder. Complete range of motion stretching exercises prior to and following strengthening exercises will be given. It is common for the pain level to slightly increase during the first week of exercising. Continue the program for a minimum of 4 weeks. At the end of 4 weeks, if your psin is diminishing, continue the program for 2-3 weeks after your symptoms have ceased to ensure the condition does not return. Following execises will be given: Shoulder shrugs Shoulder Rolls Scapular Retraction Serratus Punches Diagonal shoulder exercises (D1 Flexion/Extension) (D2 Flexion/Extension)7.2.5. MATERIALS REQUIRED : Chair Couch SPADI Questionnaire Universal Goniometer7.2.6. OUTCOME MEASURES :  Shoulder pain and Disability Index (SPADI) ROM for shoulder abduction, flexion and rotation. 7.3. STATISTICAL ANALYSIS : Paired T test for Pre and Post ROM measurements. Manwhitney U test for SPADI7.4 a) Does the study require any investigation to be conducted on patients or other humans or animals?Yes, the study will be conducted on the basis of intervention. b) Has the ethical consent for the study has been obtained from the institution is case?Yes, it has been obtained from the institution and attached in appendix (I).REFERENCES :1. Van der Windt, D.A., Koes, B.W., Boeke, A.J., Deville, W., de Jong, B.A., Bouter, L.M.,.Shoulder disorders in general practice: prognostic indicators of outcome. Br. J. Gen. Pract. 1996; 46, Pp 519-523. 8. 2. Picavet HS, Schouten JS. Musculoskeletal pain in The Netherlands: prevalences, consequences and risk groups, the DMC (3)-study. Pain. 2003; 102: Pp 167–78. 3. Urwin M, Symmons D, Allison T.Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998; 57: Pp 649–655. 4. Pope DP, Croft PR, Pritchard CM, Silman AJ. Prevalence of shoulder pain in the community: the influence of case definition. Ann Rheum Dis. 1997; 56: Pp 308–312. 5. Nygren A, Berglund A, von Koch M. Neck-and-shoulder pain, an increasing problem. Strategies for using insurance material to follow trends. Scand J Rehabil Med Suppl. 1995; 32: Pp 107–112. 6. Jeremy S. Lewis, Christine Wright, Ann Green. Subacromial Impingement Syndrome: The Effect of Changing Posture on Shoulder Range of Movement. J Orthop Sport Phys Ther. February 2005; vol 35: no 2: Pp 72-87. 7. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000; 80: Pp 276–291. 8. Lukasiewicz AC, McClure P, Michener L, Pratt N, Sennett B. Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement. J Orthop Sports Phys Ther. 1999; 29: Pp 574–583. 9. Kamkar A, lrrgang JJ, Whitney SL. Nonoperative management of secondary shoulder impingement syndrome. ) Orthop Sport Phys Ther. 1993; 17: Pp 212-224. 10. Neer, C.S. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J. Bone Joint Surg. [Am] 1972; 54; Pp 41–50. 11. Neer CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder. J Bone Joint Surg Am 1977; 54: Pp 41–50. 12. Lori A. Michener, Philip W. McClure, Andrew R. Karduna. Anatomical and biomechanical mechanisms of subacromial impingement syndrome Clinical Biomechanics; 27 February 2003; 18: Pp 369–379. 13. Laura Schmitt, Lynn Snyder-Mackler. Role of Scapular Stabilizers in Etiology and Treatment of Impingement Syndrome; Journal of Orthopaedic & Sports Physical Therapy: 1999; 29 (1): Pp 31-38. 14. www.erikdalton.com/myoskeletal mobilization tour of the upper extremities, acknowledging the Acromioclavicular Joint. 15. Hakan Gurbuz, Halil unalan, Huseyin Sarisaltic, Hooman Sekhavat, Latife Candan. The Role of Acromioclavicular Arthritis in Impingement Syndromes. Yonsei Med Journal: 1998; vol 39: no 2, Pp 97-102. 16. Lori A. Michener, Matthew K. Walsworth, Evie N. Burnet. Effectiveness of Rehabilitation for Patients with Subacromial Impingement Syndrome: A Systematic Review. Journal of Hand Therapy: April-June 2004; Pp 152-164. 17. Matsen FA, Arntz CT. Subacromial impingment. In: Rockwood CA, Matsen FA, Eds. The Shoulder, Volume 2. Philadelphia, PA: WB Saunders Company; 1990: Pp 623-646. 18. Gaunt BW. AC and SC Joint Mobilization Increases Shoulder Elevation. HPRC at St. Francis Rehabilitation Center, Columbus, Georgia, USA. 19. Başkurt Z, Başkurt F, Gelecek N, Özkan MH. The effectiveness of scapular stabilization exercise in the patients with subacromial impingement syndrome. J Back Musculoskelet Rehabil. 2011; 24(3): Pp 173-179.20. Ashim Bakshi. Management of Subacromial Impingement Syndrome. April 14, 2008; Vol. 24; Issue 8; Page 42. 21. Jason Brumitt. Scapular-stabilization exercises: early-intervention prescription. Athletic Therapy Today. 9 January 2006; 11(5): Pp 15-18. 22. Farhad O. Moola. Scapular Stabilizing Muscles: Rehabilitation Protocol. University of British Columbia. 23. David Edell. Shoulder Impingement Syndrome. Houston Orthopædics & Sports Medicine. 24. Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and Diagnostic Accuracy of 5 Physical Examination tests and Combination of Tests for subacromial impingement. Br J Sports Med. February 2008; 42(2): Pp 80-92. 25. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT 3rd et al. Physical Examination Tests of the Shoulder: a systematic review with Meta-analysis of individual tests. Duke University; 2006. 26. Catherine L Hill, Susan Lester, Anne W Taylor, Michael E Shanahan, Tiffany K Gill. Factor structure and validity of the shoulder pain and disability index in a population-based study of people with shoulder symptoms. BMC Musculoskeletal Disorders; 2011; Pp 12-18.27. Roach KE, Budiman-Mak E, Songsiridej N, Lertratanakul Y. Development of a shoulder pain and disability index. Arthritis Care Res. 1991 Dec; 4(4): Pp 143-149. 28. Aimie F. Kachingwe, Beth Phillips, Eric Sletten, Scott W. Plunkett. Comparison of Manual Therapy Techniques with Therapeutic Exercise in the Treatment of Shoulder Impingement: A Randomized Controlled Pilot Clinical Trial. Journal of Manual & Manipulative Therapy. 2008. 29. Mag.Kathie Musil, Elke Andrel. The Treatment of the Subacromial Impingement Syndrome of the Shoulder either by Osteopathic Treatment or by guided Self-Training. December 2006. Pp 5-55. 30. Scapular Stabilization Exercises. Orthopaedic Specialists of North Carolina.9. Signature of the Candidate10. Remarks of the guide 11. NAME AND DESIGNATION OF THE GUIDE11.1 Guide Mr. T. SATHIYA SELVAM, MPT Associate Professor.11.2 Signature11.3 Co-Guide11.4 SignatureMR. K.G. KIRUBAKARAN, MPT 11.3 Head of the Department PROFFESOR & PRINCIPAL.11.4 Signature 12 12.1 Remarks of chairman & Principal12.2 Signature APPENDIX- ITHE OXFORD COLLEGE OF PHYSIOTHERAPY, NO 6/9, 1ST CROSS, BEGUR ROAD, HONGASANDRA, BANGALORE:560068Review Board on Ethics for Research Review Category: Exemption from Review Expedited Review Full ReviewWe hereby declare that the project titled, “A STUDY TO FIND OUT THE EFFECTIVENESS OF CLAVICULAR MOBILIZATION IN IMPROVING THE SUBACROMIAL IMPINGEMENT SYNDROME” carried out by Ms. Ritu Mishra, of 1st Year M.P.T. has been brought forward for scrutiny to the board members. Involvement of Special groups: Yes NoIf YesPregnant/ Nursing women; Children; Economically Disadvantaged; Socially Disadvantaged; Mentally ChallengedType of Study: Cross sectional survey Case Control Cohort RCTAV Needs: Yes No After analyzing the objectives, subjects involved and the methodology of the study, the following conclusions were drawn. The study does not cause any mental or physical harm to the subjects involved and there are no risks involved in the study. The performance of the study procedure will not cause any injury to the subjects. The board has evaluated and confirmed that the experimenter is trained and qualified in measuring outcome. The informed consent form ensures that the experimenter explains the procedure of the study to the subjects, their voluntary participations is confirmed and the identification of subjects is maintained confidential.More over the finding of the study will benefit similar subjects, the profession and the society. Hence the review board has no objections on the conduct of the study. Chairman Vice ChairmanDate: APPENDIX-IIETHICAL CONSENT FORM I, the undersigned, have fully understood thatMrs./Miss………………………………………………………………………………………… ……………………… is being used as a subject for undertaking the scientific study titled “A STUDY TO FIND OUT THE EFFECTIVENESS OF CLAVICULAR MOBILIZATION IN IMPROVING THE SUBACROMIAL IMPINGEMENT SYNDROME”I have been made aware of the purpose for this study. I understand that I have to cooperate with the performer for this study and a copy of the consent form has been given to me for my reference.Date:Permission of the subjectPlace:APPENDIX-IIICONSENT FORM TITLE: “A STUDY TO FIND OUT THE EFFECTIVENESS OF CLAVICULAR MOBILIZATION IN IMPROVING THE SUBACROMIAL IMPINGEMENT SYNDROME’’INVESTIGATOR: Ms. RITU MISHRA (post graduate student)Contact Detail of Principal Investigator:Chairman IEC :No. 6/9, 1st cross, Hongasandra, Begur main road, Bangalore – 68. Phone: 080-8030219842. SUBJECT’S CONSENT:I Miss/ Mrs. ……………………. agree to participate in the study. I have understood the procedure of the study as explained to me by the investigator of the study.This study will help the health care professionals to know about the effectiveness of clavicular mobilization in reducing pain and disability in patients with subacromial impingement syndrome.PURPOSE OF THE RESEARCH:I have been informed by Ms. Ritu Mishra, is going to do an Exploratory/ Survey/ Interventional study to find out the efficacy of clavicular (AC And SC joint) mobilization among the patients with subacromial impingement syndrome, to find out which exercise programme is giving better improvement to the subjects. This study will help Physiotherapist to plan the best possible treatment protocol for subjects.PROCEDURE: I have been explained that this study is conducted by using exercise therapy as intervention and the results will be obtained through ROM and SPADI questionnaire. The study involves 30 participants/subjects.RISK AND DISCOMFORT:I know there are no risks involved in participating in the study & during the test if I feel any discomfort, Ms. Ritu Mishra will take appropriate care to safeguard the welfare and best interests of the subjects. BENEFITS: This study will give the knowledge about the effectiveness of clavicular mobilization in reducing pain and disability in patients with subacromial impingement syndrome. This will give better information to the physiotherapist that one can advise, and which may help the community. This study will not provide any direct benefit to me.CONFIDENTIALITY:I understand that the medical information produced by this study will be confidential. Apart from the investigator no one will ever access to the data without my consent. If the data are used for the publication in the medical literature or for teaching purpose no name will be used. PHOTOGRAPHY CONSENT DOCUMENT:I………….. Have been explained by Ms. Ritu Mishra that photograph are required in order to illustrate various aspect of the study for the thesis and other article, and at presentation and conference. These images may also be converted to electronic format for use in multimedia presentation and document accessible to other by computer for the purpose of sharing the result of the study and for promoting this research. By giving my consent I authorize her to use any of the photographs taken in printed format, in slides for presentation, and in electronic format. If the photograph is use the face will be taped to prevent identification.REQUEST FOR MORE INFORMATION: I understand that I am encouraged to discuss any concerns regarding this study at any time. Ms. Ritu Mishra is available to answer my question to the best of her knowledge. A copy of this consent form will be given to me for my careful reading.REFUSAL OR WITHDRAWAL OF PARTICIPATION:I understand that my participation is voluntary and I may withdraw consent and discontinue participation any time without fear of prejudice. My decision whether or not to participate will not affect relationship with any agency, heath care provider, etc. I also understand that she may terminate my participation in the study after she has explained the reason for doing so.NON COMMERCIALIZATION:The data collected will not be distributed for monetary benefit.INJURY STATEMENT:I understand that in the unlikely event of injury resulting directly from the participation in the study, medical treatment would be available, but no further compensation will be provided. I understand my agreement to participate in the study and I am not waiving any of the legal rights for the same.I have explained to Mr./ Ms.…………………..the purpose of the research, the procedures required and possible risks and benefits associated, to the best of my ability.INVESTIGATOR: DATE:I confirm that Ms. Ritu Mishra has explained me the purpose of this research, the study procedure and the possible risks and benefits associated that I may experience. I have read and understood this consent form to let myself participate as a subject in this research project and I am giving the consent willfully. SUBJECT: DATE: SIGNATURE OF WITNESS:APPENDIX-IV PROFORMA1. NAME:2. AGE:3. SEX:4. OCCUPATION:5. ADDRESS:6. SERIAL NUMBER:7. DATE:8. PHONE NO.:9. RECRUITMENT DETAILS: a. Whether willing to participate? YES/NO b. Has any past medical history? (If Yes please specify) YES/NO c. Any present complaint(If Yes please specify) YES/NO d. Have you undergone any physical exercise before participation? YES/NO e. Any training or treatment before? YES/NO f. Are you undergoing physical exercise presently? YES/NOINCLUSION CRITERIA:  Is your Age between 30-40 years? (Y/N) Are you diagnosed with Subacromial impingement syndrome? (Y/N) Are you willing to give your consent in the study? (Y/N) Do you have Unilateral shoulder pain of more than 1 week? (Y/N) Is your Pain produced or increased movement of the symptomatic shoulder? (Y/N)EXCLUSION CRITERIA: Do you presently have a fractured shoulder joint? (Y/N) Do have any history of spinal or upper limb surgeries and fractures? (Y/N) Did you have any recent shoulder injuries and falls on shoulder? (Y/N) Are you Pregnant? (Y/N) Do you have shoulder pain during your neck movements? (Y/N) Do you have any spinal deformity? (Y/N)SIGNATURE OF THE SUBJECT:SIGNATURE IF WITNESS:SIGNATURE OF INVESTIGATOR:

Rajiv Gandhi University of Health Sciences s52

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