A randomized controlled trial will be conducted to get the expected outcomes. Patients of both gender groups with unilateral shoulder pain will be selected with age range 40-60 years from Sehat medical complex and randomly allocated into four groups (Group A, B, C and D) of two different trials (Trial I and Trial II). The sample size will be 120 patients for both trials. Musculoskeletal ultrasound, goniometry, pain pressure threshold, dynamometer and functional indices will be used to measure the tendon thickness, range of motion, pain, muscle strength and function level. The group A will get BFRT, Group B will get ESWT, group c will get the combination of both and group D will be the Control group (Routine physical therapy). In Trial II the group A will get BFRT, Group B will get Eccentric Training, Group C will get combination of both A \& B and group D will be control group. data will be collected at baseline, 4th week, 8th week and 12 week of interventions. For data analysis SPSS version 25 will be used. Repeated measures ANOVA will be applied to compare the quantitative data within and between the groups. Post-Hoc test Tukey and Bonferroni correction will be used. The level of significance will be set at 5% (P\<0.05).
unilateral shoulder pain
both gender group
two positive tests of (Neer impingement test, Hawkins-Kendy test, Empty can test),
shoulder pain history up to 3 months
referred shoulder pain
limited shoulder ROM less then 90 degree
previous shoulder surgery, intra articular injection or nerve block last 6 months.
patient with 180 mmHg blood pressure/uncontrolled BP
Parallel
Blood flow Restriction therapy
Other interventionBFRT 4 Sets of exercise with restriction cuff 30,15,15,15 with cable system pulley ESWT 10 minutes shocks of 2000 J/session
ESWT
Device10 minutes shocks of 2000 J/session
Control
Other interventionElectric heating pad (Besmed, Taiwan) 10 minutes, TENS (Comfy Stim, Taiwan Model #: EV-806) 10 minutes
Shoulder Joint Range of Motion from 0-180 degree
shoulder joint ROM will be measured by Goniometer having 360 degree or inclinometer
MSK Ultrasound for shoulder
tendon thickness in long (mm) and short axis (mm)
Shoulder Functional scale
Quick-DASH (Quick-Disability of arm shoulder and hand) functional scale, it is 11 items scale with response range 0-5 on. 0 is no disability and 100 shows severe disability. The scale have 5 response options much worse, somewhat worse, unchanged, somewhat better, much better
Shoulder Joint PAIN
NPRS 0-10 , 10 is the worse imaginable pain and 0 is no pain
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