Patients who come to Tavşanlı State Hospital's Physical Therapy and Rehabilitation Department and have been diagnosed with subacromial impingement syndrome by a physician will be included. Patients will be selected by randomization method among the patients determined by the physician to receive conservative treatment, shoulder mobilization in addition to conservative treatment, and neck mobilization treatment program in addition to these. Conventional treatments such as hot packs, TENS, ultrasound, and exercise will be given to all patients by the hospital staff. Pain intensity will be evaluated with VAS. Additionally, painful arch and pain-free joint range of motion evaluation will be made using a goniometer. The DASH questionnaire will be used to evaluate shoulder functionality. Sensory evaluation will be made with pressure pain threshold and two-point discrimination tests. Measurements will be made before the intervention and repeated after 3 weeks of intervention.
Being over 18 years of age
Diagnosed with Subacromial Impingement
Not having received any treatment for shoulder problems in the last 6 months
The pain has been continuing for 3 months
History of surgery in the shoulder, cervical and thoracic region
Having a shoulder problem such as a frozen shoulder or instability
Full-thickness rotator cuff tear
Having systemic musculoskeletal disease
Parallel
Conventional Treatment
Other interventionHot pack,TENS, ultrasound and exercises
shoulder mobilization
Other interventionIn the glenohumeral joint mobilization technique, distraction, anterior-posterior gliding, and inferior gliding movements will be applied.
neck mobilization
Other interventionBridge, lateral flexion movement combined with traction, anterior-posterior gliding with traction, and lateral gliding techniques will be applied in neck mobilization.
Pain intensity
Pain intensity will be evaluated with VAS. VAS is a valid and reliable self-report scale consisting of a 10 cm long horizontal line, with scores ranging from 0 (no pain) to 10 (worst pain imaginable). Participants are asked to report the maximum pain they experienced in the last 24 hours. A change of 1.5 points is considered a minimal clinically important difference (MCID) for the VAS.
The Arm, Shoulder and Hand Problems (DASH) Questionnaire
(DASH) questionnaire is a questionnaire that evaluates the functional level and disability of the entire upper extremity. At least 27 out of 30 questions must be answered for the inquiry to be evaluated. The query gives a value between 0-100. All questions are scored from 1 to 5. A higher score indicates greater disability.
Painful arch assessment
The patient is asked to abduct his arm as much as he can while standing or sitting. The test is positive if the patient feels pain between 60-120° of elevation. The sensitivity of the painful arc test performed in CNS patients was found to be 53% and the specificity was 80%.
Painless range of motion assessment
Painless ROM evaluation will be performed in CNS patients due to the presence of a painful arch. Pain-free ROM evaluation includes flexion and abduction movements occurring in the frontal and sagittal planes. These movements are evaluated using a universal goniometer. The patient is asked to actively create 2 movements in a standing or sitting position. While performing measurements with a goniometer, the part with pain-free ROM will be noted in degrees
Pressure-pain Threshold Assessment
Pressure pain threshold is the most commonly used method among quantitative sensory tests.Measurements will be taken from the upper trapezius, supraspinatus, and middle deltoideus muscles.
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