Ultrasonographic Response to Cervical and Upper Thoracic SNAG in Medial Epicondylitis

NCT07187102 | Completed DMC

• 1 other identifier: FMBSUREC/07092025/Ahmed
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Aim of the work :

1. 1.To detect if there is any change would occur in the neovascularity and echogenicity after using cervical and upper thoracic SNAG or not in ME patients.
2. 2.To find the effect of cervical and upper thoracic SNAG on pain, function of upper extremities, grip strength in ME comparing with traditional treatment alone

Conditions

Medial Epicondylitis

Keywords

Mobilization; Medial Epicondylitis; Ultrasonography; SNAGs; PRTEE; DASH; sympathetic activity

Outcome Measures

Primary Outcomes (1)

• Colour Ultrasonography

  Change in hypervascularity and hypoechogencity measured by colour sonography ( grade 1: grade 4) include: hypo-echoic variations within the common flexor tendon, tendon sheath thickening, ruptures of varying thickness, neovascularization as seen by Doppler, and cortical damage at the medial epicondyle

  Baseline and after one month

Secondary Outcomes (4)

• The Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire

  Baseline and after one month

• A Patient-Rated Elbow Evaluation (PREE) questionnaire.

  Baseline and after one month

• The hydraulic hand dynamometer.

  Baseline and after one month

• Visual analog scale

  Baseline and after one month

Study Arms (2)

Experimental group

EXPERIMENTAL

Other: SNAG ( sustained natural apopheseal glide ); Other: (Conventional Physical Therapy)

control group

OTHER

Other: (Conventional Physical Therapy)

Interventions

SNAG ( sustained natural apopheseal glide ) OTHER

A postero-anterior glide was applied to the spinous process of the C6-7 cervical. Ten repetitions were held for 10 seconds each, followed by a 30-second rest period. The patient sat comfortably with their back resting on a straight seat and their head and neck in a relaxed neutral position. After identifying the hypomobile segment, the clinician administered a single sub-therapeutic dose of thoracic SNAG at the specified treatment level. This technique involved performing one thoracic SNAG with a cephalad glide, applied parallel to the facet joint plane, aiming towards the patient's eyes. The clinician then positioned one arm around the patient's chest, just above the designated treatment level, ensuring that the ulnar border of the mobilizing hand was placed over the thoracic spinous process of the targeted level. Over four weeks, each patient had three therapy sessions per week, with a maximum of 12 sessions total.

Experimental group

(Conventional Physical Therapy) OTHER

Conventional treatment, includes five sets of 30-second self-wrist flexor stretching; a total of 5 minutes of ultrasound therapy at a frequency of 3.3 MHz and a duty cycle of 1.2 W/cm²; five minutes of cross-friction massage focused on the most painful area; and fifteen minutes of heat application. Over four weeks, each patient had three therapy sessions per week, with a maximum of 12 sessions total.

Experimental group; control group

Eligibility Criteria

• Age: 35 Years - 50 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Age ranges from 35 to 50 years old in both sexes.
• Patients with LE that diagnosed by orthopedist.
• Pain onset is more than 3 months appear primarily with use or rest or in both, also , it appear with deep palpation of the medial epicondyle .

You may not qualify if:

• Rheumatoid Arthritis .
• Skin infection.
• History of previous elbow surgery.
• Any pathology in the shoulder joint.
• Neurologic deficit in upper extremity.
• Cervical disc prolapse and radiculopathy C5,6.
• Dislocation of elbow joint.
• Recent fractures of upper extremity.
• Arthrosis of the radiohumeral joint.
• Osteochondritis dissecans.
• Osteonecrosis.
• Plica synovialis.
• Participants receiving other treatment, in the form of physical therapy or medication, for the duration of the study that may interfere with the results of this study.

Sponsors & Collaborators

• Beni-Suef University: lead
• Benha University: collaborator

Study Sites (1)

Faculty of Physical Therapy, Beni-Suef University

Banī Suwayf, Egypt

Location

MeSH Terms

Conditions

Elbow Tendinopathy

Condition Hierarchy (Ancestors)

Tendinopathy; Muscular Diseases; Musculoskeletal Diseases; Elbow Injuries; Arm Injuries; Wounds and Injuries; Tendon Injuries

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: the participants ( patients) have been masked
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: lecturer of physical therapy for musculoskeletal disorders and its surgery , beni suef university

Model Details: one group receive SNAG plus traditional treatment second group receive traditional treatment

Study Record Dates

• First Submitted: September 15, 2025
• First Posted: September 22, 2025
• Study Start: September 8, 2025
• Primary Completion: March 25, 2026
• Study Completion: March 25, 2026
• Last Updated: March 30, 2026

Record last verified: 2025-09

Locations

EG (1)