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Completed

NCT Number: NCT07187102

Ultrasonographic Response to Cervical and Upper Thoracic SNAG in Medial Epicondylitis

Aim of the work :

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. 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

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Key information

Conditions

Medial Epicondylitis Arm Injuries Elbow Injuries Elbow Tendinopathy Muscular Diseases Musculoskeletal Diseases Tendinopathy Tendon Injuries Wounds and Injuries

Age range

35 year–50 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Faculty of Physical Therapy, Beni-Suef University

Banī Suwayf, Egypt

About this study

medial epicondylitis(ME) of the elbow is a condition characterized by aggravation of pain in the outer part of the elbow during active wrist flexion , and presentation of pain on direct palpation of the medial epicondyle, or proximal muscle belly . Biomechanical and sensorimotor deficits can occur and adversely impact upper extremity function .These functional deficits may interfere with occupational tasks and activities of daily living The study's results: Measuring the changes that will be produced by using therapeutic growth of the cervical and thoracic vertebrae on the pathological changes that persist in the tendons of the tens of the tibialis cruciate ligaments in detecting excess weight resulting from the disease of the middle epicondyle, such as increased blood vessels in the tendon and decreased echogenicity of the tendon, in addition to measuring the changes that occurred in the extent of pain sensation and the extent of functional performance of the shoulder and elbow joints. Patients will be directly selected jointly according to the patient's specifications for the research and written consent will be obtained from the patient after a detailed explanation of the research steps and what is required of him. The vocal function of the tendon will be evaluated, with the exception of functional pain of the successful upper extremity and the strength of the hand muscles before and after the experiment.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • 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 .

Exclusion criteria

  • • 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.

Treatment and study plan

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.

(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.

Primary outcomes

  1. Colour Ultrasonography

    Time frame: Baseline and after one month

    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

Secondary outcomes

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

    Time frame: Baseline and after one month

    30-question outcome measure provided by patients to assess upper-limb function. For those involved in sports and occupational assessments, an additional eight questions are available. The questionnaire employs a Likert scale ranging from one to five (where one indicates no difficulty and five signifies incapacity). The cumulative DASH rating runs between 0 and 100, with higher numbers reflecting bigger disability.

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

    Time frame: Baseline and after one month

    A questionnaire consisting of 20 items designed to assess pain and impairment associated with elbow conditions. It is divided into two main sections: function and pain. The pain category contains 5 items, while the function category includes 15 aspects. Within the functional section, there exist other subdivisions: Eleven items concentrate on specific activities, while four items relate to routine activities. Every item is evaluated on a scale from 0 to 10. The final ratingrelies on a 100-point scale, with impairment and pain weighted similarly. Pain and disability increase with a higher PREE total score

  3. The hydraulic hand dynamometer.

    Time frame: Baseline and after one month

    It is the most often utilized tool in research, has undergone extensive validation, and is the standard by which other tools are evaluated.

    Participants were positioned upright, either sitting with their knees and hips at a 90-degree angle and, if back support was available, in an elevated long-sitting position, or in bed. The dominant arm was positioned laterally, with the elbow extended at 90° and unsupported, while the wrist remained in neutral posture. Individuals were advised to use their main hand to force the dynamometer as strong as possible. For each device, three trials were recorded, and the one with the greatest score was maintained for review. Following the initial set of measurements, the volunteers took a 30-minute break before repeating the process with the second device.

  4. Visual analog scale

    Time frame: Baseline and after one month

    Pain intensity for the elbow was measured using a ten-centimeter straight visual analogue scale (VAS), with 0 reflecting painlessness and 10 meaning the highest discomfort ever experienced.

Sponsors and collaborators

Lead sponsor

Beni-Suef University

Other

Collaborators

  • Benha University

Registry information

Official study title

Ultrasonographic Response to Cervical and Upper Thoracic SNAG in Treatment of Chronic Medial Epicondylitis, a Randomized Controlled Trial

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Sep 22, 2025
Registry last updated
Mar 30, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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