COMPARISON OF ROTATOR CUFF STRENGTHENING

EXERCISES VERSUS FOREARM STRENGTHENING

EXERCISES IN PATIENTS WITH ACUTE TENNIS
ELBOW

STUDENT : Ms. VINISHATH. T

REGISTER NUMBER : RA1921001010048

GUIDE : Mr. J. AYYAPPAN, M.P.T., PGDFN., PGDET,

ASSOCIATE PROFESSOR

In partial fulfilment of the requirement for the Degree of

BACHELOR OF PHYSIOTHERAPY
JUNE-2023
A Project submitted to
SRM COLLEGE OF PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
SRM Nagar, Kattankulathur,
Chengalpattu District – 603203,
Tamilnadu, India
COMPARISON OF ROTATOR CUFF STRENGTHENING
EXERCISES VERSUS FOREARM STRENGTHENING
EXERCISES IN PATIENTS WITH ACUTE TENNIS
ELBOW
INTERNAL EXAMINER

Name _________________________

Signature with date _________________________

EXTERNAL EXAMINER

Name _________________________

Signature with date _________________________

In partial fulfilment of the requirement for the Degree of

BACHELOR OF PHYSIOTHERAPY
JUNE-2023
A Project submitted to
SRM COLLEGE OF PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
SRM Nagar, Kattankulathur,
Chengalpattu District – 603203,
Tamilnadu, India
 SRM COLLEGE OF PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
SRM Nagar, Kattankulathur - 603 203
Chengalpattu (DT), Tamilnadu, India.
044 – 2745672 9 / www.srmist.edu.in

CERTIFICATE
This is to certify that Ms. VINISHATH. T, REGISTER NO. RA1921001010048

has satisfactorily completed her project on the topic COMPARISON OF

ROTATOR CUFF STRENGTHENING EXERCISES VERSUS

FOREARM STRENGTHENING EXERCISES IN PATIENTS

WITH ACUTE TENNIS ELBOW. This project is submitted towards partial

fulfillment of BACHELOR OF PHYSIOTHERAPY Degree Examination,

JUNE-2023

OFFICIAL SEAL WITH DATE DEAN

 SRM COLLEGE OF PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
SRM Nagar, Kattankulathur - 603 203,
Chengalpattu (Dt), Tamilnadu, India.
044 – 27456729 / www.srmist.edu.in

DECLARATION BY THE STUDENT

I hereby declare that this project entitled “COMPARISON OF ROTATOR

CUFF STRENGTHENING EXERCISES VERSUS FOREARM
STRENGTHENING EXERCISES IN PATIENTS WITH ACUTE
TENNIS ELBOW” is a bonafide and genuine research work carried out by me
under the guidance of Mr. J. AYYAPPAN, M.P.T, PGDFN, PGDET,
ASSOCIATE PROFESSOR.

SIGNATURE OF THE STUDENT

CERTIFICATE BY THE GUIDE

This is to certify that the project entitled “COMPARISON OF ROTATOR

CUFF STRENGTHENING EXERCISES VERSUS FOREARM

STRENGTHENING EXERCISES IN PATIENTS WITH ACUTE
TENNIS ELBOW” is a bonafide research work done by Ms. VINISHATH. T,
RA1921001010048 towards partial fulfillment of the requirement for the Degree
BACHELOR OF PHYSIOTHERAPY.

DATE: SIGNATURE OF THE GUIDE

PLACE:

ACKNOWLEDGEMENT
 First and foremost, I would like to thank the almighty, who showered his
blessings in all walks of my life.

I submit my heartfelt thanks to Prof. T. S. VEERAGOUDHAMAN, M.P.T.,

M.S.W., DEAN I/c for the valuable advice and guidance towards this work.

I would like to thank Mr. T. N. SURESH, M.P.T., VICE PRINCIPAL for

helping me with my dissertation work.

I am highly indebted to my guide and my coordinator Mr. J. AYYAPPAN,

M.P.T., PGDFN, PGDET, ASSOCIATE PROFESSOR, who took his real personal
interest in providing me proper guidance, encouragement, and support at all levels.

I thank all my Assistant Professors who with all patience gave me helping
hands whenever I needed.

My grateful thanks to all my subject’s faculties, who contributed their time

and energy in this project.

My entire effort stands credited at this moment only because of MY

PARENTS, who whole heartedly stood beside me always in each step of my career.

Last but not least, I would like to thank MY FRIENDS for their valuable
suggestions and support in the completion of my project.

I DEDICATE THIS PROJECT TO MY PARENTS AND MY FRIENDS.

ABSTRACT
BACKGROUND: Tennis Elbow or Lateral epicondylitis is a condition with the
histopathologic features of tendinosis, which involves the common wrist Extensor
origin, particularly the origin of Extensor carpi radialis. Tennis Elbow is a common
condition seen in general clinics and prevalence reported that adults affect 1% to 3%
per each year. This condition is primarily a degenerative overuse process of the
Extensor Carpi radialis brevis and other wrist Extensors such as Extensor Carpi
radialis longus, Extensor digitorum, Extensor digit minima and Extensor ulnar is can
also involve. Any activity involving excessive and repetitive use of these muscle may
cause the tendinitis. Smoking and obesity have been identified as significant risk
factors. Functional impingement of the shoulder due to altered joint mechanism and
muscle imbalance can impair the stabilization of the shoulder resulting in over
compensation of the Extensor of the wrist. Changes in the shoulder may lead to
altered and compensatory changes in the forearm and hand which may overload the
muscles of the forearm during repetitive movements, thus causing symptoms of
Lateral epicondylitis. To date, the studies related to role of rotator cuff muscle
strength in tennis elbow is unclear. OBJECTIVE: To analyze the efficacy of rotator
cuff strengthening exercise and forearm muscles strengthening exercise in patients
with acute tennis elbow. METHODS: Experimental study,30 sample size with
positive cozen test, age group between 30 to 45 years of both female and male were
chosen and put into two groups.15 patients in group A received rotator cuff
strengthening exercises and group B received in a forearm muscle strengthening
exercises. OUTCOMEMEASURES: Numerical pain rating scale (NPRS), ROM,
Toxophore elbow score. RESULTS: The statistical analysis shows that there is a
significant improvement between group A and group B.The comparison of group A
and group B result is higher improvement of group A.CONCLUSION:The results
suggests that there is a superlative effect of rotator cuff muscle strengthening exercise
along with ultrasound therapy in patients with acute TE condition than forearm
muscle strengthening exercises with ultrasound.

KEY WORDS: Tennis elbow, Rotator cuff strengthening exercises with dumbbells,
Forearm strengthening exercises with dumbells, ultrasound.

S.NO CONTENTS PAGE NO.

1. INTRODUCTION 1

2. REVIEW OF LITERATURE 4

3. METHODOLOGY 6

4. DATA ANALYSIS 14

5. RESULT 37

6. DISCUSSION 41

7. CONCLUSION 43

8. LIMITATIONS AND RECOMMENDATIONS 44

9. REFERENCES 45

10. ANNEXURES 48

INDEX

INTRODUCTION
 Tennis elbow, commonly referred to as lateral epicondylalgia (LE), is a
painful, incapacitating musculoskeletal ailment that affects 1-3% of the population.
The condition has a significant impact on society and presents challenges for medical
professionals. There are several symptoms of it, including discomfort around the
lateral epicondyle of the humerus, pain during gripping activities, and pain during
resistance to wrist, middle finger, or both dorsiflexion’s.

LE is assumed to be brought on by overusing and overstressing the forearm's

wrist extensors. It has frequently been discovered to be linked to those who perform
repeated tasks at work or in their daily lives. The dominant hand is most typically
afflicted, and people between the ages of 35 and 64 are frequently affected.

Extensor digitorum, extensor carpi ulnar is, and carpi radialis longus may also
be involved. Extensor carpi radialis brevis (ECRB) origin is the tendon that is most
frequently affected. Degenerative or unsuccessful tendon repair is characterized by
the appearance of fibroblastic, vascular, and disordered collagen responses.1

The rotator cuff comprises four muscles - subscapularis, teres minor,

supraspinatus, and infraspinatus - that attach from the scapula to the humerus and
form a musculotendinous cuff around the glenohumeral joint. This cuff supports the
joint by holding the humeral head against the glenoid. The tendons of the rotator cuff
muscles are fused with the joint capsule, creating a collar that covers the posterior,
superior, and anterior parts of the joint while leaving the inferior part exposed.2

The majority of shoulder luxation’s involve inferior movement of the humerus

through the exposed joint, hence this construction is crucial. When the arm moves, the
rotator muscles contract, preventing the humeral head from slipping while
maintaining stability and the full range of motion.2

There is dispute about the appropriate exercise type and dosage

recommendations, despite the fact that rotator cuff strengthening activities are
frequently suggested in shoulder rehabilitation programmers. Typically, the main
goals of shoulder rehabilitation are to improve glenohumeral kinematics and rotator
cuff strength. There are several exercises, but the backing for many of them varies
greatly.3

Dumbbells are used in this research to strengthen the rotator muscles. The
process includes an explanation of the protocols.

The forearm is the component of the upper limb situated between the elbow
and the wrist. The lateral-located radius and ulna make up the skeletal framework of
the bone. (medially). The muscles of the forearm play a crucial role in the movement
and control of the hand, wrist, and fingers. There are 20 muscles in the forearm,
which are separated into two groups based on their actions on the joints: Anterior
(flexor) muscles: These muscles are located on the front (or anterior) of the forearm
and are responsible for flexing the wrist, fingers, and thumb. Some of the important
anterior muscles include the flexor carpi radialis, flexor carpi ulnar is, and the flexor
digitorum superficialis. Posterior (extensor) muscles: These muscles are on the back
(or posterior) of the forearm and helps in extending the wrist, fingers, and thumb.
Some of the important posterior muscles include the extensor carpi radialis longus,
extensor carpi radialis brevis, and the extensor digitorum. These muscles work in
coordination to perform a wide range of activities, from simple actions such as
gripping and lifting objects to complex movements such as playing a musical
instrument or typing on a keyboard. They also help in fine motor activities that
require precise control of the hand, such as writing or using tools. The forearm
muscles are critical for the movement and control of the hand, wrist, and fingers, and
they allow for intricate motions that are essential for fine motor activities.

The wrist muscles are divided into two primary compartments: the anterior
flexor compartment and the posterior extensor compartment. The layers of the face
define the borders of these divisions of the forearm. The wrist contains deep tissue
that surrounds the muscles connecting to the ulna and radius. Compartments are
created by the interosseous membrane between the radius and ulna, and the
intermuscular septum that stems from the anterior region of the radius and merges
with the deep fascia of the forearm. The forearm muscles, also known as the
antebrachium, are responsible for managing the movement of the elbow, forearm,
wrist, and fingers. These muscles are categorized into two groups: internal and
external. The inherent muscles of the radius and ulna allow for pronation and
supination, respectively.

Use weights between 5 and 10 pounds at first. Increase the weight gradually as
you get stronger. Throughout the entire exercise, maintain a firm grip on the
dumbbells. The procedure outlines the forearm muscle building regimen.

The purpose of this research is to contrast forearm muscle strengthening

exercises and rotator cuff strengthening exercises for acute tennis elbow patients.

AIM OF THE STUDY

 To analyze the efficacy of rotator cuff strengthening exercise and forearm
muscles strengthening exercise in patients with acute tennis elbow.

NEED OF THE STUDY

The purpose of the study is to compare the rotator cuff strengthening exercise
and forearm muscle strengthening exercise in acute tennis elbow patients. Previous
studies have identified the effectiveness of rotator cuff strengthening exercise and
forearm muscle strengthening exercise but have not compared yet.

REVIEW OF LITERATURE
1. SmitaMaruvada; Antonio Madrasa-Ibarra; Matthew Varicella, et al.
(2022) explains the rotator cuff muscles' anatomical make-up and therapeutic
importance.

2. Pataskala M., Sharmila B., Bhatt H.J., D’Onofrio R., et al. (2020) The
study's findings demonstrated that eccentric wrist extensor training combined
with static stretching had less of an impact on grip strength and pain in
patients with lateral epicondylitis than eccentric wrist extensor training
combined with supinator strengthening.
3. Swapnil Ramteke, Surotama, et al. (2020) The current study's findings
suggest that a rotational cuff strengthening program is very successful at
easing pain and boosting functional activity.
4. Kun-Long Ma, Hai-QiangWang et al. (2020) According to reports, people
with lateral epicondylitis who are between the ages of 35 and 55 frequently
feel uncomfortable and incapable. Most instances take between 12 and 18
months to resolve on their own. However, if the symptoms are persistent and
unresponsive, interventional treatment may be necessary. Nonoperative care
remains the foundation and focal point for treating lateral epicondylitis. Most
instances can be effectively treated with a combination of nonoperative
procedures, with a success rate of up to 90%.
5. Ju-Hyun Lee, Tae-ho Kim, Kyu-bong Lim, et al. (2018)Tennis elbow-
related functional impairments and lateral epicondylitis discomfort can both be
effectively treated with exercises for wrist eccentric control and shoulder
stability.
6. BestamiYalvaç, Neogenesis, DuyguGelerKülcü, Ozan Volkan Yurdakul,
et al (2018) found that extracorporeal shock wave therapy is equally effective
as ultrasound for treating Lateral Epicondylitis in terms of reducing pain and
improving grip strength, functional status, and quality of life. It is not,
however, more efficient than ultrasonography. Extracorporeal shock wave
therapy should only be used as a fallback treatment choice for people who lack
the time or have medical conditions that prevent using ultrasound because of
its shorter sessions and application time.
7. Meenakshi Sharm, Charu Eupen, Jaganath Kamath, et al. (2015) came to
the conclusion that group 2's pain-free grip strength significantly improved
with rotator cuff training while group 1's did not. Therefore, even though it
might not have an effect on the pain and the functional loss, Rotator cuff
strengthening may help people with Lateral epicondylitis achieve Pain-
FreeGripStrength.
8. D Stasinopoulos, K Stasinopoulos, M I Johnson, et al. (2015) Exercise
programs are commonly used to treat Lateral Elbow Tendinopathy, but more
research is needed to determine their effectiveness and the mechanisms of
action of each of its component parts.
9. Roger Menta, j Kevin D'Angelo, Jocelyn Cox, et al. (2015) Conclusion: It is
unclear whether wrist extensors would profit more from strengthening or
 stretching when treating chronic lateral epicondylitis. According to the
information at hand, continuing with regular physical activity is still
recommended for hand discomfort of varying duration rather than adding in
supervised progressive strength training.
10. Christoph Weber, et al. (2015) found that treatment differences were less
significant than those between treatment and control groups. Gains in the
control group outpaced those in the therapy group by 50–66%. Only the
treatment groups with a blend of therapy-specific and non-therapy-specific
traits met the standards for clinical applicability time and time again.

11. Lee E. Rosenzweig, Joshua S. Dines, Tal et al. (2014) recommended that the
treatment should focus on proximal muscle strengthening, eccentric wrist
extensor strengthening, and wrist extensor flexibility.
12. Frances L Cullinane, Mark G Boocock, and Trevelyan et al. (2013) showed
that the majority of reliable data strongly support the inclusion of eccentric
exercise as a component of a multimodal therapy program for excellent
efficacy in people with lateral epicondylitis.
13. Jean-Louis Crosier, Marguerite Foidart-Dessalle, France Mimantean-
Michel Crielaard, BénédicteForthomme, et al. (2007) Conclusion: The
results highlight the importance of using eccentric training that is isokinetic
ally tailored in the therapy of chronic lateral epicondylar tendinopathy.

14. Tuomo T Pinaki, Tula K Torvinen, Pretty T Sira, Heike Vanarama, et al.

(1996) The results show that progressive exercise therapy reduces pain and
improves patients' ability to function, making it a better option for treating
chronic lateral epicondylitis than ultrasound.

METHODS

STUDY DESIGN : Experimental Study

 STUDY TYPE : Pre- Post type

SAMPLING METHOD : Convenient sampling

SAMPLING DURATION : 6 weeks

SAMPLING SIZE : 30

STUDY SETTING : In and around Chengalpattu district.

INCLUSION CRITERIA

Both males and females

Age group: 30 to 45 years

Pain in the elbow region for past 3 to 4 weeks.

NPRS scale between 3-7.

Positive cozen test.

EXCLUSION CRITERIA

Patient with recent history of shoulder, elbow and cervicothoracic surgeries.

Recent history of shoulder and elbow injuries, disabilities and deformities.

Recurrent tennis elbow.

MATERIALS USED
 FIGURE 1: ULTRASOUND

FIGURE 2: DUMBELLS

PROCEDURE
 A group of 30 volunteers participated in the study to examine the impact of
various strengthening activities on the rotator cuff muscles and forearm muscles.
Based on inclusion and exclusion criteria, the participants were chosen, ensuring that
they complied with the requirements for study participation.

Group A and Group B, each with 15 participants, were formed from the 30
participants at random. Group A was given rotator cuff strengthening exercises, while
Group B was given forearm strengthening exercises.

Both groups received ultrasound treatment in continuous mode for seven

minutes, which was intended to promote healing and reduce pain. Demographic data,
such as age and gender, were collected from the participants to analyze the potential
effects of these variables on the outcomes of the study.

The dumbbell exercise 1RM (one-rep maximum) test is a common method of

assessing muscular strength. The test involves selecting a patient's 1RM weight,
which is the maximum amount of weight the patient can lift for one complete
repetition of the exercise.

During the actual test, the patient should gradually increase the weight until
they reach their maximum 1RM weight. It's important to monitor the patient closely
during the test to ensure they are using proper form and technique, and to prevent any
potential injury.

Four separate metrics the NPRS (Numeric Pain Rating Scale), ROM (Range of
Motion), MMT (Manual Muscle Testing), and OXFORD ELBOW SCORE—were
used to assess the study's main results. These parameters were assessed before and
following the six-week period, during which the participants performed a series of
exercises that were supposed to strengthen the specific muscle groups.

At the conclusion of the six-week period, the four primary outcome measures
were compared between both of the groups to evaluate the effect of the different
exercise programmers. This would provide insight into which type of exercise was
more effective for strengthening the targeted muscle groups and improving the
participants' overall condition.
 Overall, the study design aimed to test the effectiveness of different types of
strengthening exercises and their impact on the outcomes of interest. By measuring
these outcomes before and after the intervention period, the researchers could
determine whether the exercises had a significant impact on the participants' condition
and which type of exercise was more effective.

ROTATOR CUFF STRENGTHENING EXERCISE

Rotator cuff muscles are;

The subscapularis muscle plays a role in shoulder internal rotation.

The supraspinatus muscle helps with arm abduction.
The muscles infraspinatus and teres minor are responsible of the shoulder's
external rotation.

Rotator cuff muscle strengthening exercises with dumbbells:

1. Shoulder Internal and External Rotation:

MAJOR MUSCLE: Subscapularis, infraspinatus, teres minor

Lie on your side with your affected arm on top.

Hold a dumbbell in your hand and keep your elbow close to your side.

Rotate your arm inwards towards your body and then outwards away from
your body, using the dumbbell for resistance.

Aim for 30 reps, then continue the exercise program regularly for twice a

day.

2. Bent Over Horizontal Abduction:

MAJOR MUSCLE: Infraspinatus, teres minor

Lie face down on a bench or couch, with your affected arm hanging off the
edge and your palm facing the ground.
 Hold a dumbbell in your hand and lift your arm up to a 90-degree angle,
with your elbow bent.

Lower the weight back down slowly and repeat.

Aim for 30 reps, then continue the exercise program regularly for twice a

day.

3. Trapezius Strengthening:

MAJOR MUSCLE: Supraspinatus

The supraspinatus muscle is situated beneath the trapezius muscle, at the

upper posterior region of the shoulder blade. It is one of the four muscles
that comprise the rotator cuff of the shoulder. The large muscle known as
the trapezius runs from the middle of the back to the upper back and neck.
The supraspinatus muscle initiates the shoulder abduction motion and aids
in stabilizing the shoulder joint.

One dumbbell should be held in each hand as you stand with your feet
shoulder-width apart.

Lift your shoulders towards your ears for dumbbell shrugs, then slowly
bring them back down.

Hold the dumbbells in front of your body with your palms facing your
thighs for upright rows. While holding your elbows out to the side, raise the
dumbbells towards your chin and then gradually lower them back down.

Hold the dumbbells at your sides with your palms facing your thighs to
perform wide lateral raises. You raise your arms to shoulder height and
slowly lower them back to the starting position.

Aim for 30 reps of each exercise.

 Keep in mind to begin with lesser weights and raise them gradually as your
strength increases. To prevent injuries, it's crucial to keep your form correct
throughout each exercise.

The all-exercise session; 1× 2 day.

GROUP B

FOREARM STRENGTHENING EXERCISE WITH DUMBBELLS;

1.Wrist flexion and extension:

This exercise targets the muscles responsible for bending (flexion) and
extending (extension) your wrist. The patient does the exercise while sitting in a chair
with their hands propped up on pillows and weights in their injured hands. The patient
then bends their wrist upwards (flexion) and downwards (extension) while holding the
dumbbells. The patient should perform 30 repetitions of this exercise in each session,
and the recommended frequency is 1 session per day, 2 days per week.

2.Forearm supination and pronation:

This exercise targets the muscles responsible for turning your forearm. The
patient does the exercise while sitting in a chair with their hands propped up on
pillows and weights in their injured hands. While still holding the dumbbells, the
patient turns their forearm such that their palms are facing up (supination) and down
(pronation). The patient should perform 30 repetitions of this exercise in each session,
and the recommended frequency is 1 session per day, 2 days per week.

3. Rubber stress ball:

This exercise targets the muscles responsible for gripping and squeezing. The
exercise is performed by the patient while they are comfortably seated and given a
rubber stress ball to squeeze. The patient should squeeze the ball as hard as they can
and hold the squeeze for a few seconds before releasing.

The patient should perform 30 repetitions of this exercise in each session, and
the recommended frequency is 1 session per day, 2 days per week.
 GROUP A

FIGURE 3: ULTRASOUND FIGURE 4: SHOULDER INTERNAL ROTATION

FIGURE 5: SHOULDER EXTERNAL FIGURE 6: HORIZONTAL ABDUCTION

ROTATION

FIGURE 7: SHOULDER SHRUGS FIGURE 8: SHOULDER UPRIGHT

GROUP B
FIGURE 9: ULTRASOUND FIGURE 10: WRIST FLEXION

FIGURE 11: WRIST EXTENSION FIGURE 12: SUPINATION

FIGURE 13 : RUBBER STRESS BALL FIGURE 14: PRONATION

OUTCOME MEASURES
1. Oxford elbow score

2. ROM

3. MMT

4. The numerical pain rating scale (NPRS)

DATA ANALYSIS
 IBM SPSS version 20.0 software was utilized to analyze the data. The NPRS,
ROM, MMT, and OXFORD ELBOW SCORE were evaluated using a paired t-test
and an independent student's t-test.

TABLE 1
PRE AND POST TEST AND OXFORD ELBOW SCORE WITHIN

GROUP-A
NP PRE-TEST PO t- Significance
GROU RS ST TEST test
PA
N MEA S. D MEA S. D
N N

15 8.93 .703 1.80 .676 27. .000

8

OXFORD 15 54.4 2.94 17.3 2.46 29. .000

ELBOW 0
SCORE

The following table displays the mean, standard-deviation, t-test, and p value for the
NPRS and OXFORD ELBOW SCORE in connection to the pre- and post-test values
for Group-A.

Between the pre and post-test, the NPRS mean value in Group-A declined from 8.93
to 1.80. Between the pre- and post-test, the OXFORD ELBOW SCORE fell, with a
mean score falling from 54.4 to 17.3.

Between pre and post-test, the table shows a considerable decline in the NPRS,
OXFORD ELBOW SCORE value at p<0.05 level.

BAR DIAGRAM 1
PRE AND POST TEST NPRS AND OXFORD ELBOW SCORE
WITHIN GROUP-A

60

54.4

50

40

30

20
17.3

10 8.93

1.8
0
NPRS OXFORD ELBOE SCORE

PRE TEST POST TEST

TABLE 2
ROM IN PRE AND POST TEST WITHIN GROUP A
 MEAN t p
OUTCOME TEST N MEAN S. D DIFFERENCE VALUE VALUE

PRE- 15 124.33 .67

SHOULDER TEST
FLEXION -51.00 -12.30 0.000
POST 15 175.33 12.22
TEST
PRE-
SHOULDER TEST 15 31.33 6.39
EXTENSION -27.00 -12.13 0.000
POST 15
TEST 58.33 7.89
PRE- 15
SHOULDER TEST 24.66 2.43
ADDUCTION POST 15 -25.66 -20.07 0.000
TEST 50.33 5.16
PRE- 15
SHOULDER TEST 125.66 2.28
ABDUCTION -49.00 -11.98 0.000
POST 15
TEST 174.66 12.22
PRE- 15
SHOULDER TEST 33.33 7.89 -36.66
INTERNAL -18.98 0.000
POST 15
ROT
TEST 70.00 8.59
PRE- 15
SHOULDER TEST 43.00 4.22
EXTERNAL -41.00 -11.63 0.000
ROT POST 15
TEST 84.00 9.96
PRE- 15
ELBOW TEST 112.00 7.60
FLEXION -36.33 0.000
POST 15 -12.00
TEST 148.33 10.65

PRE- 15
SUPINATION TEST 39.33 .00 -38.66 -
POST 15 13.907 0.000
TEST 78.00 9.61

PRE- 15
PRONATION TEST 42.33 2.53 -35.33
POST 15 -14.075 0.000
TEST 77.66 8.42

Group-A was compared using pre- and post-test data, and the resulting mean, standard
deviation, t-test, and ROM value are presented in the table.

The Group-A mean value for shoulder flexion increased from 124.33 to 175.33 during
the pre- and post-test.
Shoulder extension ranged from 31.33 to 58.33 before and after the test.

Pre- and post-test shoulder adduction ranged from 24.66 to 50.33.

Shoulder abduction 125.66 to 174.66 between pre and posttest.

Internal shoulder rotation ranged from 33.33 to 70.00 between the pre- and post-test.

Shoulder external rotation 43.00 to 84.00 between pre and posttest.

Elbow flexion ranged from 112.00 to 148.33 before and after the test.

Supination 39.33 to 78.00 between pre and post test

Pre- and post-test pronation ranged from 42.33 to 77.66.

The table suggests that the ROM value significantly increased after the test at p>0.05
level.

BAR DIAGRAM 2

ROM IN PRE AND POST TEST WITHIN GROUP A

 77.66
PRONATION
42.33

78
SUPINATION
39.33

148.33
ELBOW FLEXTION
112

84
SHOULDER EXTERNAL ROTATION
43

70
SHOULDER INTERNAL ROTATION
33.33

174.66
SHOULSER ABDUCTION
125.66

50.33
SHOULDER ADDUCTION
24.66

58.33
SHOULDER EXTENSION
31.33

175.33
SHOULDER FLEXTION
124.33

0 20 40 60 80 100 120 140 160 180 200

POST TEST PRE TEST

TABLE 3
MMT IN PRE AND POST TEST WITHIN GROUP A
 MEAN t p
OUTCOM TEST N MEAN S. D DIFFERENCE VALU VALUE
E E
PRE-
TEST 15 2.64 .633
SHOULD POST 15
ER TEST 4.71 .46 -2.07 -16.33 0.000
FLEXION
PRE- 15
SHOULD TEST 2.73 .59
ER POST 15 -2.00 -10.24 0.000
EXTENSI TEST 4.73 .45
ON
PRE- 15
SHOULD TEST 2.26 0.7
ER POST 15 -2.2 -15.19 0.000
ADDUCTI TEST 4.46 0.63
ON
PRE- 15
SHOULD TEST 2.20 .56
ER POST 15 -2.00 -14.49 0.000
ABDUCTI TEST 4.20 .41
ON
PRE- 15
SHOULD TEST 2.13 .74 0.000
ER POST 15 -14.49
INTERNA TEST 4.13 .51 -2.00
L ROT
PRE- 15
SHOULD TEST 2.00 .65
ER POST 15 0.000
EXTERN TEST 4.33 .61 -2.33 -14.64
AL ROT
PRE- 15
ELBOW TEST 2.93 .59
FLEXION POST 15 0.000
TEST 4.93 .25 -2.00 -14.49
PRE- 15
ELBOW TEST 2.26 .59
EXTENSI -1.86 -11.29 0.000
ON POST 15
TEST 4.13 .35
PRE- 15
SUPINAT TEST 2.20 .56
ION POST 15 -1.93 -10.64 0.000
TEST 4.13 .35
PRE- 15
PRONATI TEST 2.40 .63 0.000
ON -2.33 -18.52
POST 15
TEST 4.73 .45

The presented table displays the average, variation, t-test score, and MMT p-value for
the Group-A's pre-test and post-test data.
The mean value for the Group-A has increased MMT from Between the pre- and post-
test, the shoulder flexion ranged from 2.64 to 4.71.

Pre- and post-test shoulder extension ranged from 2.73 to 4.73.

Shoulder adduction ranged from 2.26 to 4.46 before and after the test.

Pre- and post-test shoulder abduction ranged from 2.20 to 4.20 degrees.

Pre- and post-test shoulder internal rotation ranged from 2.13 to 4.13.

Pre- and post-test differences in shoulder external rotation ranged from 2.00 to 4.33.

Pre and posttest elbow flexion ranged from 2.93 to 4.93.

Pre- and post-test elbow extension ranged from 2.26 to 4.13.

Supination ranged from 2.20 to 4.13 before and after the exam.

Pre- and post-test pronation ranged from 2.40 to 4.73.

The table suggests that the MMT value significantly increased between the pre and
post-test at p >0.05 level.

BAR DIAGRAM 3
MMT IN PRE AND POST TEST WITHIN GROUP A
 4.73
PRONATION
2.4

4.13
SUPINATION
2.2

4.13
ELBOW EXTENSION
2.26

4.93
ELBOW FLEXTION
2.93

4.33
SHOULDER EXTERNAL ROTATION
2

4.13
SHOULDER INTERNAL ROTATION
2.13

4.2
SHOULSER ABDUCTION
2.2

4.46
SHOULDER ADDUCTION
2.26

4.73
SHOULDER EXTENSION
2.73

4.71
SHOULDER FLEXTION
2.64

0 1 2 3 4 5 6

POST TEST PRE TEST

TABLE 4
COMPARISON OF PRE AND POST AMONG GROUP B
 PRE-TEST P t- significanc
GROUP NPRS OST TEST test e
B
ME S. D MEA S. D
n AN N

15 9.06 0.70 4.53 0.63 21. .000

05

OXFORD 15 54.4 1.18 29.06 3.19 29. .000

ELBOW 6 50
SCORE

NPRS AND OXFORD ELBOW SCORE

The NPRS and OXFORD ELBOW SCORE mean, standard deviation, t-test, and p
value for Group-B is shown in the table above with respect to the pre- and post-test
results.

The mean NPRS score for Group-B declined from 9.06 to 4.53 during the pre- and
post-test. The OXFORD ELBOW SCORE's mean value dropped from 54.46 to 29.06
between the pre- and post-test.

Between pre- and post-test, the table shows a considerable decline in the NPRS,
OXFORD ELBOW SCORE value at p<0.05 level.

BAR DIAGRAM 4
COMPARISON OF PRE AND POST AMONG GROUP B
 NPRS AND OXFORD ELBOW SCORE
60

54.4

50

40

30 29.06

20

10 9.06

4.53

0
NPRS OXFORD ELBOE SCORE

PRE TEST POST TEST

TABLE 5
 ROM IN PRE AND POST TEST WITHIN GROUP B

OUTCOME TEST N MEAN S. D MEAN t p

DIFFERENCE VALUE VALUE
PRE-
TEST 15 118.66 11.72
SHOULDER POST 15
FLEXION TEST 170.66 3.71 -52.00 -15.74 0.000
PRE- 15
SHOULDER TEST 31.00 7.12
EXTENSION POST 15 -22.66 -13.48 0.000
TEST 53.66 3.51
PRE- 15
SHOULDER TEST 26.33 5.16
ADDUCTION POST 15 -20.66 -13.48 0.000
TEST 47.00 4.14
PRE- 15
SHOULDER TEST 119.00 8.90
ABDUCTION POST 15 -51.00 -18.71 0.000
TEST 170.00 4.62
PRE- 15
SHOULDER TEST 32.00 5.27
INTERNAL POST 15 -30.33 -24.44 0.000
ROT TEST 62.33 4.16
PRE- 15
SHOULDER TEST 38.33 5.56
EXTERNAL -42.00 -22.37 0.000
POST 15
ROT
TEST 80.33 4.41
PRE- 15
ELBOW TEST 104.00 5.73
FLEXION POST 15 0.000
TEST 139.33 2.58 -35.33 -22.38
PRE- 15
SUPINATION TEST 34.00 9.29
POST 15 -35.33 -15.62 0.000
TEST 69.33 3.19
PRE- 15
PRONATION TEST 37.33 6.77 -36.00
POST 15 -21.12 0.000
TEST 73.33 3.61
The above table shows the mean, standard deviation, t-test, and ROM value for the
comparison of the pre- and post-test results within Group-B.

The Group-B participants showed an improvement in range of motion between the

pre- and post-tests, with a mean increase in shoulder flexion of 118.66 to 170.66.

Between the pre- and post-test, the shoulder extension ranged from 31.0 to 53.66.

Pre- and post-test shoulder adduction ranged from 26.33 to 47.00 degrees.
Between the pre- and post-test, the shoulder abduction ranged from 119 to 170.00.

Pre- and post-test shoulder internal rotation ranged from 32.00 to 62.33.

Pre- and post-test shoulder external rotation ranged from 38.33 to 80.33.

Elbow flexion increased from pre-test to post-test by 104.00 to 139.33.

Between the pre- and post-test, supination ranged from 34.00 to 69.33.

Between the pre- and post-test, pronation increased by 37.33 to 73.33.

The table suggests that the ROM value significantly increased after the test at p >0.05
level.

BAR DIAGRAM 5
 ROM IN PRE AND POST TEST WITHIN GROUP B

73.33
PRONATION
37.33

69.33
SUPINATION
34

139.33
ELBOW FLEXTION
104

80.33
SHOULDER EXTERNAL ROTATION
38.33

62.33
SHOULDER INTERNAL ROTATION
32

170
SHOULSER ABDUCTION
119

47
SHOULDER ADDUCTION
26.33

53.66
SHOULDER EXTENSION
31

170.66
SHOULDER FLEXTION
118.66

0 20 40 60 80 100 120 140 160 180

POST TEST PRE TEST

TABLE 6
MMT IN PRE AND POST TEST WITHIN GROUP B
 MEAN t p
OUTCOME TEST N MEAN S. D DIFFERENCE VALUE VALUE
PRE-
TEST 15 2.13 .51
SHOULDER POST 15 -2.06 -13.48
FLEXION TEST 4.20 .56 0.000
PRE- 15
SHOULDER TEST 2.20 .67 -2.13 -12.91
EXTENSION POST 15 0.000
TEST 4.33 .72
PRE- 15
SHOULDER TEST 1.53 .74 -2.20 -12.60
ADDUCTION POST 15 0.000
TEST 3.73 .79
PRE- 15
SHOULDER TEST 1.66 .72 -2.33 -14.64
ABDUCTION POST 15
TEST 4.00 .92 0.000
PRE- 15
SHOULDER TEST 1.73 .59 -2.20 -12.60
INTERNAL POST 15 0.000
ROT TEST 3.93 .59
PRE- 15
SHOULDER TEST 1.80 .67 -2.13 -12.91
EXTERNAL POST 15 0.000
ROT TEST 3.93 .79
PRE- 15
ELBOW TEST 2.26 .59 -2.20 -15.19
FLEXION POST 15 0.000
TEST 4.46 .51
PRE- 15
ELBOW TEST 1.93 .45 -2.13 -23.48
EXTENSION POST 15 0.000
TEST 4.06 .25
PRE- 15
SUPINATION TEST 1.40 .50 -2.13 -16.00
0.000
POST 15
TEST 3.53 .63
PRE- 15
PRONATION TEST 1.80 .67 -2.20 -20.57
0.000
POST 15
TEST 4.00 .75

The pre- and post-test values for Group-B are shown in the table above along with the
mean, standard deviation, t-test, and MMT p-value.

The Group-B showed a MMT Increase in mean value, from shoulder flexion 2.13 to
4.20 between the pre- and post-test.
Between the pre- and post-test, shoulder extension increased from 2.20 to 4.33.

Pre- and post-test shoulder adduction ranged from 1.53 to 3.73 degrees.

Pre- and post-test shoulder abduction ranged from 1.66 to 4.00 degrees.

Pre- and post-test shoulder internal rotation ranged from 1.73 to 3.93.

Pre and posttest shoulder external rotation ranged from 1.80 to 3.93.

Pre and posttest elbow flexion ranged from 2.26 to 4.46.

Pre- and post-test elbow extension ranged from 1.93 to 4.06.

Supination ranged from 1.40 to 3.53 before and after the test.

Pronation ranged from 1.80 to 4.00 before and after the test.

The table suggests that the MMT value significantly increased between the pre- and
post-test at p>0.05 level.
 BAR DIAGRAM 6

MMT IN PRE AND POST TEST WITHIN GROUP B

4.73
PRONATION
1.8

3.53
SUPINATION
1.4

4.06
ELBOW EXTENSION
1.93000000000001

4.46
ELBOW FLEXTION
2.26

3.93
SHOULDER EXTERNAL ROTATION
1.8

3.93
SHOULDER INTERNAL ROTATION
1.73

4
SHOULSER ABDUCTION
1.66

3.73
SHOULDER ADDUCTION
1.53

4.33
SHOULDER EXTENSION
2.2

4.2
SHOULDER FLEXTION
2.13

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

POST TEST PRE TEST

 TABLE 7
COMPARISON OF POST GROUP A AND POST GROUP B
NPRS AND OXFORD ELBOW SCORE
GROU NPRS POST TEST POST TEST t-test Significanc
PA GROUP A GROUP B e
AND
GROU
PB N MEA S. D MEA S. D
N N

1 1.80 0.6 4.53 0.6 11.3 0.000

5 7 3 7

OXFOR 1 17.33 2.4 29.06 3.1 11.2 0.000

D 5 6 9 5
ELBOW
SCORE

The above table shows that decrease In NPRS and OXFORD ELBOW SCORE mean
value in both post Group-A and Group-B.
The table infers Not significant decrease in NPRS, OXFORD ELBOW SCORE value
between post Group-A and Group-B at p <0.05 level.

BAR DIAGRAM 7
COMPARISON OF NPRS AND OXFORD ELBOW SCORE
WITHIN POST GROUP A AND POST GROUP B
35

30 29.06

25

20
17.33

15

10

5 4.53

1.8

0
NPRS OXFORD ELBOE SCORE

group A Post test group B Post test

TABLE 8
 ROM IN POST GROUP A AND POST GROUP B

OUTCOME MEAN t p
GROUP N MEAN S. D
DIFFERENCE VALUE VALUE

GROUP 15 175.33 6.39

SHOULDER A
FLEXION 15 4.67 2.44 0.021
GROUP 170.66 3.71
B
GROUP 15
SHOULDER A 58.33 2.43 0.000
EXTENSION 4.67 4.22
GROUP 15
B 53.66 3.51
GROUP 15
SHOULDER A 50.33 2.28 0.011
ADDUCTION GROUP 15 3.3 2.72
B 47.00 4.14
GROUP 15
SHOULDER A 174.66 7.89 0.058
ABDUCTION 4.66 1.97
GROUP 15
B 170.00 4.62
GROUP 15
SHOULDER A 70.00 4.22 0.000
INTERNAL 7.77 5.00
ROT GROUP 15
B 62.33 4.16

GROUP 15
SHOULDER A 84.00 7.60
EXTERNAL 0.11
GROUP 15
ROT 3.67 1.61
B 80.33 4.41

GROUP 15
ELBOW A 148.33 2.43
FLEXION 0.000
GROUP 15
9.00 9.81
B 139.33 2.58
GROUP 15
SUPINATION A 78.00 2.53
GROUP 15 8.70 8.22 0.000
B 69.33 3.19
GROUP 15
PRONATION A 77.66 3.19
GROUP 15 4.33 3.47 0.000
B 73.33 3.61

The above table shows the mean, standard deviation, t-test, and ROM p-value for the
comparison of post and post for groups A and B.

The mean value of ROM for shoulder flexion in Group-A increased from 175.33 to
170.66 between the post-test of Group-A and Group-B.
Shoulder extension across groups A and B post-test ranged from 58.33 to 53.66.

Shoulder adduction of groups A and B after the posttest varied from 50.33 to 47.00.

Shoulder abduction ranged from 114.66 to 170.00 between groups A and B after the
post-test.

Shoulder internal rotation of group A and group B post-tests ranged from 70.00 to
62.33.

Between the post-test for groups A and B, the shoulder's external rotation decreased
from 84.00 to 80.33.

Elbow flexion ranged from 148.00 to 139.33 between groups A and B after the post-
test.

Supination varied between group A and group B post-test from 78.00 to 69.33.

Pronation varied between group A and group B after the post-test by 77.66 to 73.33.

The table suggests a substantial increase in ROM between post-test results for groups
A and B value at p>0.05 level.
 BAR DIAGRAM 8

ROM IN POST GROUP A AND POST GROUP B

73.33
PRONATION
77.66

69.33
SUPINATION
78

139.33
ELBOW FLEXTION
148.33

80.33
SHOULDER EXTERNAL ROTATION
84

62.33
SHOULDER INTERNAL ROTATION
70

170
SHOULSER ABDUCTION
174.66

47
SHOULDER ADDUCTION
50.33

53.66
SHOULDER EXTENSION
58.33

170.66
SHOULDER FLEXTION
175.33
0 20 40 60 80 100 120 140 160 180 200

group B Post test group A Post test

 TABLE 9
MMT IN POST GROUP A AND GROUP B

MEAN t p
OUTCOME GROUP N MEAN S. D DIFFERENCE VALUE VALUE

GROUP 15 .48
SHOULDER A 4.66
FLEXION GROUP 15 0.46 2.43 0.022
B 4.20 .56
GROUP 15
SHOULDER A 4.73 .45
EXTENSION 0.4 1.80 0.081
GROUP 15
B 4.33 .72
GROUP 15
SHOULDER A 4.20 .41
ADDUCTION GROUP 15 0.6 2.00 0.054
B 3.73 .79
GROUP 15
SHOULDER A 4.46 .63
ABDUCTION GROUP 15 0.46 1.60 0.120
B 4.00 .92
GROUP 15
SHOULDER A 4.13 .51
INTERNAL GROUP 15 0.2 0.98 0.333
ROT B 3.93 .59
GROUP 15
SHOULDER A 4.33 .61
EXTERNAL
GROUP 15
ROT 0.4 1.53 0.136
B 3.93 .79
GROUP 15
ELBOW A 4.93 .25
FLEXION GROUP 15
B 4.46 .51 0.46 3.13 0.004
GROUP 15
ELBOW A 4.13 .35
EXTENSION GROUP 15 0.07 0.59 0.559
B 4.06 .25
GROUP 15
SUPINATION A 4.46 .51
GROUP 15 0.93 4.39 0.000
B 3.53 .63
GROUP 15
PRONATION A 4.73 .45
GROUP 0.73 3.21 0.003
B 4.00 .75

In the table above, for the comparison of Post and Post for groups A and B, the mean,
standard deviation, t-test, and MMT p-value are shown.
Group A Post test showed a MMT between the Post tests of groups A and B. Mean
value increased from 4.66 to 4.20 with shoulder flexion.

Shoulder extension between groups A and B was 4.73 to 4.33 at the post-test.

Shoulder adduction varied across groups A and B in the post-test from 4.20 to 3.73.

The difference between group A and group B's post-test shoulder abduction was 4.46
to 4.00.

Post test differences between groups A and B were 4.13 to 3.93 in terms of shoulder
internal rotation.

Shoulder external rotation between groups A and B was 4.33 to 3.93.

The difference between group A and group B's post-test elbow flexion was 4.93 to
4.46.

Elbow extension between groups A and B during the post-test was 4.13 to 4.06.

Between group A and group B on the post-test, supination ranged from 4.46 to 3.53.

Between group A and group B on the post-test, pronation was 4.73 to 4.00.

The table suggests Between pre- and post-test values, the MMT value developed
considerably (p>0.05).
 BAR DIAGRAM 9
MMT IN POST GROUP A AND GROUP B

4
PRONATION
4.73

3.53
SUPINATION
4.46

4.06
ELBOW EXTENSION
4.13

4.46
ELBOW FLEXTION
4.93

3.93
SHOULDER EXTERNAL ROTATION
4.33

3.93
SHOULDER INTERNAL ROTATION
4.13

4
SHOULSER ABDUCTION
4.46

3.73
SHOULDER ADDUCTION
4.2

4.33
SHOULDER EXTENSION
4.73

4.2
SHOULDER FLEXTION
4.66

0 1 2 3 4 5 6

group B Post test group A Post test

 RESULTS

According to Table and bar diagram 1 The mean NPRS value for Group A
declined from 8.93 to 1.80 during the pre- and post-test. Between the pre- and post-
test, the OXFORD ELBOW SCORE fell, with a mean score falling from 54.4 to 17.3.

The table shows a marked decline in the NPRS and Oxford ELBOW Score
values between the pre- and post-test value at p<0.05 level.

According to table and bar diagram 2 Group-A's mean shoulder flexion

rose from 124.33 to 175.33 during the pre- and post-test. Shoulder extension ranged
from 31.33 to 58.33 before and after the test. Pre- and post-test shoulder adduction
ranged from 24.66 to 50.33. Between the pre- and post-test, shoulder abduction
increased from 125.66 to 174.66. Between the pre- and post-test, the internal shoulder
rotation ranged from 33.33 to 70.00. Shoulder external rotation pre- and post-test
ranged from 43.00 to 84.00. Elbow flexion before and after the test ranged from
112.00 to 148.33. Supination before and after the exam ranged from 39.33 to 78.00.
Prior to and following the test, pronation ranged from 42.33 to 77.66.

The table suggests that the ROM value significantly increased after the test
value at p>0.05 level.

According to Table and bar diagram 3 The average for Group-A has grown
MMT from the shoulder flexion varied between the pre- and post-test from 2.64 to
4.71. Pre- and post-test shoulder extension ranged from 2.73 to 4.73. Shoulder
adduction ranged from 2.26 to 4.46 before and after the test. Pre- and post-test
shoulder abduction ranged from 2.20 to 4.20 degrees. Pre- and post-test shoulder
internal rotation ranged from 2.13 to 4.13. Pre- and post-test differences in shoulder
external rotation ranged from 2.00 to 4.33. Pre and posttest elbow flexion ranged from
2.93 to 4.93. Pre- and post-test elbow extension ranged from 2.26 to 4.13. Supination
ranged from 2.20 to 4.13 before and after the exam. Pre- and post-test pronation
ranged from 2.40 to 4.73.

The table suggests that the MMT value significantly increased between the
pre- and post-test value at p>0.05 level.
 According to Table and bar diagram 4 The mean NPRS score for Group-B
declined from 9.06 to 4.53 during the pre- and post-test. The OXFORD ELBOW
SCORE's mean value dropped from 54.46 to 29.06 between the pre- and post-test.

Between pre- and post-test, the table shows a considerable decline in the
NPRS, OXFORD ELBOW SCORE value at p<0.05 level.

According to Table and bar diagram 5 Between the pretest and posttest, the
mean value for Shoulder flexion in Group-B increased from 118.66 to 170.66.
Between the pretest and posttest, the shoulder extension ranged from 31.0 to 53.66.
Pretest and posttest shoulder adduction ranged from 26.33 to 47.00 degrees. Between
the pretest and posttest, the shoulder abduction ranged from 119 to 170.00. Pretest and
posttest shoulder internal rotation ranged from 32.00 to 62.33. Pretest and posttest
shoulder external rotation ranged from 38.33 to 80.33. Elbow flexion increased from
pretest to posttest by 104.00 to 139.33. Between the pretest and posttest, supination
ranged from 34.00 to 69.33. Between the pretest and posttest, pronation increased by
37.33 to 73.33.

The table suggests that the ROM value significantly increased after the test at
p>0.05 level.

According to Table and bar diagram 6 Group-B has displayed an MMT. a

rise in the average value from Between the pre- and post-test, the shoulder flexion
ranged from 2.13 to 4.20. Between the pre- and post-test, shoulder extension
increased from 2.20 to 4.33. Pre- and post-test shoulder adduction ranged from 1.53
to 3.73 degrees. Pre- and post-test shoulder abduction ranged from 1.66 to 4.00
degrees. Pre- and post-test shoulder internal rotation ranged from 1.73 to 3.93. Pre
and posttest shoulder external rotation ranged from 1.80 to 3.93. Pre and posttest
elbow flexion ranged from 2.26 to 4.46. Pre- and post-test elbow extension ranged
from 1.93 to 4.06. Supination ranged from 1.40 to 3.53 before and after the test.
Pronation ranged from 1.80 to 4.00 before and after the test.

The table infers significant increase in MMT value between pre- and post- test
at p>0.05 level.

According to Table and bar diagram 7 shows that decrease in

NPRS and OXFORD ELBOW SCORE mean value in both pos t Group-A and
Group-B.
The table infers Not significant decrease in NPRS, OXFORD
ELBOW SCORE value between post Group-A and Group-B at p<0.05
level.
According to Table and bar diagram 8 Between the post-test of group A
and group B, group-A's mean value of ROM increased from 175.33 to 170.66 for
shoulder flexion. Shoulder extension across groups A and B post-test ranged from
58.33 to 53.66. Shoulder adduction of groups A and B after the posttest varied from
50.33 to 47.00. Shoulder abduction ranged from 114.66 to 170.00 between groups A
and B after the post-test. Shoulder internal rotation of group A and group B post-tests
ranged from 70.00 to 62.33. Between the post-test for groups A and B, the difference
in shoulder external rotation was 84.00 to 80.33. The difference in post-test elbow
flexion between group A and group B was 148.00 to 139.33. Supination varied
between group A and group B post-test from 78.00 to 69.33. pronation varied between
group A and group B post-test from 77.66 to 73.33

The table infers significant increase in ROM value between posttest of group
A and group B at p>0.05 level.

According to Table and bar diagram 9 Group A Post test showed a MMT
between the Post tests of groups A and B. Mean value increased from 4.66 to 4.20
with shoulder flexion.

Shoulder extension between groups A and B was 4.73 to 4.33 at the post-test.
Shoulder adduction varied across groups A and B in the post-test from 4.20 to 3.73.
The difference between group A and group B's post-test shoulder abduction was 4.46
to 4.00. Post test differences between groups A and B were 4.13 to 3.93 in terms of
shoulder internal rotation. Shoulder external rotation between groups A and B was
4.33 to 3.93. The difference between group A and group B's post-test elbow flexion
was 4.93 to 4.46. Elbow extension between groups A and B during the post-test was
4.13 to 4.06. Between group A and group B on the post-test, supination ranged from
4.46 to 3.53. Between group A and group B on the post-test, pronation was 4.73 to
4.00. The table suggests that the MMT value significantly increased between the pre-
and post-test value at p>0.05 level.
 DISCUSSION

1-3% of people suffer from tennis elbow, also known as lateral epicondylalgia
(LE), a painful, incapacitating musculoskeletal condition. The sickness has a negative
impact on -society and causes problems for the healthcare industry.

The wrist extensors of the forearm are thought to be overused, overstressed, or

overexercised in TE. It has been discovered that it is frequently linked to people who
engage in repetitive pastimes and/or jobs. Between the ages of 35 and 40, it most
frequently affects the dominant side.

Lateral epicondylitis, commonly referred to as tennis elbow, is a medical

condition that results in discomfort and instability located on the outer side of the
elbow. Contrary to its name, anyone can be afflicted by this illness, not just tennis
players. It happens when repetitive stress or overuse irritates or inflames the tendons
that -attach the forearm muscles to the outer elbow. Tennis elbow is distinguished by
discomfort or soreness on the outside of the elbow, weakened grip strength, and
difficulty with particular arm movements. Tennis elbow is frequently treated with
rest, physical therapy, and painkillers such cold packs and nonsteroidal anti-
inflammatory medications. Surgery might be required in extreme circumstances to
either remove or repair damaged tissue.

Both the rotator cuff muscles and the forearm muscles are important muscle
groups that are equally responsible to the stability and movement of the upper
extremities.

The four muscles comprising the rotator cuff originate from the scapula and
attach to the humerus bone of the upper arm. Together, these muscles stabilize the
shoulder joint and enable actions like internal and external rotation, arm abduction,
and adduction. Those who undertake manual labor or engage in repetitive motions
that put stress on the shoulder joint, such as baseball pitchers and swimmers, as well
as athletes who engage in overhead exercises, should pay special attention to their
rotator cuff muscles.

On the other hand, a group of muscles known as the forearm muscles join to
the wrist and hand bones after emerging from the humerus. These muscles control
motions like pronation and supination of the forearm as well as flexion and extension
of the wrist. For tasks requiring gripping and object manipulation, such as typing,
playing an instrument, and doing manual labor, the forearm muscles are especially
crucial.

While the rotator cuff muscles and forearm muscles serve different functions,
they are both critical for maintaining optimal upper extremity function and preventing
injuries related to overuse or trauma. Regular exercise, proper form during activities,
and rest and recovery after strenuous activity can all help to maintain the health and
function of these important muscle groups.

Meenakshi Sharma, charueapen, jaganaathkamath (2015) Although other

tendons, including the extensor carpi radialis longus, extensor digitorum, and extensor
carpi ulnar is, may also be affected, the extensor carpi radialis brevis (ECRB) origin is
most frequently affected. A fibroblastic, vascular, and disorganized collagen reaction
occurs when a tendon degenerates or fails to mend.

Functional impingement of the shoulder caused by a changed joint mechanism

and muscle mismatch can impede shoulder stabilization, leading to an overuse of the
wrist extensors. This could cause minor damage to the soft tissue structures at the
lateral epicondyle, resulting in TE symptoms

Changes in the shoulder may result in altered and compensatory changes in the
forearm and hand, overloading the forearm muscles during repeated motions and
contributing to the symptoms of TE.

TE can be managed with a variety of therapies, including physical therapy,

electrical modalities, exercise, and manual therapy, as well as medical procedures like
surgery, corticosteroid injections, and medication.

High-frequency sound waves are used in ultrasound therapy, a non-invasive medical

procedure, to reach deep within the tissues of the body. A portable metallic probe that
emits sound waves is positioned on the skin after being treated with a specific gel.
The gel is used to ensure that sound waves pass through the skin unhindered.

During the procedure, the therapist moves the probe continuously over the
selected area of the body for 7 minutes. The intensity or power of the ultrasound can
be adjusted according to the desired therapeutic effect. This adjustment can be made
by the therapist based on the patient's individual needs and the specific condition
being treated.

The sound waves generated by the ultrasound probe cause vibration in the
body tissues, which produces heat. This heat increases the blood flow to the area,
which helps to reduce inflammation and swelling. As a result of the increased blood
flow, the area's cells receive more nutrients and oxygen, which aids in the healing
process.

In addition to the thermal effect, ultrasound therapy also produces a

mechanical effect. The sound waves cause the tissues to vibrate, which can help to
break down scar tissue and promote tissue regeneration.

During the ultrasound therapy, some people may feel a mild pulsing sensation
or a slight warmth in the treated-area. These sensations are normal and generally not
uncomfortable. However, if you experience any pain or discomfort during the
procedure, it's important to let your therapist know so that they can adjust the intensity
of the ultrasound.

The most popular application of ultrasound is to decrease discomfort and

inflammation by boosting blood flow-to the injured area. Studies have shown that
activities to strengthen the forearm and rotator cuff muscles are more advantageous
for treating lateral epicondylitis. Exercise strengthens muscles by encouraging
tenocytes' mechanoreceptors to make collagen, which controls recovery. Additionally,
no other research compared the effectiveness of strengthening routines with
modalities.

In order to compare their effectiveness in treating tennis elbow, rotator cuff

strengthening exercise and forearm muscle strengthening exercise were combined
with ultrasound in this research.

Exercises to strengthen the forearm and rotator cuff were given to research
participants who had acute tennis elbow. associated with improved and statistically
significant results-for the Oxford Elbow Score, Manual Muscle Test, and Numerical
Pain Rating Scale. 30 individuals between the ages of 30 and 45 were chosen and
received treatment.
 CONCLUSION
The results suggests that there is an-superlative effect of rotator cuff muscle
strengthening exercise along with ultrasound therapy in patients with acute TE
condition than forearm muscle strengthening exercises with ultrasound.
 LIMITATIONS AND RECOMMENDATIONS

LIMITATIONS
 Study duration was less

 Sample size was small

 Awareness was very less that TE can be treated with strengthening exercises

RECOMMENDATIONS
 Study can do with longer duration

 Sample size can be increased

 REFFERENCES

1. Sharma M, Eupen C, Kamath JB. Effect of adding rotator cuff strengthening

to therapeutic ultrasound and wrist extensor eccentric exercise for lateral
epicondylalgia-A randomized clinical trial. International Journal of Health
Sciences & Research. 2015;5(7):250-7.

2. Ramteke S, Samali S. To Study the Effect of Rotator Cuff Exercises on

Tennis Elbow. Indian Journal of Public Health Research & Development.
2020 Mar 26;11(3):610-4.

3. Stasinopoulos D, Stasinopoulos K, Johnson MI. An exercise programmed for

the management of lateral elbow tendinopathy. British journal of sports
medicine. 2005 Dec 1;39(12):944-7.

4. Ma KL, Wang HQ. Management of lateral epicondylitis: a narrative literature

review. Pain Research and Management. 2020 May 5;2020.

5. Yadva B, Mesic N, Kelce DG, Kurakula OV. Comparison of ultrasound and

extracorporeal shock wave therapy in lateral epicondylitis. Acta
orthopaedical et traumatological turcica. 2018 Sep 1;52(5):357-62.

6. Ramteke S, Samali S. To Study the Effect of Rotator Cuff Exercises on

Tennis Elbow. Indian Journal of Public Health Research & Development.
2020 Mar 26;11(3):610-4.

7. Alizadehkhaiyat O, Fisher AC, Kemp GJ, Viswanathan K, FRO stick SP.

Upper limb muscle imbalance in tennis elbow: a functional and
electromyographic assessment. Journal of Orthopedic Research. 2007
Dec;25(12):1651-7.

8. Dan Pope DP. Physical Therapy Diagnosis and Treatment for Tennis Elbow
[Case Study] Lateral Epicondylalgia, Epicondylitis, Tendinitis,
Tendinopathy: FPF Show Episode 34.

9. Aksoy A, Gulch A, Aslan A. Comparison of Clinical Outcomes on Different

Treatment Methods for Lateral Epicondylitis. Acta Medica Alanya.;6(3):307-
14.

10. Kashinath SJ, Alazani AM, Hafez AR, Agarin AD, Latuhihin AM.
Comparison of the effects of short-duration wrist joint splinting combined
with physical therapy and physical therapy alone on the management of
 patients with lateral epicondylitis. European journal of physical and
rehabilitation medicine. 2019 Mar 21;55(4):488-93.

11. Sharma M, Eupen C, Kamath JB. Effect of adding rotator cuff strengthening
to therapeutic ultrasound and wrist extensor eccentric exercise for lateral
epicondylalgia-A randomized clinical trial. International Journal of Health
Sciences & Research. 2015;5(7):250-7.

12. Battalia N, Dias S, Marino DA, Parica JA. The effectiveness of land and
water-based resistance training on shoulder rotator cuff strength and balance
of youth swimmers. Journal of Human Kinetics. 2018 Jun 13;62(1):91-102.

13. Sharma M, Eupen C, Kamath JB. Effect of adding rotator cuff strengthening
to therapeutic ultrasound and wrist extensor eccentric exercise for lateral
epicondylalgia-A randomized clinical trial. International Journal of Health
Sciences & Research. 2015;5(7):250-7.

14. Yadva B, Mesic N, Kelce DG, Kurakula OV. Comparison of ultrasound and
extracorporeal shock wave therapy in lateral epicondylitis. Acta
orthopaedical et traumatological turcica. 2018 Sep 1;52(5):357-62.

15. Weber C, Thai V, Neu Heuser K, Groover K, Christ O. Efficacy of physical

therapy for the treatment of lateral epicondylitis: a meta-analysis. BMC
musculoskeletal disorders. 2015 Dec;16(1):1-3.

16. Stasinopoulos D, Stasinopoulos K, Johnson MI. An exercise programmed for

the management of lateral elbow tendinopathy. British journal of sports
medicine. 2005 Dec 1;39(12):944-7.

17. Bisset L, Biller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilization

with movement and exercise, corticosteroid injection, or wait and see for
tennis elbow: randomized trial. Bamji. 2006 Nov 2;333(7575): 939.

18. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic
review and a synthesized evidence-based rehabilitation protocol. Journal of
shoulder and elbow surgery. 2009 Jan 1;18(1):138-60.

19. Giannakopoulos K, Beenak A, Calliou P, Goolies G. Isolated vs. complex

exercise in strengthening the rotator cuff muscle group. The Journal of
Strength & Conditioning Research. 2004 Feb 1;18(1):144-8.

20. STERIS H, Alamode A. Regarding “Exercise in the treatment of rotator cuff

impingement: A systematic review and a synthesized evidence-based
rehabilitation protocol”. Journal of Shoulder and Elbow Surgery. 2009 Jul
1;18(4): e33.

21. Visas R, Ramachandran R, Kordei Anant Kumar P. Comparison of

effectiveness of supervised exercise program and Cyrix physiotherapy in
 patients with tennis elbow (lateral epicondylitis): a randomized clinical trial.
The scientific world journals. 2012 May;2012.

22. Luginbuhl R, Brunner F, Schnee Berger AG. No effect of forearm band and
extensor strengthening exercises for the treatment of tennis elbow: a
prospective randomized study. La Chirurgic deli organic di movement. 2008
Jan; 91:35-40.

23. Battalia N, Dias S, Marino DA, Parica JA. The effectiveness of land and
water-based resistance training on shoulder rotator cuff strength and balance
of youth swimmers. Journal of Human Kinetics. 2018 Jun 13;62(1):91-102.

24. Kuemper M, Hull T, Hazelrigg H. Effect of stretching and strengthening

shoulder muscles on forward shoulder posture in competitive swimmers.
Journal of sport rehabilitation. 2006 Feb 1;15(1):58.

25. Duncan J, Duncan R, Bansal S, Davenport D, Hacker A. Lateral

epicondylitis: the condition and current management strategies. British
Journal of Hospital Medicine. 2019 Nov 2;80(11):647-51.

26. Kumar S, Stanley D, Burke NG, Mullet H. Tennis elbow. The Annals of The
Royal College of Surgeons of England. 2011 Sep;93(6):432-.

27. Page P. A new exercise for tennis elbow that works! North American journal
of sports physical therapy: NAJSPT. 2010 Sep;5(3):189.

28. Smet’s MP, Potvin JR, Keir PJ. Constrained handgrip force decreases upper
extremity muscle activation and arm strength. Ergonomics. 2009 Sep
1;52(9):1144-52.

29. Ahmad Z, Siddiqui N, Malik SS, Abdus-Samee M, Tethering-Strong G,

Rushton N. Lateral epicondylitis: a review of pathology and management.
The bone & joint journal. 2013 Sep;95(9):1158-64.

30. Lenoir H, Mares O, Curlier Y. Management of lateral epicondylitis.

Orthopedics & Traumatology: Surgery & Research. 2019 Dec 1;105(8):
S241-6.
 ANNEXURE I
INSTITUIONAL ETHICAL CLEARANCE CERTIFICATE
 ANNEXURE II
INFORMED CONSENT FORM

I Mr./MS ________________________   freely and voluntarily agree to participate in

the study conducted on “COMPARISON OF ROTATOR CUFF
STRENGTHENING EXERCISES VERSUS FOREARM STRENGTHENING
EXERCISES IN PATIENT WITH TENNIS ELBOW” done by
Ms. VINISHATH. T, BPT VIII SEMESTER, SRM COLLEGE OF
PHYSIOTHERAPY, SRM INSTITUTE OF SCIENCE AND TECHNOLOGY,
KATTANKULATHUR, CHENGALPATTU 603203.

I was explained in detail about the procedure of the study and understood the
requirements and benefits of this study.

I surely solely give consent to participate in this study.

DATE:                                                            SIGNATURE

PLACE: 
 ANNEXURE III
ASSESMENT FORM

Name:

Age:

Gender:

Occupation:

Address:

Phone number:

Date of assessment:

Hand dominance:

Chief complaints:

Present history:

Past history:

Medical history:

PAIN ASSESSMENT:

Side and site:

Onset:

Duration:

Nature:

Type:

Irritability:

24 hours pattern:

Aggravating factors:

Relieving factors:

Severity VAS:

No pain Max pain

 VALUES
OUTCOME MEASURES
PRE POST

NPRS

ROM
SHOULDER:

Flexion

Extension

Adduction

Abduction

Internal rotation

External rotation

ELBOW:

Flexion

Extension

Supination
MMT Pronation

SHOULDER:

Flexion

Extension

Adduction

Abduction

Internal rotation

External rotation

ELBOW:
 Flexion

Extension

Supination

Pronation

OXFORD ELBOW SCORE

ANNEXURE IV
 NPRS

ANNEXURE V
OXRORD ELBOW SCORE
 ANNEXURE VI

MASTER CHART
GROUP 1:

ROM Shoulder
NPRS Internal External
Flexion Extension Adduction Abduction
S.n Gende Ag Rotation Rotation
o r e Pr Pre Pre Pre Pre Pre
Pos Pos Pos Pos Pos Pos Pre Pos
e - - - - -
t t t t t t - t
tes Tes Tes Tes Tes Tes
test test test test test test test test
t t t t t t
1 1 21 9 2 140 170 40 55 25 50 145 170 50 70 70 85
2 1 24 9 3 130 175 40 55 30 50 140 170 45 70 40 65
3 1 38 9 1 135 180 45 60 25 50 135 175 40 70 55 85
4 2 42 8 2 140 155 40 60 30 55 140 180 35 75 50 80
5 1 29 9 1 145 175 35 55 20 45 135 175 30 75 45 80
6 2 37 10 2 130 180 40 60 15 50 130 170 25 70 40 90
7 1 39 10 2 120 180 30 60 25 50 125 180 45 75 40 85
8 2 24 9 1 120 175 20 60 20 50 130 180 35 70 45 90
9 2 29 8 3 105 180 25 55 25 55 125 175 20 65 35 85
10 1 38 8 2 120 175 30 60 25 50 110 180 25 60 30 90
11 2 32 9 2 115 175 25 60 20 50 120 150 30 70 35 90
12 1 48 8 1 105 175 20 60 20 50 110 180 30 70 35 90
13 2 19 9 2 115 180 25 60 30 50 115 180 35 75 45 70
14 2 25 10 2 120 175 30 55 35 50 120 175 30 70 45 85
15 2 29 9 1 125 180 25 60 25 50 105 180 25 65 35 90

S.n Gende Age NPRS ROM Elbow

 Flexio
Extension Supination Pronation
n
o r
Pre Post Pre Post Pre Post Pre Post Pre Post
test test test test test test test test test test
1 1 21 9 2 130 145 0 0 55 75 55 75
2 1 24 9 3 120 150 0 0 50 75 55 80
3 1 38 9 1 125 145 0 0 55 80 50 75
4 2 42 8 2 130 150 0 0 50 75 55 80
5 1 29 9 1 120 145 0 0 45 80 40 75
6 2 37 10 2 105 145 0 0 40 75 45 80
7 1 39 10 2 100 150 0 0 35 80 40 80
8 2 24 9 1 115 150 0 0 35 80 35 80
9 2 29 8 3 110 150 0 0 30 75 35 80
10 1 38 8 2 105 150 0 0 30 80 35 80
11 2 32 9 2 105 150 0 0 35 80 30 80
12 1 48 8 1 100 150 0 0 40 80 35 75
13 2 19 9 2 105 145 0 0 35 75 45 70
14 2 25 10 2 110 150 0 0 30 80 45 75
15 2 29 9 1 100 150 0 0 25 80 35 80

MMT Shoulder
NPRS Internal External
Flexion Extension Adduction Abduction
S.n Gende Ag Rotation Rotation
o r e Pr Pr Pr Pr Pr Pr
Pos Pos Pos Pos Pos Pos
e Pre Post e e e e e
t t t t t t
tes test test tes tes tes tes tes
test test test test test test
t t t t t t
grad grad
1 1 21 9 2 3 5 2 4 2 4 2 4 2 4
e2 e4
2 1 24 9 3 4 5 3 4 2 4 2 5 2 4 2 4
3 1 38 9 1 3 5 4 5 2 4 2 4 1 3 1 4
4 2 42 8 2 2 4 2 5 1 4 1 4 2 4 1 3
5 1 29 9 1 3 5 2 5 2 4 1 3 1 4 1 4
6 2 37 10 2 3 5 3 4 2 4 3 5 2 4 2 4
7 1 39 10 2 2 5 3 4 2 4 3 5 2 4 3 5
8 2 24 9 1 2 4 3 5 3 5 3 5 2 4 2 5
9 2 29 8 3 3 5 3 5 2 4 2 5 3 4 2 5
10 1 38 8 2 3 5 2 5 3 4 2 5 3 4 3 4
11 2 32 9 2 2 4 3 5 2 5 3 4 3 5 2 5
12 1 48 8 1 3 5 2 4 3 4 3 5 2 4 3 5
13 2 19 9 2 2 5 3 5 2 4 2 4 3 5 2 5
14 2 25 10 2 3 5 3 5 2 4 3 5 1 4 2 4
15 2 29 9 1 2 4 2 5 3 5 2 4 3 5 2 4
 MMT Elbow Oxford
NPRS Elbow
Flexion Extension Supination Pronation Score
S.no Gender Age
Pos Pre Pos Pre Pos Pre Pos
Pre Post Pre
Pre test Post test t tes t tes t tes t
test test test
test t test t test t test
1 1 21 9 2 4 5 3 4 2 5 2 5 51 16
2 1 24 9 3 3 5 3 4 2 5 2 4 46 25
3 1 38 9 1 3 5 2 4 2 5 2 4 52 18
4 2 42 8 2 4 5 3 4 2 4 2 5 56 17
5 1 29 9 1 3 5 2 4 1 4 1 4 56 16
6 2 37 10 2 3 5 2 4 2 4 3 5 55 18
7 1 39 10 2 3 5 2 4 3 5 3 5 56 16
8 2 24 9 1 3 5 2 4 3 5 2 5 54 15
9 2 29 8 3 3 5 2 4 3 4 2 4 56 15
10 1 38 8 2 2 4 3 5 2 4 3 5 57 16
11 2 32 9 2 2 5 3 4 2 5 2 5 58 19
12 1 48 8 1 3 5 2 5 2 4 3 5 56 17
13 2 19 9 2 3 5 2 4 2 4 3 5 55 16
14 2 25 10 2 3 5 1 4 2 4 3 5 54 17
15 2 29 9 1 2 5 2 4 3 5 3 5 54 19

GROUP 2:

ROM Shoulder
NPRS Internal External
Flexion Extension Adduction Abduction
S.n Gende Ag Rotation Rotation
o r e Pr Pr Pr Pr Pr Pr Pr
Pos Pos Pos Pos Pos Pos Pos
e e e e e e e
t t t t t t t
tes tes tes tes tes tes tes
test test test test test test test
t t t t t t t
10 10
1 1 38 10 5 170 25 50 20 45 175 30 60 35 85
0 5
10 11
2 2 48 9 5 175 30 55 25 50 170 30 55 30 80
5 0
12 11
3 2 33 8 4 170 30 55 25 45 165 25 60 30 80
0 0
13 12
4 1 43 9 4 180 45 60 30 50 170 35 65 45 80
0 5
11 12
5 2 29 10 5 170 40 60 25 55 175 25 60 45 85
0 0
11 11
6 1 28 9 5 170 35 50 30 40 165 35 65 40 70
5 5
12 12
7 2 39 9 5 170 30 55 35 50 170 30 65 45 80
0 0
11 11
8 2 33 10 4 175 25 55 30 45 175 35 65 40 85
0 5
10 11
9 1 22 8 4 170 20 50 20 40 165 30 60 35 75
5 0
12 13
10 1 39 9 6 170 30 50 25 45 160 35 60 35 80
5 0
12 11
11 2 29 9 4 170 30 55 25 50 175 25 60 30 85
0 0
14 13
12 2 35 9 5 170 30 50 35 50 175 35 60 40 75
5 0
12 13
13 1 31 10 4 170 20 55 20 50 170 35 60 45 80
0 0
12 13
14 1 26 9 4 165 35 55 30 45 170 45 70 40 80
5 0
13 12
15 2 41 8 4 165 40 50 20 45 170 30 70 40 85
0 5
 ROM ELBOW
NPRS
S.n Gende Flexion Extension Supination Pronation
Age
o r Pos
Pre Post Pre Post Pre
Pre test Post test Pre test Post test t
test test test test test
test
1 1 38 10 5 95 140 0 0 30 70 35 75
2 2 48 9 5 100 145 0 0 25 65 30 75
3 2 33 8 4 105 140 0 0 20 70 35 75
4 1 43 9 4 100 140 0 0 35 70 30 75
5 2 29 10 5 105 140 0 0 30 70 35 75
6 1 28 9 5 100 140 0 0 25 65 30 70
7 2 39 9 5 110 140 0 0 30 70 45 75
8 2 33 10 4 105 135 0 0 35 70 45 75
9 1 22 8 4 100 135 0 0 40 65 35 70
10 1 39 9 6 115 140 0 0 60 75 55 80
11 2 29 9 4 105 140 0 0 30 75 35 75
12 2 35 9 5 105 140 0 0 40 70 35 75
13 1 31 10 4 115 140 0 0 35 70 35 70
14 1 26 9 4 100 140 0 0 35 70 40 70
15 2 41 8 4 100 135 0 0 40 65 40 65

MMT Shoulder
NPRS Internal External
Flexion Extension Adduction Abduction
S.n Gende Ag Rotation Rotation
o r e Pr Pr Pr Pr Pr Pr Pr
Pos Pos Pos Pos Pos Pos Pos
e e e e e e e
t t t t t t t
tes tes tes tes tes tes tes
test test test test test test test
t t t t t t t
1 1 38 10 5 3 4 2 3 3 4 3 5 2 4 1 4
2 2 48 9 5 2 5 1 4 2 4 2 5 1 4 2 4
3 2 33 8 4 2 4 3 5 1 4 1 4 2 5 3 5
4 1 43 9 4 2 5 3 5 2 4 1 4 2 5 2 5
5 2 29 10 5 1 4 2 5 1 4 2 4 1 4 2 5
6 1 28 9 5 2 4 1 4 1 4 2 5 1 4 2 5
7 2 39 9 5 3 5 2 5 1 4 2 4 2 4 1 3
8 2 33 10 4 2 4 3 5 2 5 2 5 3 4 2 4
9 1 22 8 4 3 5 2 4 1 3 1 4 2 4 3 4
10 1 39 9 6 2 4 3 5 2 4 3 5 2 4 1 3
11 2 29 9 4 2 3 2 3 1 2 1 2 2 3 2 3
12 2 35 9 5 2 4 2 4 1 3 1 3 2 4 2 4
13 1 31 10 4 2 4 3 5 3 5 2 4 1 3 1 3
14 1 26 9 4 2 4 2 4 1 3 1 3 2 4 2 4
15 2 41 8 4 2 4 2 4 1 3 1 3 1 3 1 3

S.no Gende Ag NPRS MMT Elbow Oxford

r e Elbow
Flexion Extension Supinatio Pronation
Score
n
 Pr Pr
Pos Pos Pos
Pre Post Pre Pre Post e e Post Pre
t t t
test test test test test tes tes test test
test test test
t t
1 1 38 10 5 2 5 1 4 2 3 2 4 56 30
2 2 48 9 5 3 4 2 4 1 4 2 5 55 30
3 2 33 8 4 1 4 2 4 2 5 2 5 54 33
4 1 43 9 4 2 4 2 4 1 3 2 4 53 33
5 2 29 10 5 2 5 2 4 1 3 1 4 56 28
6 1 28 9 5 3 5 2 4 1 4 2 4 55 35
7 2 39 9 5 2 5 1 4 2 4 2 4 56 32
8 2 33 10 4 3 5 2 4 2 4 3 5 53 28
9 1 22 8 4 3 5 2 4 2 4 3 5 54 24
10 1 39 9 6 2 4 2 4 1 3 1 3 55 25
11 2 29 9 4 2 4 2 4 1 3 1 3 54 28
12 2 35 9 5 2 4 2 4 1 3 1 3 55 27
13 1 31 10 4 2 4 2 4 1 3 2 4 52 29
14 1 26 9 4 3 5 3 5 2 4 2 4 55 29
15 2 41 8 4 2 4 2 4 1 3 1 3 54 25
 ANNEXURE VII
PLAGIARISM FORMAT-I
SRM INSTITUTE OF SCIENCE AND TECHNOLOGY
(Deemed to be University u/s 3 of UGC Act, 1956)
Office of Controller of Examinations

REPORT FOR PLAGIARISM CHECK ON THE PROJECT REPORTS FOR UG

PROGRAMMES
1. Name of the Candidate Ms. VINISHATH. T

2. Address of the Candidate NO.152, PERUMAL KOVIL STREET,

Mobile KANDIYANKUPPAM,
TIRUVANNAMALAI (DT)
Mobile Number: 9994559074

3. Registration Number RA1921001010048

4. Date of Birth 10/06/2002

5. Department SRM College of Physiotherapy
6. Faculty Health Sciences
7. Title of the Project COMPARISON OF ROTATOR CUFF
STRENGTHENING EXERCISES
VERSUS FOREARM
STRENGTHENING EXERCISES IN
PATIENTS WITH ACUTE TENNIS
ELBOW

8. Whether the above project is Individual or group: INDIVIDUAL

done by
9. Name and address of the Mr. J. AYYAPPAN, M.P.T.,
Guide (ADVANCED PT IN
ORTHOPEDICS)
SRM COLLEGE OF
PHYSIOTHERAPY
SRM INSTITUTE OF SCIENCE
AND TECHNOLOGY

Mail ID: ayyappanpt@srmist.edu.in

Mobile Number: 9994948597
910. Name and address of the Co- NA
Supervisor / Co-Guide (if any)
11. Software Used TURNITIN
12. Date of Verification 27/04/2023
 13. Plagiarism Details: (to attach the final report from the software)
Enclosed
Title of the study Percentage Percentage % of
of similarity of Plagiarism
index similarity after
(Including index excluding
self- (Excluding Quotes,
citation) self- Bibliography,
citation) etc.,
COMPARISON OF ROTATOR
CUFF STRENGTHENING -------- 8% 8%
EXERCISES VERSUS FOREARM
STRENGTHENING EXERCISES IN
PATIENTS WITH ACUTE TENNIS
ELBOW

I declare that the above information has been verified and found true to the best of
my knowledge.

Signature of the Candidate Name & Signature of the Staff

(who uses the Plagiarism check
software)

Name & Signature of the Guide Name & Signature of the Co-
Supervisor/ Co-Guide

Name & Signature of the HOD

 ANNEXURE VIII
PLAGIARISM REPORT