Efficacy of Diclofenac Sodium Shock Wave Phonophoresis on Patients With Subacromial Impingement Syndrome

The goal of the study is to determine the effect of radial shock wave Phonophoresis on patients with impingement syndromes. to answer the following questions: does shock wave Phonophoresis have and effect on pain? does shock wave Phonophoresis have and effect on shoulder function? does shock wave Phonophoresis have and effect on subacromial space? patients will be randomized to two groups: Group (A): patients will receive shock wave Phonophoresis plus conventional physical therapy. Group (B): Patients will receive shock wave plus conventional Physical therapy.

Inclusion Criteria: * Patients age range between 25-40 years ago. * Shoulder pain between 60- 120° with shoulder elevation (positive painful arch test). * Grade 2 impingement syndrome according to neer classification. Exclusion Criteria: * Shoulder affected bilaterally * Receiving anesthetic or corticosteroid injections within 4 weeks of study enrollment * Surgery or previous fractures of the ipsilateral humeral head of the affected shoulder * Osteoarthritis in the acromioclavicular or glenohumeral joints