The efficiency of the conventional physical treatment of the shoulder pain compared to conventional treatment plus the Mulligan's joint mobilization technique and acupuncture

Introduction: Shoulder pain is the most common form of extra-articular rheumatism. We aimed to determine the efficiency of the conventional physical treatment of the shoulder pain compared to the conventional treatment plus the Mulligan's joint mobilization technique and acupuncture. Methods: We included a total of 277 patients with the shoulder pain caused by adhesive capsulitis (frozen shoulder), calcific tendinitis, rotator cuff syndrome, or the tendinitis of the biceps muscle. We used clinical and radiological diagnostic criteria to make the diagnosis. Patients were assigned into group treated with conventional physiotherapy treatment during the ten days (CP)(n=148), and the group treated with conventional physiotherapy treatment plus the Mulligan joint mobilization and acupuncture (CP+MA)(n=128). Treatment efficiency was evaluated by assessing the status of the patients before and after the treatment with the Work Abilities and Activities of Daily Living (WAADL) scale as well as the Treatment Success scale. Results: Mean treatment duration was 13.36±5.83 and 10.86±4.55 days in CP and CP+MA group, respectively (p<0.05). Mean WAADL scores after the treatment were 3.98±1.04 and 4.61±1.10 in CP and CP+MA group, respectively (p<0.05). Mean Treatment success score was 3.16±0.74 and 4.35±0.78 in CP and CP+MA group, respectively (p< 0.05). Conclusions: Conventional physical therapy plus the Mulligan's joint mobilization technique and acupuncture resulted in shorter treatment duration and higher WAADL and Treatment success scores in patients with shoulder pain.

Download Full-text

Effect of Spencer Muscle Energy Technique Versus Maitland’s Mobilization Technique on Pain, ROM and Disability in Patients with Frozen Shoulder: A Comparative Study

International Journal of Physiotherapy and Research ◽

10.16965/ijpr.2021.148 ◽

2021 ◽

Vol 9 (4) ◽

pp. 3928-3936

Author(s):

Raksha R. Jivani ◽

◽

Dharti N Hingarajia ◽

Keyword(s):

Range Of Motion ◽

Shoulder Pain ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Group Comparison ◽

Post Intervention ◽

Muscle Energy Technique ◽

Significant Difference ◽

Muscle Energy ◽

Conventional Physiotherapy

Background: Adhesive capsulitis is characterized by a painful, gradual loss of both active and passive glenohumeral motion resulting from progressive fibrosis and ultimate contracture of the glenohumeral joint capsule. Patients with Adhesive capsulitis have difficulties in everyday activities and shoulder pain also disturbs sleep at night on the affected side. Muscle energy technique helps in increasing shoulder range of motion. Maitland Mobilization is commonly used in the treatment of frozen shoulder. SPENCER Muscle Energy Technique (MET) is unique in its application as the client provides the initial effort while the practitioner facilitates the process. Objective: Objectives of the study was to compare the effect of Spencer MET Vs Maitland’s mobilization on pain, Range of Motion (ROM) and Disability in the patients with frozen shoulder. Methods: In the present experimental study, total 58 patients with frozen shoulder were included. Inclusion criteria were male and female with age of 40 to 60 year with unilateral frozen shoulder (at least 3-month duration). Patients were randomly allocated in two groups with 29 patients in each group: SPENCER MET and Conventional physiotherapy and MM and conventional physiotherapy for 5days a week with total duration of 4 weeks. Pre and post intervention assessment was carried out by using VAS, SPADI and ROM. Data was analysed by using SPSS 15 version. Results: Paired t test was applied within group comparison and result showed statistically significant difference in post intervention measurement compared to pre intervention for improving pain, reducing disability and increasing all ROM in both the groups. Independent t test was applied between group comparison and result showed statistically significant difference between groups mean pre-post differences in improving pain, reducing disability and increasing all ROM except extension and internal rotation. Conclusion: This study concludes that both the techniques used in the present study i.e., Spencer Muscle Energy Technique and Maitland Mobilization are effective for improving pain, reducing disability, and increasing ROM. However, SPENCER MET is the more effective for improving pain, reducing disability, and increasing ROM compared to Maitland Mobilization in patients with frozen shoulder. KEY WORDS: Frozen shoulder, SPENCER MET, Maitland mobilization, Shoulder Pain and Disability Index, Visual Analogue Scale.

Download Full-text

Effectiveness of Acromioclavicular Joint Mobilization and Physical Therapy vs Physical Therapy Alone in Patients with Frozen Shoulder: A Randomized Clinical Trial

10.21203/rs.3.rs-548390/v1 ◽

2021 ◽

Author(s):

Mohammad Rahbar ◽

Sepideh Ranjbar Kiyakalayeh ◽

Bina Eftekharsadat ◽

Behzad Izadseresht ◽

Neda Dolatkhah

Keyword(s):

Clinical Trial ◽

Physical Therapy ◽

Randomized Clinical Trial ◽

Shoulder Pain ◽

Acromioclavicular Joint ◽

Frozen Shoulder ◽

Secondary Outcome ◽

Control Group ◽

Joint Mobilization ◽

Active Abduction

Abstract Background: Frozen shoulder (FS) is a prevalent musculoskeletal condition characterized by an often prolonged pain, disability and limited active and passive range of motion (ROM), however its management remains challenging yet. The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and physical therapy versus physical therapy in treatment of FS.Methods: In this single-blind randomized clinical trial, patients with diagnosis of FS were randomly allocated into mobilization + physical therapy (n=28) as experiment group, and physical therapy (n=28) as control group in two outpatient clinics of Tabriz University of Medical Sciences, Iran. The primary outcomes were self-reported shoulder pain-related disability measured by the Shoulder Pain and Disability Index (SPADI) questionnaire and goniometric assessment of shoulder ROM. The secondary outcome was the Visual Analogue Scale (VAS). Measures were performed at the baseline, immediately and one month after beginning the treatments.Results: Totally 51 patients with 25.73 ± 6.88 years old of age completed the study and their data were analyzed. VAS, SPADI, pain and disability improved more significantly in experiment group compared to control group immediately [-4.63 (-5.58- -3.67) vs. -2.22 (-2.96- -1.47), p<0.001; -23.08 (-28.63- -17.53) vs. -13.04 (-17.93- -8.16), p=0.008; -26.00 (-31.71- -20.29) vs. -16.35 (-23.39- -9.31), p=0.034 and -21.25 (-29.11- -13.39) vs. -10.98 (-17.53- -4.43), p=0.042, respectively] and one month after beginning of treatment [-5.58 (-6.45- -4.72) vs. -3.61 (-4.60- -2.62), p<0.001; -33.43 (-40.85- -26.01) vs. -20.03 (-26.00- -14.07), p=0.001; --42.83 (-49.09- -36.57) vs. -25.57 (-33.92- -17.21), p<0.001 and -27.55 (-36.19- -15.94) vs. -16.58 (-24.48- -8.67), p=0.041, respectively]. Active abduction ROM was also improved more significantly immediately after treatment in experiment group compared to control group [25.83 (11.45- 40.13) vs. 10.17 (1.02- 19.15), p=0.025], however there were no significant differences between two groups concerning other measured ROMs immediately and one month after treatment (all p>0.05). Conclusions: Acromioclavicular mobilization along with conventional physical therapy was more efficient in decreasing pain and disability and improving active abduction ROM compared to physical therapy in patients with FS. These findings would suggest a new therapeutic method for shoulder disorders with pain and disability.Trial registrationwww.irct.ir, IRCT20100605004104N7, registered 06.01.2019 (https://www.irct.ir/trial/35900)

Download Full-text

Manual Therapy Interventions for Adhesive Capsulitis: A Review

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20211042 ◽

2021 ◽

Vol 6 (4) ◽

pp. 299-308

Author(s):

Piumi Nakandala

Keyword(s):

Manual Therapy ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Inflammatory Reactions ◽

Joint Mobilization ◽

Functional Activities ◽

Oral Medications ◽

Manual Treatment ◽

Therapy Interventions ◽

Passive Movements

Adhesive Capsulitis is a debilitating condition which causes the capsule of the Gleno-humeral joint to get thickened and contracted progressively. The prevalence of the disease is much higher in the middle aged and elderly community. It is characterized by pain in the shoulder, and advance towards the restriction of the active and passive glenohumeral motions and thereby obstructing the overall functional activities of the daily living. The effectiveness of various non-operative methods in the treatment of Adhesive Capsulitis has been demonstrated in the literature. Corticosteroid injections and the oral medications are known to be alleviating the pain levels and the inflammatory reactions but not the mobility of the affected joint. Joint mobilization techniques, electrotherapeutic modalities and other manual treatment methods are also found to be effective. In summary, this review focuses on the pathophysiology of the adhesive capsulitis, stages of the condition progress and various manual therapy interventions. Keywords: Gleno-humeral joint, frozen shoulder, rehabilitation, active and passive movements, functional activities.

Download Full-text

Thermotherapy for shoulder pain: a protocol for systematic review

10.37766/inplasy2021.11.0086 ◽

2021 ◽

Author(s):

Bin Chen ◽

◽

Cimin Shen ◽

Na Li ◽

Lu Wang ◽

...

Keyword(s):

Shoulder Pain ◽

Musculoskeletal Disorder ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Biomedical Literature ◽

Cochrane Library ◽

Shoulder Impingement ◽

Search Terms ◽

Heat Therapy ◽

Review Question

Review question / Objective: Shoulder pain is a common musculoskeletal disorder prompting many patients to seek treatment. Thermotherapy is a common treatment for shoulder which has been widely used in hospitals. But its efficiency has not been scientifically and methodically evaluated. This protocol aims to evaluate the efficacy and safety of Thermotherapy for treating shoulder pain. Information sources: Eight databases will be searched from their inception to October 2021. They are as follows: PubMed, Embase, Cochrane Library, ClinicalTrials.gov, China Knowledge Resource Integrated Database (CNKI), Weipu Database for Chinese Technical Periodicals (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang Database. There will be no limitation to study publication status or language. The search terms include shoulder impingement syndrome, rotator cuff, bursitis, adhesive capsulitis, frozen shoulder, shoulder pain, thermotherapy, diathermy, heat therapy, Moxibustion, and RCTs. The equivalent search words will be used in the Chinese databases.

Download Full-text

Adhesive Capsulitis

Mayo Clinic Principles of Shoulder Surgery ◽

10.1093/med/9780190602765.003.0008 ◽

2018 ◽

pp. 215-226

Author(s):

Joaquin Sanchez-Sotelo

Keyword(s):

Natural History ◽

Shoulder Pain ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Patient Evaluation ◽

Clear Cut ◽

Essentially Normal ◽

And Function ◽

Number Of Individuals

Some individuals experience a condition characterized by spontaneous shoulder pain and stiffness due to synovitis, fibrosis, and loss of capsule elasticity without a clear-cut inciting cause. Most commonly, this condition is named adhesive capsulitis or frozen shoulder, terms applied only when shoulder radiographs are essentially normal and other reasons for shoulder pain and stiffness (e.g., cuff disease, fractures, dislocations, and arthritis) can be excluded. Although this condition resolves spontaneously in many patients, its course is protracted and a number of individuals may experience permanent restrictions in motion and function. This chapter discusses various aspects of adhesive capsulitis including pathogenesis, natural history, patient evaluation, and treatment.

Download Full-text

The effectiveness of ultrasound guided hydrodistension and physiotherapy in the treatment of frozen shoulder/adhesive capsulitis in primary care: a single centre service evaluation

Shoulder & Elbow ◽

10.1177/1758573217701063 ◽

2017 ◽

Vol 9 (4) ◽

pp. 292-298 ◽

Cited By ~ 3

Author(s):

Michael Bryant ◽

Andrew Gough ◽

James Selfe ◽

Jim Richards ◽

Elizabeth Burgess

Keyword(s):

Primary Care ◽

Shoulder Pain ◽

Operative Treatment ◽

Treatment Strategy ◽

External Rotation ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Exercise Programme ◽

Service Evaluation ◽

Stage Ii

Background Evidence for optimal non-operative treatment of frozen shoulder is lacking. The present study aimed to evaluate a treatment strategy for stage II to III frozen shoulder provided by the current primary care musculoskeletal service. Methods General practioner referrals of shoulder pain to the musculoskeletal service diagnosed with stage II to III frozen shoulder and who opted for a treatment strategy of hydrodistension and guided physiotherapy exercise programme over a 12-month period were evaluated for 6 months. Thirty-three patients were diagnosed with stage II to III frozen shoulder by specialist physiotherapists and opted for the treatment strategy. Outcome measures included Shoulder Pain Disability Index (SPADI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain score and range of movement. Data were collected at baseline, as well as at 6 weeks, 12 weeks and 6 months. Results All patients significantly improved in shoulder symptoms on the SPADI and QuickDASH scores ( p < 0.001). Pain scores and range of shoulder movement flexion, abduction, external rotation showed significant improvement at all time points ( p < 0.001). Conclusions This service evaluation demonstrates that management of frozen shoulder stage II to III, as conducted by physiotherapists in a primary care setting utilizing hydrodistension and a guided exercise programme, represents an effective non-operative treatment strategy.

Download Full-text

Effect of manipulation by maitland method in the treatment of adhesive capsulitis of the shoulder: case studies

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2016.14.427 ◽

2020 ◽

pp. 1-6

Author(s):

Mafra Raiele Torres Oliveira ◽

Vivianne Camila Souza Bastos ◽

Lívia Shirahige Gomes do Nascimento ◽

Maria de Fátima Alcântara Barros ◽

Antonio Geraldo Cidrão de Carvalho ◽

...

Keyword(s):

Case Studies ◽

Shoulder Pain ◽

Functional Capacity ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Age Group ◽

Analog Scale ◽

Improved Outcomes ◽

Insidious Onset ◽

Capacity Method

Introduction: Adhesive capsulitis, also called frozen shoulder, affects about 3-5% of the population, especially in the age group 40 to 60 years, affecting more women and having an insidious onset. Objective: Analyze the isolated effect of joint manipulation by Maitland method in treating patients with adhesive capsulitis of the shoulder, the level of pain, range of motions of the shoulder and functional capacity. Method: It is about a cases studies in which four volunteers underwent protocol Maitland to shoulder for 15 sessions. The evaluation instruments used were the Visual Analog Scale, Goniometer and Shoulder Pain and Disability Index to measure the level of disability of the shoulder. Results: There was decreased pain from 55.5 to 80.0%, increased all range of motions, especially flexion of the shoulder, with more than 100% gains in the four cases investigated and improved functional capacity between 27.9 – 91.9%. Conclusion: These results suggest that the therapy had improved outcomes assessed, as clinically relevant contribution, but indicate the need to develop more studies to prove the effectiveness of the method isolated.

Download Full-text

Effect of Hijamah (Dry Cupping) on Frozen Shoulder: A Case Study

Journal of Advanced Research in Ayurveda Yoga Unani Sidhha & Homeopathy ◽

10.24321/2394.6547.202105 ◽

2021 ◽

Vol 08 (1&2) ◽

pp. 14-17

Author(s):

Mohammad Abid ◽

Keyword(s):

General Population ◽

Range Of Motion ◽

Shoulder Pain ◽

Clinical Presentation ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Left Shoulder ◽

Radiological Assessment ◽

Common Causes

Frozen shoulder or adhesive capsulitis is one of the most common causes of shoulder pain and disability in the general population. Its prevalence is 2-5% in the general population and 10-20% among diabetics. It predominantly affects females and most commonly affects people between the ages of 40 and 60 years. The left shoulder is more likely to be affected, with both shoulders affected in 12% of cases. A case study is presented to illustrate the clinical presentation, aetiology, diagnosis, radiological assessment, and management of frozen shoulder through Hijamah bila shurt (dry cupping) in a 60-year-old diabetic male patient. The present case was studied for over 8 weeks; Hijamah (dry cupping) was done on prescribed points for the affected shoulder twice a week for 8 weeks, and assessment was done at baseline and every 2 weeks. This study concluded that regimental therapy Hijamah bila shurt (dry cupping) has a significant effect in reducing pain, stiffness of joints, and increasing range of motion in frozen shoulder.

Download Full-text

Study on Effectiveness of Kaltenborn Mobilization Techniques Grade III in Patient with Frozen Stage of Adhesive Capsulitis of Shoulder Joint

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.5.1050 ◽

2021 ◽

Vol 3 (5) ◽

pp. 50-53

Author(s):

A. K. M. Rezwan ◽

T. M. Shahriar ◽

A. N. M. Rasal ◽

M. Rahman ◽

T. Haque ◽

...

Keyword(s):

Shoulder Joint ◽

Adhesive Capsulitis ◽

Frozen Shoulder ◽

Control Group ◽

Physiotherapy Treatment ◽

Quasi Experimental ◽

Group A ◽

Group B ◽

Joint Range ◽

Grade Iii

Background: Frozen shoulder is the stage II of adhesive capsulitis characterized by progressive loss of shoulder movement and symptoms of pain, decrease joint range of motion. Objective: To determine the effectiveness of kaltenborn mobilization technique grade-III to the treatment of frozen stage of adhesive capsulitis of shoulder joint. Methods: This quasi-experimental study in total number of 40 respondent were diagnosed with frozen stage of adhesive capsulitis of shoulder joint and randomly allocated into 2 groups. Within both group (n=20) & experimental group were treated by kaltenborn mobilization technique grade III whereas control group were treated by routine physiotherapy treatment and apply one session per day for four weeks. Outcome measures used were Visual analog scale (VAS) and Shoulder disability questioner (SDI). Paired ‘t’-tests was used to compare the pre and posttest value of treatment within both groups. Participants were selected based on the inclusion and exclusion criteria. Statistics & Results: Data was collected on a data sheet & encoded for computerized analysis using SPSS version 19. The statistical analysis of post values of Group A (Kaltenborn mobilization technique grade III) where VAS mean of pretest (6.90 ± 1.02) and posttest (4.35 ± 1.60) value where (p < 0.0001). SDI mean of pretest (4.1±1.45) and posttest (2.9 ±1.20) value where (p < 0.0002). In group B (Routine physiotherapy treatment) where VAS mean of pretest (6.75 ± 1.07) and posttest (6.25 ± 1.06) value where (p < 0.0003). SDI mean of pretest (4.1±1.45) and posttest (3.5 ±0.49) value where (p < 0.0077). Conclusion: It was concluded that both techniques were effective but kaltenborn mobilization techniques grade III was more effective then routine physiotherapy technique.

Download Full-text

Patients with shoulder pain referred to specialist care; treatment, predictors of pain and disability, emotional distress, main symptoms and sick-leave: a cohort study with a six-months follow-up

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0044 ◽

2020 ◽

Vol 20 (4) ◽

pp. 775-783

Author(s):

Kaia B. Engebretsen ◽

Jens Ivar Brox ◽

Niels Gunnar Juel

Keyword(s):

Clinical Trials ◽

Cohort Study ◽

Sick Leave ◽

Shoulder Pain ◽

Emotional Distress ◽

Outpatient Clinic ◽

Treatment Duration ◽

Specialist Care ◽

Yellow Flags

AbstractObjectivesRecommendations for referral of patients with shoulder pain from primary to specialist care are mainly clinical. Several patients are referred without meeting these criteria for referral, whereas some are referred for a second opinion although surgery is not recommended. The aims of this study were to describe a shoulder pain cohort in specialist healthcare according to demographic data, clinical, and psychological factors; evaluate changes in pain and disability, distress and main symptoms from baseline to six-month follow-up; and to assess predictors of pain and disability, changes in the main symptoms and sick-leave at six-months. Results were compared to previous randomised trials conducted at the same clinic in patients with subacromial shoulder pain.MethodsThis prospective study included 167 patients from an outpatient clinic in specialist healthcare with shoulder pain for more than 6 weeks. Clinical (pain duration, intensity, pain sites), sociodemographic (age, gender, educational level, work status) and psychological variables (emotional distress (HSCL-10), fear of pain, screening of “yellow flags”, health-related quality of life) were collected. Shoulder pain and disability (SPADI-score) were assessed and the patients were asked about their outcome expectation and to predict their status of their shoulder problem the next month. They underwent a clinical interview, a clinical assessment of shoulder function and orthopaedic tests for diagnostic purposes. After six months they received a questionnaire with main variables.ResultsOf the 167 patients (55% women), 50% had symptoms for more than 12 months and 37 (22%) were on sick-leave. Characteristics were in general comparable to patients previously included in clinical trials at the same department. The SPADI-score was 46 (23) points. Mean emotional distress was within the normal range (1.7 (SD 0.6)). More than 80% had received treatment before, mainly physiotherapy in addition to the GPs treatment. One hundred and thirty-seven patients (82%) were re-referred to physiotherapy, 74 (44%) in the outpatient clinic specialist healthcare, and 63 (38%) in primary care. One hundred and eighteen (71%) answered the follow-up questionnaire. Mean change in SPADI-score was 10.5 points (95% CI (6.5–14.5)), and 29% of the patients improved more than the smallest detectable difference (SDD). The percentage sick-listed was 19.5%, and mean change in main symptoms (−9 to +9) was 3.4 (SD 3.9). The subgroup of patients receiving physiotherapy in outpatient specialist care did not show any significant change in the main variables. The prediction models suggested that a lower level of education, more fear of pain and a high baseline SPADI-score, predicted a higher SPADI-score at follow-up. A high baseline HSCL-10 score was the only significant predictor for a high HSCL-10 score. At follow-up, less pain at rest predicted more change in main symptoms and more yellow flags (a higher score on the Örebro screening test) predicted sick-leave.ConclusionsWithin the limitations of a cohort study, patients with persistent shoulder pain referred to an outpatient specialist clinic had similar baseline characteristics but shorter treatment duration, inferior clinical results and predictors somewhat different compared with previous clinical trials conducted at the same clinic. The study raises some questions about the effectiveness of the routines in daily clinical practice, the selection of patients, the treatment duration and content.

Download Full-text