Need for including Hand Eye Coordination and Hand Function Training in the Management of Adhesive Capsulitis – A non-randomized control trial

Objectives: The objective of the study was to identify the effect of Maitland mobilization with hand-eye coordination and hand function exercises in the prognosis of adhesive capsulitis. Methods: This non-randomized control trial was done with 40 patients with adhesive capsulitis referred to the OPD at UCA College of Physiotherapy, Chennai. The study was performed for 8 months duration from August 2018 to March 2019. After providing a sufficient explanation of the procedure, the patients were divided into Group-A and Group-B. Group-A were allocated to Maitland group (n=20) (MG) and Group-B, were assigned to the Maitland, Hand-eye coordination and Hand Function exercises group (n=20) (MHG), respectively. We measured Quality of life using SF36 to know whether these patients had poor QOL compared to normative. Each patient underwent testing before the experiment to evaluate the range of motion of the shoulder (Abduction and External rotation) measured using a 180º goniometer, Functional Disability assessed using SPADI index. Statistical analysis was applied using SPSS version 20.0. Before the study, data normality was tested. A parametric test was used to compare pre-and post-intervention data in each Group-And also compare the MG vs. MHG. An α < 0.05 is the level of significance in all analyses. Results: A total of 40 subjects accounted for the study results. Their quality of life was significantly lower from the normative values. Both groups were homogenous at baseline with no significant difference between the ROM and SPADI scores. Both groups showed a significant improvement in ER, abduction ROM and SPADI scores, however the between group posttest analysis revealed that the Group-B subjects progressed significantly better. Conclusions: The study concluded that the Maitland mobilization and hand-eye coordination and hand function exercises are an effective tool in improving shoulder abduction, external rotation and shoulder functions. doi: https://doi.org/10.12669/pjms.38.3.5153 How to cite this:Senthil Kumar B, Subbaiah S, Ramachandran A. Need for including Hand Eye Coordination and Hand Function Training in the Management of Adhesive Capsulitis – A non-randomized control trial. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5153 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A Review on Frozen Shoulder: Pathophysiology and Its Associated Diagnosis

Background: Frozen shoulder is a commonly occurring disease of the population. It is also referred to as shoulder capsulitis. It causes pain and stiffness of the shoulder and dominant in left shoulder. Various things are still unclear regarding the treatment and causes of this disease. It is a painful and n quickly healed disease. Patients show recovery but are often unable to regain their full potential movements. Painful stiffness of the shoulder is an ill-described medical entity, this is hard to evaluate and sensitive to treat. The nomenclature sed and consists of phrinclude cluding frozen shoulder, adhesive capsulitis, focal dystrophy, stiff shoulder, shriveled shoulder, and following. Apart from its idiopathic form, the disease can be initiated with the resource of the usage of trauma, infection, tumor, radiation, systemic and neighborhood metabolic concerns. Patho- anatomically, the common place region denominates an inflammatory vascular proliferation found with the resource of the usage thickening, scarring, and retraction of the joint cover. Summary: The inflammatory technique frequently begins to evolved on the rotator language and can increase to the subacromial space. Clinical analysis is primarily based totally records and bodily examination. Generally, the onset of ache precedes the belief of a discounted variety of movement with the aid of using weeks or months. In early ranges of ailment, the inflammatory form of ache dominates, the patient's most important criticism is ache at night. In the later stage, variety of movement step by step decreases. Patients no longer frequently whine approximately decreased movement, likely due to its gradual onset. Conclusion: Treatment options are a mixture of mobilization carrying sports with intra-articular steroids, hydraulic distension of the joint capsule, manipulation below anaesthesia,arthroscopic and/or open arthrosis.The appropriate preference of protocol is really as critical as its correct timing. In the inflammatory phase, competitive invasive protocols are uncommon, but deleterious and therefore need to be taken into consideration. New anti- angiogenic outlets also can moreover enhance beneficial effects and shorten the rehabilitation phase.

Usefulness of combined handheld ultrasound and fluoroscopy-guided injection in adhesive capsulitis of the shoulder: A prospective, randomized single blind-pilot study

BACKGROUND: Ultrasound is increasingly being utilized in the diagnosis and treatment of adhesive capsulitis. OBJECTIVE: To compare the therapeutic effects and advantages of combined handheld ultrasound and fluoroscopy-guided intra-articular corticosteroid injection with those of conventional ultrasound-guided corticosteroid injection in adhesive capsulitis of the shoulder. METHODS: A total of 39 patients diagnosed with adhesive capsulitis of the shoulder were randomly assigned into two groups. Group A patients (n= 19) underwent combined handheld ultrasound and fluoroscopy-guided corticosteroid injection and group B patients (n= 20) underwent conventional ultrasound-guided corticosteroid injection to the intra-articular space of the shoulder twice. Treatment efficacy was assessed at 2 and 6 weeks after the final injection, based on the verbal numeric pain scale, Shoulder Pain and Disability Index, and range of motion. Secondary outcome measures were the accuracy and procedure time. RESULTS: Both injection methods were effective in the treatment of adhesive capsulitis. No significant differences in treatment efficacy and injection accuracy were observed between the two groups (p> 0.05). CONCLUSIONS: This study showed no statistical differences in treatment efficacy between 2 groups. However, the combined use of ultrasound and fluoroscopy can increase the accuracy of injection compared with conventional ultrasound alone.

Manual Therapy Interventions for Adhesive Capsulitis: A Review

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.

Effect of Cyriax Deep Friction Massage Versus Cryotherapy in Stage 1 & 2 of Adhesive Capsulitis: A Randomized Controlled Trial

Background: Adhesive capsulitis is one of the common pathologies of the Shoulder. The prevalence of adhesive capsulitis is estimated to be 2% to 5% of the general population. Several treatment techniques are existing for the improvement of adhesive capsulitis and Cyriax deep friction massage is a technique designed to improve adhesive capsulitis. Objective: To compare between the effects of Cyriax deep friction massage and conventional physical therapy with Cryotherapy and conventional physical therapy in stage 1 &2 of adhesive capsulitis. Methods/ Design: The study is a randomized controlled trial which included 34 subjects of the age group 40-85 years and were randomly assigned into two groups: group A (n=17) and group B (n=17). The Group A was given Cyriax deep friction massage with conventional physical therapy while group B was given Cryotherapy therapy with conventional physical therapy. Outcome measure were taken at baseline, and then taken on last day of sixth session by using Visual Analogue Scale (VAS), Range of Motion (ROM), and Shoulder Pain and Disability Index (SPADI). The treatment was given for 6 sessions over a period of two weeks. Results: Group A showed greater improvement after 2 weeks of intervention with a statistical significance value for SPADI, VAS and ROM. Conclusion: Cyriax deep friction massage with conventional physical therapy has significant effect on pain, range of motion and functional activity in patients with adhesive capsulitis. Trial registration: prospectively registered in the clinical trial registry-India in the registration number of CTRI/2019/09/021375.

Effects of Different Types of Contraction Exercises on Shoulder Function and Muscle Strength in Patients with Adhesive Capsulitis

Although several studies have reported the effect of exercise therapy for adhesive capsulitis (AC), studies on the comparison of different exercise types on shoulder muscle strength and function in patients with AC are lacking. This study aimed to investigate the effect of different exercise types on shoulder muscle strength and function in patients with AC. Thirty female patients with AC were categorized into an eccentric contraction exercise group (ECG, n = 15; age, 51.53 ± 4.73 years) and a concentric contraction exercise group (CCG, n = 15; age, 52.40 ± 4.03 years). The participants in each group performed a different exercise program three times per week for 60 min per session for 12 weeks. The range of motion (ROM) of the shoulder joint, visual analog scale, shoulder muscle strength, and Constant–Murley score (CMS) were measured before the intervention and after 12 weeks of the exercise intervention. Shoulder ROM in flexion (increase of 31%) and external rotation (ER) (increase of 54%) showed a significant improvement in the ECG (p < 0.05). Muscle strength in ER was significantly different between the two groups (p < 0.05). Pain severity showed improvement in the ECG (decrease of 61%) after the intervention (p < 0.01). The CMS in the ECG (increase of 48%) showed a greater improvement than that in the CCG after the intervention (p < 0.01). This study showed that eccentric contraction exercise had a more beneficial effect than concentric contraction exercise for improving shoulder muscle strength and function in females with AC.

Additional effects of Thoracic manipulation on pain, shoulder disability and range of motion in Adhesive Capsulitis

Aim: To determine the additional effects of thoracic manipulation on shoulder pain, shoulder range of motion (ROM) and disability in combination with conventional physical therapy exercises for individuals with adhesive capsulitis. Materials: A parallel, randomized controlled clinical trial was conducted. 32 patients (16 in each group), aged between 40‑60 years from both genders having shoulder pain, clinically diagnosed with adhesive capsulitis (Stage II and III), along with thoracic spine hypo mobility were included. Patients were randomized into conventional physiotherapy group (A) and thoracic manipulation group (B). Clinical trial was continued for two weeks with three sessions per week and a follow up was done at the end of 3rd week. Visual analogue scale (VAS), shoulder range of motion (ROM) and Disabilities of Arm Shoulder and Hand (DASH) score were used for outcomes measurement. Results: Intragroup comparison for shoulder ROM, DASH and VAS scores shows a significant (p value=≤0.001) for both groups. Intergroup comparison for shoulder ROM was improved significantly on post-intervention (p value=≤0.001). While intergroup comparison of baseline to end value for VAS showed insignificant result (p value=0.373). Conclusion: Additional effects of thoracic manipulation to conventional physical therapy underwent a greater improvement regarding shoulder range of motions and disability. Conventional physical therapy exercises and a combination of thoracic manipulation to conventional physical therapy exercises are equally effective for decreasing shoulder pain. Keywords: Adhesive Capsulitis, Pain, Frozen shoulder, Physical Therapy, Rehabilitation

Arthroscopic capsular release for adhesive capsulitis secondary to diabetes provides better functional outcome than conservative management

Objectives: Comparison of outcome of subacromial bursal resection with capsular release for adhesive capsulitis of shoulder secondary to diabetes, with conservative management. Materials and Methods: This study was conducted on 68 patients of adhesive capsulitis of shoulder secondary to diabetes. The patients were divided into two groups: Arthroscopic capsular release group (group I n 32) and Conservative management group (Group II n 36) after fulfilling inclusion/ exclusion criteria. Follow-up was done at 2, 6, 24 weeks, 6 months, 1 year, and 2 years. In addition to pre-operative measurement, at each follow-up pain was assessed by visual analog scale (VAS), range of motion (ROM) was assessed by goniometer and functional outcome was assessed by Constant-Murley score. Values obtained were filled in Excel sheet and analyzed by independent t-test, Wilcoxon Rankosin test, and Analysis of Variance test on Statistical Package for the Social Sciences software. Results: Two patients in Group I and six in Group II were lost to follow-up. There was statistically significant improvement in VAS of both groups at each follow-up, but the noticeable difference was that the patients in arthroscopic release group were pain free by 6 weeks and the pain relief was sustained till final follow-up. In contrast, though there was pain relief in conservative group but they were not completely pain free till final follow-up. There was statistically significant improvement in Constant Murley score in both groups at each follow-up but arthroscopic release group achieved near normal score by 6 months and the improvement was maintained till last follow-up. The comparison of mean and median values of ROM, between the arthroscopic capsular release group and conservative group were statistically significant (P value of 0.001) for each movement. Conclusion: The improvement in ROM, decrease in pain, and functional outcome are better in diabetic patients with adhesive capsulitis undergoing Arthroscopic capsular release than conservative management.