Effects of two different mobilization techniques on pain, range of motion and functional disability in patients with adhesive capsulitis: a comparative study

Comparison of Kaltenborn mobilization technique and muscle energy technique on range of motion, pain and function in subjects with chronic shoulder adhesive capsulitis

Background

Shoulder adhesive capsulitis (AC) is a common musculoskeletal condition causing pain, loss of range of motion (ROM) in the shoulder, and a decrease in its functionality, yet poorly defined and understood since its identification. Kaltenborn mobilization technique (KMT) and muscle energy technique (MET) are commonly used physiotherapeutic techniques for their treatment. To the best of our understanding, there was no study found to compare the effectiveness of one technique over another.

Objective

The objective of this study was to compare the effectiveness of KMT and MET on the ROM, pain and function in subjects with chronic shoulder AC.

Methods

In this single-centred, single-blinded quasi-experimental study with a pretest-posttest design 35 subjects were randomized into two groups: Group A (n = 18 ) received KMT and Group B (n = 17 ) received MET along with the moist hot pack (MHP), supervised exercises and home exercises common to both the groups. A total of 32 subjects completed the study with three dropouts. Subjects were evaluated before and after 10 treatment sessions for the outcomes, shoulder external rotation passive range of motion (ER-PROM) and abduction passive range of motion (ABD-PROM) using the universal goniometer, intensity of pain using the numeric pain rating scale (NPRS) and functional disability using the shoulder pain and disability index (SPADI).

Results

Analysis of 32 subjects showed that both groups were homogenous at baseline. The within-group analysis showed significant improvement (p < 0 . 05 ) in both groups related to all the outcomes. But when we compared the groups, Group B showed significant (p < 0 . 05 ) improvement in NPRS and SPADI in comparison to Group A. However, there was non-significant (p > 0 . 05 ) difference found in ER-PROM and ABD-PROM.

Conclusion

Both KMT and MET are effective in improving ROM, pain and function but MET showed a significant reduction of pain and improvement in function in subjects with chronic shoulder AC, thus supporting its use as a physiotherapeutic treatment technique.

Manual therapy and exercise for adhesive capsulitis: a systematic review with meta-analysis

BACKGROUND

Adhesive capsulitis (AC) affects approximately 1% of the general population. Current research lacks clear guidance on the dosage of manual therapy and exercise interventions.

OBJECTIVE

The purpose of this systematic review was to assess the effectiveness of manual therapy and exercise in the management of AC, with a secondary aim of describing the available literature present on the dosage of interventions.

METHODS

Eligible studies were randomized clinical/quasi-experimental trials with complete data analysis and no limits on date of publication, published in English, recruited participants >18 years of age with primary adhesive capsulitis, that had at least two groups with one group receiving manual therapy (MT) alone, exercise alone, or MT and exercise, that included at least one outcome measure of pain, disability, or external rotation range of motion, and that had dosage of visits clearly defined. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 Tool. The Grading of Recommendations Assessment, Development, and Evaluation was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted when possible, and dosage was discussed in narrative form.

RESULTS

Sixteen studies were included. All meta-analyses revealed non-significant effects of pain, disability, and external rotation range of motion at short- and long-term follow-up, with an overall level of evidence ranging from very low to low.

CONCLUSION

Non-significant findings with low-to-very-low-quality of evidence were found across meta-analyses, preventing seamless transition of research evidence to clinical practice. Lack of consistency in study designs, manual therapy techniques, dosing parameters, and duration of care impedes the ability to make strong recommendations regarding optimal dosage of physical therapy for individuals with AC.

Effect of Scapular Fixation on Lateral Movement and Scapular Rotation during Glenohumeral Lateral Distraction Mobilisation

BACKGROUND

Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation.

METHODS

Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation.

RESULTS

The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p < 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application.

CONCLUSIONS

Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition.

Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review

PURPOSE

To study the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following arthroscopic rotator cuff repair (ARCR) at a minimum of 10-years follow-up.

METHODS

Two independent reviewers performed a literature search of PubMed, Embase, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only studies reporting on outcomes of ARCR with a minimum 10-year follow-up were considered for inclusion. Patient demographics, satisfaction, and clinical, radiologic, and surgical outcomes were evaluated.

RESULTS

Our search found 9 studies including 455 shoulders in 448 patients (51.6% male patients), with age at time of surgery ranging from 45 to 90 years met our inclusion criteria. Overall follow-up ranged from 10 to 18 years. At final follow-up, the ranges of American Shoulder & Elbow Surgeons, age- and sex-adjusted Constant-Morley, and University of California Los Angeles scores were reported in 5, 6, and 3 studies, respectively, as 79.4 to 93.2, 73.2 to 94, and 26.5 to 33, respectively. Of the included studies, satisfaction rates varied in 6 studies from 85.7% to 100% in the long-term. Additionally, the overall radiologic retear rate ranged from 9.5% to 63.2%. The overall surgical revision rates ranged in 6 studies from 3.8% to 15.4%, with from 0% to 6.7% requiring revision ARCR and from 1.0% to 3.6% requiring revision subacromial decompression in 6 and 2 studies, respectively, at minimum 10-years' follow-up.

CONCLUSIONS

In this study, we found that ARCR results in high rates of patient satisfaction, satisfactory clinical outcomes with respect to patient-reported functional outcomes and range of motion, and low revision rates at minimum 10-years' follow-up. However, an overall 30% retear rate was observed in asymptomatic patients.

LEVEL OF EVIDENCE

Level IV, systematic review of Level II-IV studies.

A Review on Current Notion in Frozen Shoulder: A Mystery Shoulder

Frozen shoulder (FS) is a common condition affecting the population between the ages of 30 and 60; the causative agent is idiopathic, sedentary lifestyle, post-traumatic, or secondary to any pathological conditions. The pathology of FS is characterized by cytokine-mediated synovial inflammation with fibroblastic proliferation. The clinical features of FS vary depending on the phase in which the individual is present. The common clinical features are pain, and reduction in the range of motion in the capsular pattern. The available treatment options are medical therapy such as corticosteroid injection, physical therapy, joint mobilization, joint mobilization under anesthesia, and mirror therapy. When all the conservative methods fail then surgical procedures are used which include the surgical release of the restriction formed in the capsule. In conclusion, steroid injection along with physical therapy shows significant improvement in the range of motion and reduction in pain in the shoulder.

Investigating the effects of mobilization with movement and exercise on pain modulation processes in shoulder pain - a single cohort pilot study with short-term follow up

OBJECTIVE

To explore the association between manual therapy and exercise and pain modulation and clinical characteristics in people with musculoskeletal shoulder pain.

METHODS

This is a prospective, longitudinal, single cohort pilot study. People with shoulder pain for longer than 6 weeks underwent 4 weeks of glenohumeral mobilization with movement and shoulder exercises. Measures of pain modulation, shoulder pain, disability, range of motion and psychosocial factors were assessed at baseline and immediately after the 4-week period of treatment. Treatment effectiveness was assessed through parametric, non-parametric and multilevel modeling statistics.

RESULTS

Twenty-three individuals participatedwith no loss to follow-up. Significant and meaningful improvements in shoulder pain (NRS mean change 1.6/10, 95% CI 0.4 to 2.7), disability (SPADI mean change 20.5/100, 95% CI 13.1 to 27.9) and range of motion (mean change 33°, 95% CI 23 to 43°) were observed following treatment. Statistical but non-clinically meaningful changes were observed in temporal summation of pain (mean change 0.3/10, 95% CI 0.1 to 0.4) and anxiety (mean change 0.86/21, 95% CI 0.18 to 1.55). Significant reductions were observed in temporal summation of pain (mean change 0.3/10, 95% CI 0.1 to 0.4) and anxiety (mean change 0.86/21, 95% CI 0.18 to 1.55), however these were not considered clinically important. No association was found between clinical characteristics and sensory measures. No association was found between clinical characteristics and sensory measures.

CONCLUSION

Glenohumeral mobilization with movement and exercise did not improve pain modulation, despite improvements in pain, function and range of motion, in people with shoulder pain.

The Effect of Scapular Fixation on Scapular and Humeral Head Movements during Glenohumeral Axial Distraction Mobilization

Background and Objectives: Glenohumeral axial distraction mobilization (GADM) is a usual mobilization technique for patients with shoulder dysfunctions. The effect of scapular fixation on the movement of the scapula and the humeral head during GADM is unknown. To analyze the caudal movement of the humeral head and the rotatory movement of the scapula when applying three different intensities of GADM force with or without scapular fixation. Materials and Methods: Fifteen healthy subjects (mean age 28 ± 9 years; 73.3% male) participated in the study (twenty-eight upper limbs). Low-, medium- and high-force GADM in open-packed position were applied in scapular fixation and non-fixation conditions. The caudal movement of humeral head was evaluated by ultrasound measurements. The scapular rotatory movement was assessed with a universal goniometer. The magnitude of force applied during GADM and the region (glenohumeral joint, shoulder girdle, neck or nowhere) where subjects felt the effect of GADM mobilization were also recorded. Results: A greater caudal movement of the humeral head was observed in the non-scapular fixation condition at the three grades of GADM (p < 0.008). The rotatory movement of the scapula in the scapular fixation condition was practically insignificant (0.05−0.75°). The high-force GADM rotated scapula 18.6° in non-scapular fixation condition. Subjects reported a greater feeling of effect of the techniques in the glenohumeral joint with scapular fixation compared with non-scapular fixation. Conclusions: The caudal movement of the humeral head and the scapular movement were significantly greater in non-scapular fixation condition than in scapular fixation condition for the three magnitudes of GADM force.

Effectiveness of extracorporeal shockwave therapy for frozen shoulder in perimenopausal diabetic women

Study aim: To evaluate the effectiveness of extracorporeal shockwave therapy (ESWT) for frozen shoulder in perimenopausal diabetic women.

Materials and methods: A single blind randomized controlled trial was conducted on sixty-two perimenopausal women diagnosed with diabetic frozen shoulder. They were divided randomly into two groups. Group (A) received physiotherapy program in the form of maitland joint mobilization for shoulder joint, self-stretching exercises, range of motion exercises (ROM) and strengthening exercises. Sessions were held 3 times per week, for 4 weeks. Group (B) study group: received the same physiotherapy program in addition to ESWT, once per week, for 4 weeks. Visual analogue scale was used to measure pain intensity, shoulder pain and disability index (SPADI) was used to evaluate disability level, while an electrogoniometer was used to measure shoulder flexion, abduction and external rotation range of motion. All measurements were recorded pretreatment and posttreatment program.

Results: For intragroup comparison, significant improvement in all treatment outcomes was noted in both groups (P < 0.05). However, no significant differences were found between both groups regarding all outcome measures in case of intergroup comparison in the study (P > 0.05).

Conclusion: The use of ESWT have a positive effect in reducing pain and improving shoulder range of motion in perimenopausal women suffering from frozen.

In vivo measurements of glenohumeral distraction technique performed in three different joint positions

Introduction: Distraction techniques are an important part of the manual approach in the glenohumeral joint; however, there is controversy regarding the initial joint position to maximize separation of joint surfaces.Objective: To identify, through an in vivo exploration, the behavior of the coracohumeral distance (CHD) during the application of a short lever arm grade III distraction technique on the humeral head, executed in three different glenohumeral positions (zero position (P0), rest position (RP) and 90º abduction position with maximum external rotation (ABD+ER)).Methods: 15 participants were selected. A physical therapist executed grade III distraction techniques in described joint positions. Ultrasound was used to visualize the differences in CHD. Statistical analysis included interclass correlation coefficients (ICC) and repeated measurements of ANOVA.Results: The range of ICC values was 0.740 and 0.948. The differences in CHD were 5.74 ± 0.51 mm, 3.97 ± 0.24 mm, and 0.64 ± 0.02 mm, for P0, RP and ABD+ER during application of distraction technique, respectively. There were differences between P0 and RP with ABD+ER (P < 0.001), and no differences between P0 and RP.Conclusion: Initial joint position of application influences the separation of the articular surfaces, being wider in the zero and rest positions.

A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized Controlled Trial

PURPOSE

To investigate the possible effects of multisite injection therapy around the shoulder and prospectively compare the pain relief, range of motion (ROM), and functional scores of randomly selected patients with primary frozen shoulder using the American Shoulder and Elbow Surgeons score and the University of California-Los Angeles score after the completion of a standard physiotherapy program.

METHODS

Seventy-six patients with primary frozen shoulder were randomly divided into 2 groups based on the treatment: multisite injection and single injection. In the multisite-injection group, the glenohumeral joint and posteroinferior capsule, subacromial space, posterosuperior capsule, biceps long head, and coracohumeral ligament were injected with a combination of 2 mL of triamcinolone acetonide (40 mg/mL), 4 mL of bupivacaine (0.5%), and 34 mL of saline solution. The glenohumeral joint in the single-injection group was injected with 1 mL of triamcinolone acetonide (40 mg/mL) and 2 mL of bupivacaine (0.5%). Patients in both groups underwent physical therapy using the same protocol. Patients were evaluated for pain (visual analog scale score), functional status, and active and passive joint ROM at 1, 3, and 6 months and 1 year after the injection.

RESULTS

The follow-up rate was 82.6%, and significantly lower VAS scores were recorded in all periods in the multisite-injection group compared with the single-injection group (P = .01). In terms of active and passive ROM, the follow-up results were significantly better in the multisite-injection group (P < .05). Significantly higher functional scores were recorded in the multisite-injection group (P < .05).

CONCLUSIONS

Both treatments were effective in patients with primary frozen shoulder. However, the multisite-injection technique provided better pain palliation, better ROM restoration, and better functional results than the single glenohumeral injection in patients with primary frozen shoulder who were treated with the same physiotherapy regimen.

LEVEL OF EVIDENCE

Level I, prognostic comparative study.

How to Assess Shoulder Functionality: A Systematic Review of Existing Validated Outcome Measures

The objective of this review was to compile validated functional shoulder assessment tools and analyse the methodological quality of their validations. Secondarily, we aimed to provide a comparison of the tools, including parameter descriptions, indications/applications, languages and operating instructions, to choose the most suitable for future clinical and research approaches. A systematic review (PRISMA) was conducted using: PubMed, WoS Scopus, CINHAL, Dialnet and reference lists until 2020. The main criteria for inclusion were that papers were original studies of validated tools or validation studies. Pre-established tables showed tools, validations, items/components, etc. The QUADAS-2 and COSMIN-RB were used to assess the methodological quality of validations. Ultimately, 85 studies were selected, 32 tools and 111 validations. Risk of bias scored lower than applicability, and patient selection got the best scores (QUADAS-2). Internal consistency had the highest quality and PROMs development the lowest (COSMIN-RB). Responsiveness was the most analysed metric property. Modified UCLA and SST obtained the highest quality in shoulder instability surgery, and SPADI in pain. The most approached topic was activities of daily living (81%). We compiled 32 validated functional shoulder assessment tools, and conducted an analysis of the methodological quality of 111 validations associated with them. Modified UCLA and SST showed the highest methodological quality in instability surgery and SPADI in pain.

Dynamic scapular recognition exercise improves scapular upward rotation and shoulder pain and disability in patients with adhesive capsulitis: a randomized controlled trial

BACKGROUND

Examine the ability of a dynamic scapular recognition exercise to improve scapular upward rotation and decrease shoulder pain and disability in patients with adhesive capsulitis of the shoulder.

METHODS

A test-retest randomized controlled study design was used. A total of sixty-six patients with unilateral adhesive capsulitis were equally divided into two groups. The study group received a dynamic scapular recognition exercise using a wireless biofeedback system, while the control group received placebo treatment in the form of active range-of-motion (ROM) exercises of the sound upper limb. A digital inclinometer was used to measure the scapular upward rotation and ROM of the shoulder joint, and the Shoulder Pain and Disability Index (SPADI) was used to measure the shoulder pain and disability.

RESULTS

Study results showed that after two weeks, there were statistically significant differences between the study and control groups in scapular upward rotation and shoulder flexion and abduction (P < .05) and nonsignificant differences in shoulder external rotation and SPADI (P > .05). After two and six months, there were statistically significant differences between study and control groups in scapular upward rotation; shoulder flexion, abduction and external rotation; and SPADI scores (P < .05).

CONCLUSION

This study showed that a dynamic scapular recognition exercise significantly improves scapular upward rotation and the ROM of shoulder flexion and abduction after two weeks. At two and six months, this exercise improves scapular upward rotation; ROM of shoulder flexion, abduction, and external rotation; and SPADI scores. These improvements persisted for six months after the performance of this exercise.

The effectiveness of joint mobilization techniques for range of motion in adult patients with primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis

OBJECTIVE

To determine the effectiveness of joint mobilization techniques in the range of motion in adult patients with primary adhesive shoulder capsulitis.

METHODS

Systematic review with meta-analysis. The search was performed in the MEDLINE/PubMed, PEDro, CENTRAL, LILACS, EMBASE, CINAHL, Scopus and Web of Science databases. The eligibility criteria were studies that used an oscillatory and/or maintained joint mobilization technique applied alone or added-on to a treatment program in patients with primary adhesive capsulitis at any stage. Two authors carried out the selection of studies and the extraction of data, independently. Risk of bias was evaluated according to the tool proposed by Cochrane.

RESULTS

We included 14 studies with variable risk of bias. Posterior mobilization compared to any other technique was not significantly different (0.95 degrees; 95% CI: - 5.93 to 4.02), whereas compared to a control group, the difference is 26.80 degrees (CI 95%: 22.71 to 30.89). When applying a set of joint techniques versus a control group, for abduction the difference is 20.14 degrees (95% CI: 10.22 to 30.05). In both cases, the results are statistically significant, and the effect size is moderate.

CONCLUSIONS

The evidence is not conclusive about the effectiveness of joint mobilization. When compared with treatments that do not include manual therapy, joint mobilization seems to have a favorable effect on the range of motion and pain reduction in patients with primary adhesive shoulder capsulitis.