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Objective: To investigate the effectiveness of extracorporeal shockwave therapy (ESWT) on pain, range of motion (ROM) and disability on adhesive capsulitis (AC) in patients with type 2 diabetes mellitus (DM). Method: Clinical trials assessing the effectiveness of extracorporeal shockwave therapy on adhesive capsulitis in diabetes mellitus patients were included. Academic databases of Pubmed, Scopus, Web of Science, Cochrane Library, Science Direct, PEDro and grey literature sources such as Clinical trials.gov and Google Scholar were searched from the year 2000 to 2021.Physiotherapy Evidence Database (PEDro) scale was used to determine overall quality of each included article. Result: The search yielded eight studies evaluating the effectiveness of ESWT plus shoulder exercises and mobilization on AC in type 2 DM patient population. Compared to control treatment groups in majority of included studies ESWT appeared to be effective in managing pain, ROM and disability and showed large to very large treatment effects. Two of included studies reported positive effects of ESWT on inflammatory markers and blood glucose levels. Conclusion: Findings from this review suggested that ESWT combined with shoulder exercises and mobilization may be a useful treatment modality in shoulder AC for type 2 DM patients for pain reduction, disability and ROM improvement. There was insufficient data to confirm the findings of ESWT on blood glucose and inflammatory markers in diabetic patients. Therefore, future studies are needed to evaluate its effectiveness on these outcomes. Trial registration number: #CRD4202127949. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the therapeutic effect of combining ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy compared with physical therapy alone in patients with adhesive capsulitis. Design: A prospective, single-blinded, randomised controlled trial. Setting: Single medical centre. Participants: Patients with adhesive capsulitis (N = 62) were divided into group A: ultrasound-guided hydrodilatation with hyaluronic acid + physical therapy (N = 31) and group B: physical therapy alone (N = 31). Interventions: Group A received three doses of ultrasound-guided hydrodilatation with hyaluronic acid-based injectates (20 mL in total). Both groups underwent structured physical therapy. Outcome measures: The primary outcome measure was Constant score, while secondary outcomes included Shoulder Pain and Disability Index score, numerical rating scale (at rest, night, and during motion), 36-item Short Form Health Survey, and range of motion of the shoulder. All measurements were collected at baseline, 6 weeks, and 12 weeks post-injection. Results: At week 12, the Constant scores were 68.29 ± 14.55 and 62.77 ± 14.44 for groups A and B, respectively. There was a greater reduction in the Constant score, Shoulder Pain and Disability Index, and numerical rating scale between the baseline and 6 weeks and between the baseline and 12 weeks in group A (Constant score: p < 0.05, Shoulder Pain and Disability Index: p < 0.01, and numerical rating scale: p < 0.05). Conclusion: The combination of ultrasound-guided hydrodilatation with hyaluronic acid in conjunction with physical therapy provides additional benefits compared to physical therapy alone for the treatment of adhesive capsulitis at up to 12 weeks. Trial registration: ClinicalTrials.gov: NCT02708706. [ABSTRACT FROM AUTHOR]

Platelet rich plasma (PRP) injections have been utilized in an attempt to provide improved pain and functional outcomes to patients with a variety of orthopaedic ailments. Adhesive capsulitis, also known as frozen shoulder is a common debilitating condition that carries significant morbidity due to the painful and prolonged course. Various studies have investigated intra-articular PRP administration with different methodologies and outcomes. We sought to perform a meta-analysis on outcomes of adhesive capsulitis after PRP injection, determine effectiveness compared to corticosteroid, and compare adverse events. Meta analysis. EMBASE, EBSCO, Pubmed and Google Scholar were used to extract titles and abstracts using keywords "adhesive capsulitis", "frozen shoulder", "PRP", "platelet rich plasma". 41 articles were found and after duplicates removed and full-text review, 7 studies investigating 385 patients undergoing PRP or corticosteroid injections were found. Age, gender, body mass index (BMI), and ASA scores were obtained. Patient reported outcomes (PROs) were obtained and all reported range of motion (ROM) were recorded and compared after PRP and steroid injections using random effects meta-regression pre-injection and post-injection. Both intra-articular PRP and steroid injections resulted in improved outcomes for treatment of adhesive capsulitis at 3 months. PRP injections had significantly better range of motion in passive forward flexion (151° vs 144.1°, p = 0.024) and had improved Shoulder Pain and Disability Index (SPADI) scores (14.6° vs 18.6°, p = 0.009) compared to steroid, however these may not reach minimum clinical thresholds. PRP had significantly better active (60° vs 43. 5°, p = 0.038) and passive internal rotation (69.6° vs 52.7°, p = 0.017) compared to steroid which did reach minimum clinical thresholds. There were no differences detected between VAS pain, active forward flexion, extension, abduction, external rotation nor difference in adverse events. Both injections decreased pain and improved range of motion in patients. Intra-articular PRP injections may result in improved internal rotation compared to corticosteroid. Improvement in SPADI and passive forward flexion may be statistically significantly but may not be clinically relevant. 3, Therapeutic. [ABSTRACT FROM AUTHOR]

Introduction: Adhesive Capsulitis is a common condition of the shoulder with significant morbidity and protracted disease. It is usually characterized by sudden onset with progressive symptoms of pain and loss of function. This systematic review compares platelet rich plasma (PRP) intra-articular injections with corticosteroids (CS) injections and physiotherapy. Material and methods: A literature search was performed using online databases (Pubmed, Cochrane, EMBASE, Medline and CINAHL) including all the studies performed on humans through April 2023. Prospective comparative studies were included in this review of patients with adhesive capsulitis assessing the use of PRP injections versus corticosteroid injections or physiotherapy. The standardized mean difference (SMD) with 95 % confidence interval in VAS/DASH/SPADI and ROM scores was calculated using a random effects model, comparing PRP to corticosteroids injections and physiotherapy across studies. Results: A total of 11 studies and 971 patients, with a mean age of 52.1, were included in this analysis with 7 being randomised trials and four cohort studies. The control group was corticosteroid injections in 8 studies and physiotherapy in the other three studies. Overall PRP lead to a statistically significant improved outcome at 3 and 6 months follow up for all outcome parameters. The outcome measures at three months includes VAS 0.73 (0.31, 1.16) SMD, DASH 0.66 (0.36, 0.96) SMD, SPADI 1.50 (0.43, 2.57) SMD, ER 1.47 (0.27, 2.66) SMD and Abduction 1.10 (0.21, 1.98) SMD. Six months assessment similarly favoured PRP with VAS 3.17 (1.26, 5.08) SMD and DASH 2.10 (1.66, 2.55) SMD scores. Furthermore, a subgroup analysis demonstrated that PRP was favourable to corticosteroids as control with significant improvement in pain (VAS) at 3 months 0.65 (0.29, 1.00) and 6 months 3.17 (1.26, 5.08) SMD. Conclusion: This review demonstrated that intra-articular PRP injections for adhesive capsulitis produces favourable outcomes when compared to corticosteroid injections and physiotherapy. PRP produces improved pain and functional scores as well as range of motion, which is statistically significant from 3 to 6 months post intervention. PRP seems to be a safe and effective alternative non-invasive treatment modality for patients with adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis is an inflammatory condition that causes discomfort and stiffness in the shoulder which has a prevalence of 2% to 5%. Hence this research work is done to check the efficacy of Maitland mobilization technique versus Exercise with therapeutic ultrasound in adhesive capsulitis. Purpose: To find out the effects of Maitland mobilization technique & exercise with therapeutic ultrasound in adhesive capsulitis. Materials and Methods: Total of 28 participants were selected from Vijay physiotherapy clinic and divided into two groups. Group A was allocated with 14 participants and managed with Maitland mobilization technique and ultrasound. Group B 14 participants were managed with exercises and ultrasound for 4 weeks. The participant's intervention effects were assessed using VAS, SPADI Scale and Range of motion Study Period: November 2022 to July 2023. Result: This study results showed a significant (p value 0.0001) reduction in pain and improvement in shoulder disability values and ROM of adhesive capsulitis participants in group A (Maitland mobilization technique and Ultrasound) compared with group B (Exercise and Ultrasound). Conclusion: This study found that the Maitland Mobilization technique as well as Exercise both seems to be effective in treating adhesive capsulitis. But the patients in Maitland Group show greater improvement than the exercise group. [ABSTRACT FROM AUTHOR]

Background: Adhesive Capsulitis in the shoulder characterized as a self-limiting situation that lasts only while it has also been described as a 24 week long-term impairment caused by a chronic condition. SMET is a widely used method to restore normal ROM and reduce pain. PNF aims to improve joint synchronization, movement control, and mobility. Purpose: This study focuses on the effect of Spencer Muscle Energy Technique and Proprioceptive Neuromuscular Facilitation for reducing pain and disability in Adhesive Capsulitis. Materials and Methods: A total of 40 participants were selected based on inclusion and exclusion criteria from Eyan Healthcare Foundation during the period of November 2022 to July 2023. They were split into two groups, with 20 Participants receiving Spencer Muscle Energy Technique and 20 Participants receiving Proprioceptive Neuromuscular Facilitation. Subjects with age of 40-70 years, with or without diabetes and pain or stiffness on shoulder were included and Subjects with recent trauma, injury around the shoulder were excluded in the study. All the subjects underwent pre-test measurement with Shoulder Pain and Disability Index (SPADI) and the same repeated for post-test measurement at the end of 4 weeks. Results: By statistical analysis there is a significant difference between the two groups. The Spencer group displays a greater difference than the PNF group when comparing mean differences of the two groups using SPADI. Conclusion: The study concluded that subjects who underwent Spencer Muscle Energy Technique are found to be more effective in reducing pain and disability than Proprioceptive Neuromuscular Facilitation in Adhesive Capsulitis. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether combination of corticosteroid subdeltoid injections and physiotherapy was more effective than either treatment alone in chronic subacromial bursitis. Design: Prospective, three-arm randomised controlled trial. Setting: Rehabilitation department of an academic hospital. Subjects: Patients with chronic subacromial bursitis. Interventions: Patients were divided into corticosteroid injection (N = 36), physiotherapy (N = 40) and combined (N = 35) groups. Two corticosteroid subdeltoid injections in corticosteroid group, 8-week physical therapy emphasising on therapeutic exercise in physiotherapy group, and combined both treatments in combined group. Main outcome measures: The primary outcome measures were pain visual analogue scale and Shoulder Pain and Disability Index at 8 weeks after finishing treatment. The secondary outcome measures were active range of motion, Shoulder Disability Questionnaire, Western Ontario Rotator Cuff Index, patient's evaluation of treatment effect, and symptom recurrence. Results: Group comparison showed significant statistical difference in shoulder flexion (P < 0.003) and patient's evaluation of treatment effect (P < 0.001). The time and group interactions comparison revealed significant statistical differences in pain score (P < 0.024), external rotation (P < 0.044) and patient's evaluation of treatment effect (P < 0.001). The above statistics were in favour of the corticosteroid and combined groups rather than physiotherapy group. The percentage of recurrence was 36.1, 7.5 and 17.1 in the corticosteroid, physiotherapy and combined groups, respectively (P < 0.001). Conclusion: Corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone, but the recurrence rate was least in the physiotherapy group. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis is a progressive, idiopathic disorder that significantly impacts individuals? daily lives and increases their medical burden. Pharmacopuncture therapy, which combines acupuncture techniques with herbal medicine, involves injecting herbal extracts into specific acupoints. This study aims to determine the effectiveness and safety of pharmacopuncture therapy in comparison to physiotherapy (PT) for treating adhesive capsulitis Methods: This research protocol outlines a two-arm, parallel, multi-center, pragmatic randomized controlled trial. Fifty participants will be randomly allocated to either the pharmacopuncture therapy or PT group, and they will receive 12 sessions of their respective therapies over a 6-week period. The primary outcome measure is the numeric rating scale for shoulder pain. Secondary outcomes include the visual analog scale score for shoulder pain, Shoulder Pain and Disability Index, Patients? Global Impression of Change score, Short Form-12 Health Survey Version 2 score, and EuroQol-5 Dimension. Statistical analysis will be conducted based on the intention-to-treat principle. Discussion: This trial may offer high-quality and reliable clinical evidence for evaluating the effectiveness and safety of pharmacopuncture therapy compared to PT in the treatment of adhesive capsulitis. Furthermore, this study will serve as a valuable guideline for practitioners when making clinical decisions and managing adhesive capsulitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adhesive capsulitis (AC) is a common musculoskeletal disease characterized with shoulder pain, limitation of range of motion (ROM) and disability. Although physical therapy is used in the treatment of AC, studies on its effectiveness are continuing. OBJECTIVE: This study aimed to assess the effectiveness of ultrasound (US) and high-intensity laser therapy (HILT) in the treatment of AC. METHODS: Sixty patients were randomized into two groups. Group I received US (15 sessions) and Group II received HILT (9 sessions) for 3 weeks. In addition, all patients received physical therapy program (hot pack, TENS and exercises). Assessments were made using VAS-pain, Shoulder Pain and Disability Index (SPADI), range of motion (ROM) at baseline and in post-treatment 3 rd , 8 th and 24 th weeks. RESULTS: There was no statistically significant difference between the groups in terms of all pre-treatment values. In intragroup assessment, statistically significant difference was identified in all the values of Groups 1 and 2 in all assessment periods compared with the pre-treatment values (p < 0.05). There was no significant difference between groups in all assessment periods. CONCLUSION: According to results, US therapy and HILT were effective on the improvement of pain, ROM and functional conditions of patients in the treatment of AC. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis is a clinical diagnosis made from a history of the gradual onset of severe shoulder pain with the progressive limitation of active and passive glenohumeral movements. The most significant loss of movement is in the external rotation of the joint. Traditionally physical therapists have used an anterior glide of the humeral head on the glenoid technique to improve external rotation range of motion a choice based on 'convex on concave' concept of joint surface motion. Aim & objective of the study: To compare the effect of IFT with anterior glide versus posterior glide joint mobilization technique on shoulder external rotation ROM in patients with adhesive capsulitis. Data Analysis and Results: This study results shows that there is statistically significant improvement in the variables of shoulder pain and disability index (SPADI) and Shoulder External Rotation ROM between pre and post mean values in both control and experimental group with p<0.05. The Post mean values of SPADI and Shoulder External Rotation ROM in degrees with p values p<0.05 in Control group when compared to Experimental Group. Conclusion: This study concluded that both anterior glide and posterior glide with Interferential therapy reduce the pain and improve the external rotation range of motion in adhesive capsulitis. Meanwhile, interferential therapy with anterior glide is more effective than the interferential therapy with posterior glide in reducing the pain and improving the external rotation range of motion in adhesive capsulitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Frozen shoulder (FS), also known as shoulder adhesive capsulitis, is a musculoskeletal disorder associated with pain and functional disability. There is a lack of evidence on the optimal treatment strategy for FS. OBJECTIVE: The present study aimed to evaluate the effectiveness and safety of ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy for treatment of FS. METHODS: In this prospective randomized, double-blind, controlled study, 63 FS patients were recruited, and equally allocated to treatment group and control group. The treatment group was treated with ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy, while the control group was only treated with ultrasound-guided hydrodilatation of glenohumeral joint. The pain and mobility of shoulder, overall efficacy and adverse reactions were evaluated 3 months after treatment. RESULTS: At baseline, no significant difference in all characteristic value was found between the treatment group (n = 33) and control group (n = 30). Three months after operation, the joint's Active Range of Motion (AROM) and Constant-Murley Scale (CMS) scores in the experimental group were higher than those in the control group, and the coracohumeral ligament (CHL) thickness and the rate of hypoechoic thickening in rotator cuff space in the experimental group were lower than those in the control group (all P < 0.05). The amount of injection volume at the third hydrodilatation was significantly higher in the experimental group than that in the control group (15.8 ± 4.7 vs 12.2 ± 5.2, P = 0.03). After 2 times of treatment, the volume increment of glenohumeral joint Δ 2 in the experimental group was greater than that in the control group (3.5 ± 1.8 vs 1.2 ± 1.6, P < 0.001). There were significant differences in the effective rate between the two groups (93.94% vs. 76.67%, P = 0.04). CONCLUSION: The ultrasound-guided hydrodilatation of glenohumeral joint combined with acupotomy may benefit FS patients. [ABSTRACT FROM AUTHOR]

To summarise factors that might influence treatment outcomes of physical therapy in patients with frozen shoulder. A systematic literature study was performed by searching electronic bibliographies PubMed and Web of Science. Original full text research articles about human adults with frozen shoulder, assessing influencing factors of treatment outcome of physical therapy were included in the review. Sixteen studies were included in this systematic review. Methodological quality of the included studies was low to moderate and most studies had level of evidence B. Duration of symptoms and affected shoulder were found not to influence range of motion. Preliminary evidence was found for shoulder kinematics, pain, functionality, therapy compliance, and interactive rehabilitation as possible influencing factors. Conflicting evidence was found for co-morbidities, gender, and age. Most frequent used interventions were exercises, stretching, and mobilisation. Level of conclusion 2 was found for duration of symptoms and affected shoulder for not influencing range of motion. Some limitations are that only few studies specifically investigated influencing factors and there is a difference in research and physical therapy protocols and outcome measures used. Therefore, more high-quality research with standardised protocols is needed to confirm preliminary evidence and elucidate conflicting results. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. Design: Single-blind randomized clinical trial. Setting: Outpatient setting. Subjects: Patients with frozen shoulder. Intervention: Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. Main Measures: The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. Results: Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [−4.63 (−5.58–−3.67) vs. −2.22 (−2.96–−1.47), P < 0.001 and −23.08 (−28.63–−17.53) vs. −13.04 (−17.93–−8.16), P = 0.008, respectively] and one month after the beginning of the treatment [−5.58 (−6.45–−4.72) vs. −3.61 (−4.60–−2.62), P < 0.001 and −33.43 (−40.85–−26.01) vs. −20.03 (−26.00–−14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy 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 range of motions. Conclusions: Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients. [ABSTRACT FROM AUTHOR]

Background. Frozen shoulder is a widespread concern having an unknown etiology. Management mainly aims at restoring function and treating symptoms. The choice of treatment may differ based on patient variables, stage of presentation, priorities of clinicians, and funding. No robust evidence exists to endorse one treatment modality over another in a conclusive way. Therefore, we performed a systematic review of the conservative therapeutic options for the frozen shoulder. Materials and methods. A wide range of electronic bibliographic databases such as PubMed, Embase, and ERIC was searched. Based on the eligibility criteria, all randomized controlled trials that compared the efficacy of any type of non-surgical or conservative management from 2010 to 2020 are incorporated in the review. Following screening and assessing the abstracts, we ended up reviewing 12 full-text articles and data extracted on essential parameters such as sample size, type of non-surgical treatment, time of follow-up, and primary outcomes. Results. Overall, the systematic review results seem promising for the efficacy of different non-surgical modalities. They improve multiple outcomes such a pain, range of motion, Constant-Murley score, simple Shoulder Test, Shoulder Pain, Disability Index, and patient satisfaction. Nonsurgical management is the preferred initial care option, with most patients typically improving within 6 to 18 months. Steroids, physiotherapies, hydrodilatation with hypertonic saline, suprascapular nerve block (SNB), Extracorporeal shockwave therapy, and intra-articular steroid or sodium hyaluronate injections are conservative treatment choices. Conclusions. Treatment of frozen shoulder remains a challenge, and high-level conclusive evidence is needed to recommend one treatment method over another. The results of this systematic review showed that nonsurgical management, regardless of the preferred treatment option, is beneficial and effective in the treatment of frozen shoulder, and that can guide clinicians in making evidence-based decisions when managing this condition conservatively. This will avoid unnecessary burdens on the healthcare system and patients, as they might be treated effectively without undergoing surgery. [ABSTRACT FROM AUTHOR]

Frozen shoulder syndrome, also called an adhesive capsule, is in many ways a mysterious disease; the exact causes of this complication are unknown. Pain and stiffness associated with frozen shoulders are caused by the shoulder joint capsule. This is a group of ligaments or connective tissues that attach the shoulder to the arm. When the capsule hardens or swells, the shoulder freezes. There are different types of exercise therapy useful to improve the range of motion and level of pain. This paper has tried to determine this issue based on the previously published papers, especially among retired athletes. For this purpose, various databases were used and papers published after 2016 were collected. The findings of this analysis emphasized doing regular exercise training and stretching among retired athletes to prevent frozen shoulders. [ABSTRACT FROM AUTHOR]

Background Hypervascularity of the rotator interval with increased expression of the vascular endothelial growth factor may be the causative factor of conventionally managed adhesive capsulitis. Hence, transcatheter arterial embolisation(TAE) has emerged as an alternative treatment option to occlude the target neovessels by infusing an embolic agent. The present study reviews the literature regarding the efficacy of the TAE for adhesive capsulitis. Material and methods The systematic review was performed following PRISMA guidelines. MEDLINE, Google Scholar, Scopus and Cochrane database of systemic reviews (CDSR) were searched for relevant publication (from 1960 to 2021). The search algorithm used was Transcatheter arterial embolisation and resistant adhesive capsulitis or refractory adhesive capsulitis or vascular adhesive capsulitis. The database search produced a total of 12026 publications. After exclusion of the non relevant titles, 113 abstracts were reviewed. From these abstracts, three full-text articles were obtained for final review. Results All the studies were analyzed in depth. Patients with no or minimal improvement with conservative treatment for at least 3 months underwent TAE. Pre and post embolisation visual analog score(VAS), shoulder range of motion(ROM) were noted. Any additional therapy was also taken into account. Significant improvement of the VAS score and shoulder ROM was noted immediately after surgery and maintained till final follow up at 24.5 months. Conclusion Resistant cases of adhesive capsulitis can be managed successfully with TAE. But ample evidence is lacking regarding the appropriate patient selection and efficacy of TAE as a sole management option of resistant AC. [ABSTRACT FROM AUTHOR]

Objective. To determine whether arthrographic distention combined with manipulation for frozen shoulder provides additional benefits. Methods. A total of 180 participants from five clinical centers with pain and stiffness in predominantly 1 shoulder for >3 months entered the study, and 165 completed the study. The control group was treated with arthrographic distention alone, and the treatment group underwent manipulation after resting for 5 minutes following arthrographic distention. Patients were followed up at the one and two weeks and at three and six months. For the clinical evaluation, shoulder-specific disability measure (SPADI) score, the visual analog scales (VASs) for pain, and range of active motion were used. Results. 83 patients out of 90 in the treatment group and 82 out of 90 in the control finished the entire study period. SPADI, VAS, Constant-Murley (CM), and range of motion (ROM) were improved after treatments in both groups. The statistical differences were not observed in the CM, adduction, internal rotation, and posterior extension function between groups (P >.05) after the first treatment. And the statistical differences were not observed in the internal rotation, the extorsion, and posterior extension function (P >.05) after the second treatment. Conclusion. Distention arthrography plus manual therapy provided faster pain relief, a higher level of patient satisfaction, and an earlier improvement in AROM of the shoulder than distention arthrography alone in patients with frozen shoulder. [ABSTRACT FROM AUTHOR]

Background: Although the clinical outcomes of manipulation under ultrasound-guided fifth and sixth cervical nerve root block for frozen shoulder have been reported, few studies have focused on the timing of manipulation. This study aimed to determine whether the timing of manipulation impacts the clinical outcomes.Methods: We retrospectively reviewed the outcomes of 103 frozen shoulder patients (mean age 51.5 years) who underwent manipulation in one shoulder (n = 103 shoulders) between January 2012 and April 2019. Stiff shoulder was defined as limited range of motion in at least three directions, i.e., passive forward flexion of ≤100°, passive external rotation at the side of ≤10°, and internal rotation of ≤L5. The patients were categorized into two groups: those mobilized within 6 months after symptom onset (early group, 44 shoulders) and those mobilized >6 months after symptom onset (late group, 59 shoulders). The range of motion (forward flexion, external rotation, and internal rotation), Japanese Orthopaedic Association shoulder scores, Constant Shoulder Score, and University of California, Los Angeles scores before and 3, 6, and 12 months after manipulation were compared between groups.Results: The late group exhibited significant improvement in forward flexion, external rotation, internal rotation, Japanese Orthopaedic Association scores, Constant Shoulder Score, and University of California, Los Angeles scores at 3 months; forward flexion at 6 months; and forward flexion and University of California, Los Angeles scores at 12 months after manipulation compared to the early group.Conclusions: Our results indicate that timing has a significant influence on the outcome of manipulation for frozen shoulders. The optimal time for manipulation may be >6 months after symptom onset. These findings can be applied in counselling for frozen shoulder patients and for improved outcomes after manipulation. [ABSTRACT FROM AUTHOR]

Background: While platelet-rich plasma (PRP) has been widely studied for musculoskeletal disorders, few studies to date have reported its use for adhesive capsulitis (AC). Fully characterized and standardized allogenic PRP may provide clues to solve the underlying mechanism of PRP with respect to synovial inflammation and thus may clarify its clinical indications. Purpose: To clinically evaluate the safety and efficacy of a fully characterized pure PRP injection in patients with AC and to assess the effects of pure PRP on synoviocytes with or without inflammation in vitro. Study Design: Controlled laboratory study and cohort study; Level of evidence, 3. Methods: For the clinical analysis, a total of 15 patients with AC received an ultrasonography-guided intra-articular PRP injection and were observed for 6 months. Pain, range of motion (ROM), muscle strength, shoulder function, and overall satisfaction in the patients were evaluated using questionnaires at 1 week as well as at 1, 3, and 6 months after the PRP injection and results were compared with the results of a propensity score−matched control group that received a corticosteroid injection (40 mg triamcinolone acetonide). For the in vitro analysis, synoviocytes were cultured with or without interleukin-1β (IL-1β) and PRP. The gene expression of proinflammatory and anti-inflammatory cytokines as well as matrix enzymes and their inhibitors was evaluated. Results: At 6-month follow-up, pure PRP significantly decreased pain and improved ROM, muscle strength, and shoulder function to levels comparable with those after a corticosteroid injection. All pain values, strength measurements, and functional scores significantly improved up to 6 months in the PRP group, but these measures improved up to 3 months and then were decreased at 6 months in the corticosteroid group. ROM was significantly improved in the 2 groups at 6 months compared with baseline. Allogenic PRP did not cause adverse events. For the in vitro findings, PRP induced inflammation but significantly improved the IL 1β−induced synovial inflammatory condition by decreasing proinflammatory cytokines such as IL-1β, tumor necrosis factor−α, IL-6, cyclooxygenase-2, and microsomal prostaglandin E synthase−1 and decreased matrix enzymes (matrix metalloproteinase−1, −3, and −13 as well as a disintegrin and metalloproteinase with thrombospondin motifs−4 and −5) and further increasing anti-inflammatory cytokines such as vasoactive intestinal peptide. Conclusion: This study showed that PRP decreased pain and improved shoulder ROM and function to an extent comparable with that of a corticosteroid in patients with AC. Allogenic pure PRP acted in a pleiotropic manner and decreased proinflammatory cytokines only in the inflammatory condition. Clinical Relevance: Allogenic PRP could be a treatment option for the inflammatory stage of AC. [ABSTRACT FROM AUTHOR]

Purpose: Adhesive capsulitis of the hip (ACH) is likely that this condition had been previously encountered, but easily unrecognised. We investigated the clinical features of patients with ACH, the efficacy of ultrasound-guided intra-articular hydrodilatation, and the patients' prognosis.Methods: We enrolled 84 patients (93 hips) who visited the outpatient clinic from August 2018 to November 2019. ACH was diagnosed by restricted range of motion and sharp pain when turning with the affected leg fixed on the ground. We evaluated patient demographics and associated intra-articular pathologies found on magnetic resonance angiography (MRA) images. Injections were performed twice at two week intervals with a mixture of 0.5% lidocaine (25 mL) and triamcinolone (40 mg; 1 mL) with capsular distension under ultrasound guidance. Patients were assessed before and after treatment using a visual analogue scale (VAS), hip disability and osteoarthritis outcome score (HOOS), hip range of motion (ROM), and distance from floor to knee (DFK) when sitting in the cross-legged position.Results: On MRA, 18 patients had abnormal findings (eight labral tears, seven abductor tendinosis, three primary arthrosis). The mean VAS decreased from 7.1 ± 1.1 to 0.8 ± 0.9 after the last injection, and the HOOS improved in all subsets. The mean DFK decreased from 17.9 ± 4.8 to 9.7 ± 2.8 cm, and passive ROM showed improvement, especially in flexion and rotation. In seven patients, symptom recurrence was reported a mean of 4.1 months after the latest injection, but no independent risk factor for recurrence was identified.Conclusion: Based on these current observations, patients with ACH may receive relief from hip joint pain and experience improved function with a timely diagnosis and effective treatment. [ABSTRACT FROM AUTHOR]

Background: Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about their comparative efficacy and the effects of moderators. Purpose: To compare the efficacy of different nonsurgical interventions and identify potential patient-specific moderating factors for frozen shoulder. Study Design: Systematic review and network meta-analysis. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to February 18, 2019. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants with frozen shoulder that compared nonsurgical interventions were selected. Measured outcomes included pain, shoulder function in daily activities, and range of motion. Results: Of 3136 records identified, 92 trials were eligible, evaluating 32 nonsurgical interventions in 5946 patients. Intra-articular injection improved pain (pooled standardized mean difference [95% CI]: steroid injection, 1.68 [1.03-2.34]; capsular distension, 2.68 [1.32-4.05]) and shoulder function (steroid injection, 2.16 [1.52-2.81]; distension, 2.89 [1.71-4.06]) to a greater extent than placebo. Capsular distension and extracorporeal shockwave therapy showed the highest ranking for pain relief and functional improvement, respectively. Laser therapy also showed benefits for pain relief (3.02 [1.84-4.20]) and functional improvement (3.66 [1.65-5.67]). Subgroup analyses by disease stages revealed that steroid injection combined with physical therapy provided more benefits during the freezing phase, whereas joint manipulation provided more benefits in the adhesive phase. Adjunctive therapies, female sex, and diabetes were also identified as moderators of effectiveness. Conclusion: Capsular distension is a highly recommended choice for treatment of frozen shoulder, contributing greatly to pain relief and functional improvement; steroid injection is also a prevailing effective intervention. Among new options, extracorporeal shockwave therapy and laser therapy show potential benefits for multiple outcomes. Individualized optimal intervention should be considered, given that treatment effect is moderated by factors including the disease stage, time of assessment, adjunctive therapies, female sex, and diabetes. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effects of three modalities of pain management i.e. SSNB (suprascapular nerve block) with NIR (non invasive rehabilitation), IAI (intra articular injection) with NIR and, NIR alone in idiopathic frozen shoulder patients. Methods: A double blinded randomized clinical trial was conducted. 60 cases of idiopathic frozen shoulder were selected and randomly divided into three treatment groups; group 1: NIR, group 2: NIR + SSNB, group 3: NIR +IAI. Range of motion, pain score and disability (SPADI: shoulder pain and disability index) score were evaluated pre-treatment and at 12 weeks follow up. Results: All three groups were homogenous and comparable regarding their age, sex ratio, pretreatment pain score, disability score and range of motion. There was significant improvement (p < 0.05) post treatment in all three groups with respect to pain score, disability score and range of motion. SSNB with NIR group patients demonstrated better improvement in all parameters examined, which was statistically significant in pain score, disability score and internal rotation but was statistically equivalent for total range of motion and external rotation as compared to shoulder injection group. Conclusion: SSNB in combination with non invasive rehabilitation is an effective and safe mode of treatment for idiopathic frozen shoulder. Present study also proves that SSNB with NIR is a more effective mode of treatment for idiopathic frozen shoulder as compared to NIR alone or in combination with IAI. Level of evidence: Level 1. [ABSTRACT FROM AUTHOR]

The article offers insights on frozen shoulder diagnosis and individual treatment based on biomedical and psychosocial factors. Topics discussed include the unclear aetiology of the painful and stiff glenohumeral joint, the condition's pathophysiology and clinical presentation, its conservative management, and mobilisation techniques for it. Also noted the biopsychosocial component to shoulder pain.

Background: Adhesive Capsulitis idiopathic painful restriction of Shoulder movement results in global restriction of the glenohumeral joint. It is affecting 2% to 3% of the general population and affects many functional activities like combing, lifting, pushing and pulling. Although Physiotherapy is often the first line of management, there are various treatments has found its effectiveness but yet to date its protocol of treatment has not been established. So, it is necessary to find effectiveness of specific Physiotherapy treatment protocol for Adhesive Capsulitis. The aim of this study was to find effectiveness of Therapeutic Protocol for Physiotherapy management of Adhesive Capsulitis. Materials and Method: Experimental trial of 30 patients, diagnosed with primary Adhesive Capsulitis selected and divided into two groups. One group was given a Therapeutic Protocol based on review of literature and the other group was treated with Conventional Physiotherapy treatment for 4 Weeks. Pre and post treatment measurement of ROM, and SPADI Index were taken and statistical analysis was done. The two treatment strategies were compared, Group A showed better improvement in Abduction, IR ROM and Functional Score (SPADI) as compare to Group B which was treated with Conventional regular Physiotherapy Treatment. Improvement in Flexion, Extension and ER ROM was relatively less. Conclusion: Therapeutic Protocol proved effective for management of Adhesive Capsulitis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC. Methods: A consecutive series of 42 shoulders in 39 patients with idiopathic frozen shoulder underwent MUC. All patients were assessed according to the American Shoulder Elbow Surgeon (ASES) score and shoulder range of motion (ROM) both before MUC and at 1 year thereafter. If patients continued to have pain and limited ROM at 3 months after the procedure, they were offered a repeat MUC. Such patients were also assessed before the procedure and at 3 months and 1 year thereafter. Results: The initial MUC was successful in 31 shoulders (single group). Repeat MUC was required in 11 shoulders (repeat group). Patients in the single group showed significant improvement in ROM and ASES score at 1 year after the procedure (p < 0.001); similarly, patients in the repeat group had significant improvement in ROM and ASES score at 3 months and 1 year after the procedure (p < 0.001). Patients in the repeat group had had significantly more severely limited ROM (p < 0.01) and decreased ASES score (p < 0.001) before the procedure compared with those in the single group. Conclusions: A repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. When there is severely limited ROM and decreased ASES score before the MUC, a repeat MUC may be necessary, which would require the patient's informed consent. Trial registration: Retrospectively registered [ABSTRACT FROM AUTHOR]

Background: Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection.Methods: In this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508.Findings: Between April 1, 2015, and Dec 31, 2017, we screened 914 patients, of whom 503 (55%) were randomly assigned. At 12 months, OSS data were available for 189 (94%) of 201 participants assigned to manipulation (mean estimate 38·3 points, 95% CI 36·9 to 39·7), 191 (94%) of 203 participants assigned to capsular release (40·3 points, 38·9 to 41·7), and 93 (94%) of 99 participants assigned to physiotherapy (37·2 points, 35·3 to 39·2). The mean group differences were 2·01 points (0·10 to 3·91) between the capsular release and manipulation groups, 3·06 points (0·71 to 5·41) between capsular release and physiotherapy, and 1·05 points (-1·28 to 3·39) between manipulation and physiotherapy. Eight serious adverse events were reported with capsular release and two with manipulation. At a willingness-to-pay threshold of £20 000 per quality-adjusted life-year, manipulation under anaesthesia had the highest probability of being cost-effective (0·8632, compared with 0·1366 for physiotherapy and 0·0002 for capsular release).Interpretation: All mean differences on the assessment of shoulder pain and function (OSS) at the primary endpoint of 12 months were less than the target differences. Therefore, none of the three interventions were clinically superior. Arthoscopic capsular release carried higher risks, and manipulation under anaesthesia was the most cost-effective.Funding: The National Institute for Health Research Health Technology Assessment programme. [ABSTRACT FROM AUTHOR]

BACKGROUND: The pathological changes in adhesive capsulitis occurs surrounding the intrinsic structure tightness. Movement with mobilization mostly works on intracapsular & sleeper's stretch mainly acts on capsule. There are some studies which supports that M.W.M. is more effective in patients with adhesive capsulitis. At the same time, some studies have been done which proves sleeper's stretch to be beneficial in capsular tightness. As a result, present study thought to determine the combined effects of M.W.M.& Sleeper's Stretch on adhesive capsulitis. OBJECTIVES: To find the effects of M.W.M. on R.O.M., pain and functional disability in populations with adhesive capsulitis. To find the effects of M.W.M. and sleeper's stretch on R.O.M., pain and functional disability in populations with adhesive capsulitis. To compare the effects of M.W.M. and M.W.M. with sleeper's stretch on R.O.M., pain and functional disability in populations with adhesive capsulitis. METHODOLOGY: A Randomized, controlled, single blinded study, 50 patients with adhesive capsulitis were selected based on the inclusion and exclusion criteria. Pre -assessment of pain, R.O.M. and disability index had been taken. The patients are randomly allocated into two groups. 25 patients in Group 'A' with adhesive capsulitis was treated with M.W.M. alone where as another 25 patients in Group 'B' with adhesive capsulitis was treated with M.W.M. plus, sleeper's stretch. Both the groups were given the conventional therapy which includes hot packs, pendular exercises, finger ladder exercises and active range of motion exercises. Post assessment was done. RESULTS: In total, 50 patients were randomized to the study interventions. The flexion R.O.M. in pre and post mean values of Groups 'A' and 'B' are 18.41 and 29.16, P value is 0.04. The internal rotation R.O.M. in pre and post mean values of Groups 'A' and 'B' are 7.72 and 14.44, P value is 0.09. The external rotation R.O.M. in pre and post mean values of Groups 'A' and 'B' are 13.72 and 16.85, P value is 0.39. In SPADI, Pre & Post mean values of Group 'A' & Group 'B' are 16.83 and 24.41 respectively, P value is 0.28. In NPRS, Pre and post mean values of Groups 'A' and 'B' are 2.72 & 2.88 respectively, P value is 0.02. CONCLUSIONS: Adding sleeper's stretch with M.W.M. to standard therapy for adhesive capsulitis may offer significant advantages. [ABSTRACT FROM AUTHOR]

Background and Objectives: Adhesive capsulitis(AC) is a condition commonly affecting the shoulder with 2% prevalence, causing insidious pain and restriction of active as well as passive gleno-humeral movement. This study compares the effectiveness of Kaltenborn mobilization versus Mulligan's MWM technique for AC of the shoulder. Method: 56 participants were randomly allocated in Group M and Group K for the shoulder. SPADI and shoulder ROM were used as outcome measures. These were recorded at baseline and at the end of 2 weeks post treatment. Results: Statistically significant (p<0.05) improvements were found in Group K with respect to SPADI scores, while the same was observed in ROM although not statistically significant. Conclusion: Pain and disability along with ROM improved in both groups. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis is the very common in people with diabetes and people between the age group of 40 - 65 years of age. It is essential to design a treatment protocol which reduces pain and improve ROM and functional activity of the shoulder in least possible. As this condition is very painful and hampers the functional activity of the shoulder. Objectives: Objectives of the study were to determine the effect of posterior glide with MET for subscapularis muscle on adhesive capsulitis in reducing pain, improving ROM and functional activity of the shoulder. Material and Method: In this experimental study, the subject with adhesive capsulitis were assessed with VAS, ROM and SPADI, the subjects were given Maitland Technique (posterior glide) along with MET for subscapularis with conventional treatment. Results: Statistical analysis was done of VAS, ROM and SPADI in 40 subjects in which it was seen that post treatment showed extremely significant results in all the outcome measures. Conclusion: The current study concluded that Maitland technique (posterior glide) along with MET for subscapularis is effective in the management of Frozen Shoulder. Maitland technique (posterior glide) along with MET for subscapularis given with Conventional Treatment is significantly effective in reducing pain, increasing range of motion and functional status of Shoulder and thus Alternate Hypothesis accepted. [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence on the clinical effectiveness of hydrodistension for frozen shoulder following failed conservative management. Methods: A total of 90 patients opted for hydrodistension following failed initial treatment which included physiotherapy and at least one corticosteroid injection. Shoulder pain and function were assessed at baseline, and 6, 12 and 24 weeks using the Shoulder Pain Disability Index (SPADI), The Upper Extremity Functional Index (UEFI) and a visual analogue scale (VAS) for pain. Active ranges of motion were assessed at baseline, post‐24 hr and discharge. Results: We observed clinically important improvements in pain (VAS −5.5; 90% confidence interval [CI] −6.0 to −5.0; SPADI pain, −20; 90% CI−23 to −17) and function (UEFI 23; 90% CI 19 to 26; SPADI disability, −32; 90% CI −36 to −28) at 6 weeks. These improvements remained clearly substantial at 24 weeks. Active range of motion improved substantially post‐24 hr (flexion 20, 90% CI 18 to 23; lateral rotation 14, 90% CI 12 to 16; abduction 22, 90% CI 19 to 25) and at discharge (flexion 37, 90% CI 33 to 41; lateral rotation 24, 90% CI 21 to 27; abduction 44, 90% CI 38 to 50). Discussion: This single‐arm observational study suggests that hydrodistension is an effective treatment of frozen shoulder within a UK primary care setting when standard treatment has failed. [ABSTRACT FROM AUTHOR]

Background: Although numerous studies have suggested that frozen shoulder (FS) is a self-limiting disease with most patients recovering within 2 years, its long-term outcome is still controversial. The aims of this study were to evaluate the clinical outcomes after conservative treatment for FS and to determine the predictors of its clinical outcome.Methods: This study included 234 shoulders of 215 patients who received conservative treatment for FS. The mean follow-up period was 41.8 months (range 27-117 months). Initial evaluation included demographics, detailed medical history, and clinical assessments of shoulder status. Questionnaires, which included the Visual Analogue Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV) and satisfaction grading for the current shoulder status were assessed at the final follow-up.Results: The mean VAS pain score, ASES score, and SSV significantly improved from 6.7, 37.0, and 40.1% at the time of initial evaluation to 1.5, 87.6, and 85.0% at the final follow-up evaluation (all p < 0.001). According to satisfaction grading, the shoulder status at the final follow-up was very satisfied in 101 shoulders (43.2%), satisfied in 68 (29.1%), fair in 37 (15.8%), unsatisfied in 20 (8.5%), and very unsatisfied in 8 (3.4%). Univariate analysis revealed that gender, diabetes, simultaneous bilateral involvement, overall bilateral involvement and duration of symptoms were associated with clinical outcomes at the final follow-up. Multivariate analysis revealed that duration of symptoms (p = 0.002) was an independent risk factor for unsuccessful outcome.Conclusions: At the mean follow-up period of 41.8 months, 72.3% of patients revealed subjective satisfaction for the current shoulder status. Duration of symptoms was an independent risk factor for poor prognosis. [ABSTRACT FROM AUTHOR]

Adhesive capsulitis, a common primary care and orthopedic diagnosis often referred to as frozen shoulder, is a painful inflammatory process that leads to a mechanical block in active and passive range of shoulder motion. Risk factors include diabetes and thyroid dysfunction. Diagnosis is made based on physical examination, but can be augmented by diagnostic imaging. Nonsurgical management is the mainstay of treatment because the disease is self-limiting. However, some patients may need surgical intervention. [ABSTRACT FROM AUTHOR]

Study Design: Nonrandomized controlled trial. Objective: To determine whether translational manipulation under anesthesia/local block (TMUA) adds to the benefit of mobilization and range of motion exercise for improving pain and functional status among patients with adhesive capsulitis of the shoulder (AC). Background: TMUA has been shown to improve pain and dysfunction in patients with AC. This intervention has not been directly compared to physical therapy treatment without TMUA in a prospective trial. Methods: Sixteen consecutive patients with a primary diagnosis of AC were divided into two groups. Patients in the first (TMUA) group received a session of translational manipulation under interscalene block, followed by six sessions of manipulation and exercise. Patients in the comparison group received seven sessions of manipulation and exercise. Outcome measures taken at baseline and 3, 6, 12 months and 4 years included Shoulder Pain and Disability Index (SPADI) scores. Four-year outcomes included percent of normal ratings, medication use, and activity limitations. Results: Both groups showed improved SPADI scores across all follow-up times compared to baseline. The TMUA group showed a greater improvement in SPADI scores than the comparison group at 3 weeks, with no significant differences in SPADI scores at other time points. However, at 4 years, significantly more subjects in the comparison group (5 of 8) had activity limitations versus subjects in the TMUA group (1 of 8). No subject experienced a complication from either intervention protocol. Conclusion: Physical therapy consisting of manual therapy and exercise provides benefit for patients with AC. Translational manipulation under local block may be a useful adjunct to manual therapy and exercise for patients with AC. [ABSTRACT FROM AUTHOR]

Background: Frozen shoulder is a painful and debilitating condition with an incidence of 3% to 5% in the general population and up to 20% in those with diabetes. Physiotherapy has been found to be very effective in treatment of frozen shoulder. Cryoflow IR is a new advanced modality, which is the first cryotherapy device to cool down free surrounding air with a biofeedback system, thereby ensuring a constant temperature on a treated spot. Hence this study was conducted to compare the effect of moist hot pack and Cryoflow (IR Guided). Aims and Objectives: To study and compare the effect of Cryoflow (IR guided) and moist hot pack on pain and function in frozen shoulder. Methodology: 15 patients of frozen shoulder were included by simple random sampling after taking ethical approval for the present study. The patients were then divided in two groups. Along with the conventional physiotherapy, patients in Group A were given moist hot pack; while in Group B Cryoflow (IR Guided) was given for 6 days/week for 4 weeks. Pre and post interventional outcome measures in terms of VAS score at rest, ROM and SPADI score were evaluated. Results: Both groups showed significant improvement when pre and post data were analyzed for all outcome measures (p< 0.05).Whereas between group comparison showed no significant difference. Conclusion: It can be concluded that Conventional physiotherapy along with moist hot pack and conventional physiotherapy along with Cryoflow (IR guided), both are individually effective in relieving pain, improving range of motion and functional ability in patients with frozen shoulder. [ABSTRACT FROM AUTHOR]

*BACKGROUND: Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome (FSCS), but no evidence exists to support one form of manual therapy over another. This case series describes both short- and long-term outcomes after a manual therapy program and home stretching exercises based on specific impairments in shoulder mobility and level of tissue irritability in patients with FSCS. *CASE DESCRIPTION: Eleven patients with primary FSCS were treated with an individually tailored, multimodal manual therapy approach once weekly for 12 visits, coupled with home stretching exercises once a day, 5 days per week. Pain, disability, range of motion (ROM), and muscle strength of the affected shoulder were assessed at baseline, posttreatment, at 6 months, and at 9 months. *OUTCOMES: Significant improvements in self-reported pain, disability, shoulder ROM, and strength were reported following treatment. Additionally, 4 of 11 patients showed pain improvements that exceeded the minimal clinically important difference (MCID) on the visual analog scale postintervention, and 8 of 11 showed pain improvements at 6 and 9 months. Moreover, 7 of 11 patients showed improvements in Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores exceeding the MCID postintervention and at 6 months, and 8 of 11 exceeded the MCID at 9 months. *DISCUSSION: Clinically meaningful changes in shoulder pain and disability, ROM, or muscle strength were observed in 11 patients with primary FSCS treated with an individually tailored approach of both manual therapy techniques and stretching exercises, accounting for tissue irritability. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the effect of mirror therapy (MT) in conjunction with a standard physical therapy program on shoulder range of motion (ROM), pain and quality of life in patients with adhesive capsulitis (AC). METHOD: This prospective, randomized, controlled, single blind study included 30 patients with AC who were scheduled to undergo 10 sessions of standard physical therapy. The participants were divided into two identical groups, namely, The MT group and the control group. After each session, the MT group underwent active ROM exercises with the reflective side of the mirror while the control group underwent active ROM exercises with the non-reflective side of the mirror. Pre-treatment and post-treatment shoulder pain (VAS), shoulder function (UCLA shoulder scale) and quality of life (SF-36) were assessed, and active and passive ROM were quantified with a goniometer. RESULTS: Both groups revealed a significant reduction of shoulder pain and significant improvement of shoulder function, active and passive ROM, and quality of life after the treatment. Post-treatment measurements showed that the MT group had a significantly lower amount of pain compared to the control group (p = 0.007). The UCLA scores were significantly higher in the MT group (p = 0.003). The MT group had significantly better post-treatment active flexion, active abduction, passive flexion, and passive abduction values (p = 0.001, p = 0.02, p = 0.002, and p = 0.02, respectively). The MT group had significant post-treatment improvement in physical function, physical role limitation and emotional role limitation, and pain parameters including SF-36 (p = 0.003, p = 0.01, p = 0.015, and p = 0.002, respectively). CONCLUSION: MT in conjunction with physical therapy appears to be an effective treatment modality that reduces shoulder pain and improves shoulder ROM, shoulder function, and quality of life among patients with AC. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of active release technique and capsular stretch along with conventional therapy in patients with frozen shoulder Study Design: Experimental study design. Subjects: 30 patients between the age group 40 yrs to 60 yrs having frozen shoulder were selected as per the inclusion and exclusion criterion. Procedure: Using random sampling method the 30 subjects were divided into 2 equal groups with 15 patients each and treated with active release technique and capsular stretch along with conventional therapy and capsular stretch with conventional therapy. 18 sessions over a period of 5 weks. Outcomes scores were evaluated using goniometer and VAS scale. Result: Subjects receiving active release technique and capsular stretch along with conventional therapy showed significant reductions in pain and other symptoms with an improvement in quality of life. Conclusion: Active release technique and capsular stretch with conventional therapy is more effective in increasing ROM and decreasing pain of frozen shoulder rather alone capsular stretch with conventional therapy. These changes are clinically significant. [ABSTRACT FROM AUTHOR]

BACKGROUND: In treatment of adhesive capsulitis, deep heating agents have been shown to have positive effects on pain and function. OBJECTIVE: To evaluate if addition of ultrasound used in treatment of adhesive capsulitis will provide additional benefits. METHODS: Thirty patients with adhesive capsulitis were included in a prospective, double-blind, randomized controlled trial. Hotpack, TENS (Transcutaneus Electrical Nerve Stimulation), exercise and active ultrasound therapies were applied to the first group (n = 15), whereas sham ultrasound was applied to the second group (n = 15) in addition to hotpack, TENS and exercise. The patients were evaluated using joint range of motion, UCLA shoulder scale and Shoulder Disability Questionnaire scales at baseline and at 6th and 24th weeks post-treatment. RESULTS: When pain and the clinical and functional parameters were compared in both groups, significant improvement was found compared to baseline (p < 0.001). At week 24, no difference was found in terms of pain at rest, but all other parameters were improved compared to week 6. When the groups were compared, no difference was found in any comparison between 6th and 24th week (p > 0.05). CONCLUSION: Adding ultrasound treatment to a combination of physical therapy modalities did not provide any additional benefits for the treatment of adhesive capsulitis. [ABSTRACT FROM AUTHOR]

Frozen Shoulder remains one of the most misunderstood pathologies to affect the shoulder joint. Frozen Shoulder is characterised by pain, loss of active and passive range of motion especially in flexion and external rotation with normal radiological findings undergoing three stages of presentation: initial pain, stiffness and near full resolution with time. Current treatment options include manual physiotherapy techniques, injection therapy, manipulation under anaesthetic and surgical release of shoulder capsule. Presently there remains a paucity of significant research supporting the sole use of any of these techniques in the treatment of frozen shoulder. Future studies should incorporate larger subject populations with closely related symptoms and be multicentred across a larger geographical area. [ABSTRACT FROM AUTHOR]

Objectives:: Although the shoulder is known to move together with the scapula and other upper quarter joints, the current frozen shoulder clinical practice guidelines describe only physical therapy study treatments directed to the shoulder. None received a strong recommendation, highlighting the need for alternate interventions. This retrospective case series describes a pragmatic regional interdependence approach to frozen shoulder with impairment and functional outcomes, noting whether final ROM approached normal. Methods:: Five consecutive patients referred with frozen shoulder diagnoses attended 11-21 sessions over 5-10 weeks with one physical therapist. Treatment addressed inter-related regions (shoulder, shoulder girdle, scapulothoracic/humerothoracic, and spine) following a pragmatic approach using impairment-based interventions (joint/soft tissue mobilization, muscle stretching/strengthening) as well as patient education, modalities and warm up that addressed individual presentations. Results:: All patients improved on all outcomes. Mean shoulder ROM at discharge, the impairment outcome, demonstrated large effect size increases: flexion (117 ± 10-179 ± 12, d = 5.9), abduction (74 ± 8-175 ± 9, d = 9.3), external rotation (23 ± 7-89 ± 2, d = 12.0). The Disability of Arm Shoulder Hand functional outcome score upon follow up demonstrated a large effect size improvement (d = 1.5) from 40.0 ± 19.4-6.2 ± 3.7. Final ROM approached normal. Discussion:: This case series utilized a regional interdependence approach to frozen shoulder that included manual therapy interventions directed to consistent upper quarter body segments. Shoulder ROM was returned to near normal with functional improvements evident months after discharge. A pragmatic regional interdependence approach addressing multiple joints related to shoulder function may benefit other people with frozen shoulder. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Clinical Question: In patients diagnosed with adhesive capsulitis, is scapular mobilization combined with end range glenohumeral mobilization more effective at improving shoulder range of motion when compared to glenohumeral mobilization alone? Clinical Bottom Line: There is moderate evidence to support the use of scapular mobilization combined with end range glenohumeral mobilization to improve shoulder range of motion in patients with adhesive capsulitis. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Case report. BACKGROUND: Aggressive physical therapy in the freezing stage of frozen shoulder may prolong the course of recovery. Central sensitization may play a role in the early stages of frozen shoulder. Pain neuroscience education, tactile discrimination, and graded motor imagery have been used in a number of conditions with central sensitization. The purpose of this case report was to describe the examination and treatment of a patient in the freezing stage of frozen shoulder using pain neuroscience education, tactile discrimination, and graded motor imagery. CASE DESCRIPTION: A 54-year-old woman with a diagnosis of frozen shoulder was referred by an orthopaedic surgeon following lack of progress after 4 weeks of intensive daily physical therapy. Pain at rest was 7/10, and her Shoulder Pain and Disability Index score was 64%. She had painful and limited active range of motion and elevated fear-avoidance beliefs. Tactile discrimination and limb laterality were impaired, with signs of central sensitization. A "top-down" approach using pain neuroscience education, tactile discrimination, and graded motor imagery was used for the first 6 weeks, followed by a "bottom-up" impairment-based approach. OUTCOMES: The patient was seen for 20 sessions over 12 weeks. At discharge, her Shoulder Pain and Disability Index score was 22%, resting pain was 0/10, and fear-avoidance beliefs improved. Improvements in active range of motion, laterality, and tactile discrimination were also noted. DISCUSSION: Intensive physical therapy in the freezing stage of frozen shoulder may be detrimental to long-term outcomes. This case report suggests that a top-down approach may allow a quicker transition through the freezing stage of frozen shoulder. LEVEL OF EVIDENCE: Therapy, level 5. [ABSTRACT FROM AUTHOR]

Objectives. This study aims to explore whether extracorporeal shockwave treatment (ESWT) based on the theory of fascial manipulation (FM) at select treatment points is superior to traditional local ESWT for pain relief in adhesive capsulitis of the shoulder. Methods. Data from patients with adhesive capsulitis of the shoulder who received weekly ESWT according to fascial manipulation theory (ESWT-FM) or local extracorporeal shockwave treatment (L-ESWT) during a 5-week treatment period were evaluated. Pain-on-movement numeric rating scale (p-NRS) and range of motion (ROM) testing were performed before the treatment period, after the first treatment, and after the fifth treatment. Results. There were significant reductions in pain scores in the ESWT-FM group (p<0.05) after the first treatment, and after the fifth treatment, both groups had marked, significant improvement (p<0.05), with a significantly greater reduction in pain (p-NRS) in the ESWT-FM group compared to the L-ESWT group (p<0.05). There was no significant difference in terms of ROM in the L-ESWT group, while there was slight improvement of forward flexion in the ESWT-FM group after the fifth treatment. Conclusions. ESWT-FM provided faster pain relief and slightly more notable improvement of function compared with L-ESWT for the patients with adhesive capsulitis of shoulder. [ABSTRACT FROM AUTHOR]

Study Design: Case series study. Objectives: Although there have been no reported complications from translational manipulation under anesthesia (tMUA) for individuals with adhesive capsulitis (AC) there are no cases reporting surgical findings post tMUA. Also, there are no studies evaluating health care utilization following tMUA. The purpose of this study was to: (1) report clinical outcomes following tMUA, (2) describe relevant health care costs and utilization following tMUA, and (3) summarize findings from two cases receiving joint arthroscopy following tMUA. Methods: Fourteen Individuals with AC underwent tMUA. Range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) values were collected at baseline and six weeks follow-up. Shoulder-related health care cost and utilization were analyzed for a five-year period following tMUA. Two additional patients with AC underwent tMUA followed by arthroscopic assessment for evidence of iatrogenic injury. Results: Thirteen patients completed the six-week follow-up. Mean change scores for ROM and SPADI values were flexion; +38.5°, abduction; +71.1°, external rotation (shoulder abducted); +49.8°, internal rotation (shoulder abducted); +26.6°, SPADI scores; +44.4. 13 patient records were analyzed for health care utilization. Ten of the 13 patients utilized no additional shoulderrelated health care. Surgical evaluation revealed no evidence of iatrogenic injury. Discussion: Clinical outcomes were similar to previous studies. Utilization data indicated that for the majority of patients, little shoulder-related health care was utilized. Surgical evaluation provided further evidence that tMUA performed by a physical therapist is safe. Future research will be required to establish a causal relationship between tMUA and the results observed in this study. Level of Evidence: Therapy, Level 4. [ABSTRACT FROM AUTHOR]

Frozen shoulder, also known as adhesive capsulitis, is a common presentation in the primary care setting and can be significantly painful and disabling. The condition progresses in three stages: freezing (painful), frozen (adhesive) and thawing, and is often self-limiting. Common conservative treatments include nonsteroidal anti-inflammatory drugs, oral glucocorticoids, intra-articular glucocorticoid injections and/or physical therapy. However, many physicians may find themselves limited to prescribing medications for treatment. This article elaborates on physical therapy exercises targeted at adhesive capsulitis, which can be used in combination with common analgesics. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of mobilization with movement and end range mobilization along with conventional therapy for the treatment of frozen shoulder. Study Design: Experimental study design. Subjects: 30 patients between the age group 40 yrs to 60 yrs were selected as per the inclusion and exclusion criterion. Procedure: By random sampling method the 30 subjects were divided into 2 equal groups with 15 patients each.Experimental group A received Hot Pack,Exercises,MWM .Experimental group B received Hot Pack,Exercises,ERM. The study was performed for 4 months.The treatment was given 6 days per week.once in a day for 12 weeks .Evaluation was done before starting the treatment and then after 4 months. Outcomes scores were evaluated using SPADI & ROM . Result: Experimental group A showed improvement in SPADI score 62.9 % and ROM improved by 81.87 degree. The ERM group showed improvement in SPADI scores by 47.9 % and 76.8 degree Conclusion: The study found that both the treatment that is MWM and ERM are effective in the management of frozen shoulder but MWM is found to be slightly more effective. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to examine the effects of reminders, encouragement, and educational messages delivered by mobile phone on shoulder exercise compliance and improvements in shoulder function among patients with a frozen shoulder. Design and Methods A randomized controlled trial design was used. A convenience sample of patients with a frozen shoulder in an orthopedic outpatient clinic was recruited. All participants were instructed on how to do shoulder exercises and were provided with a printed pamphlet about shoulder exercises. Then, the intervention group received reminders, encouragement, and educational messages by mobile phone daily for the next 2 weeks, while the comparison group did not. Findings The intervention group had higher compliance with shoulder exercises than did the comparison group ( t = 2.263, p = .03) and had significant improvements in shoulder forward flexion ( F = 12.067, p = .001), external rotation ( F = 13.61, p = .001), and internal rotation ( F = 5.903, p = .018) compared to those in the comparison group after the 2-week intervention. Conclusions The text messages significantly increased patient compliance with shoulder exercises and thus improved patients' shoulder range of motion. Clinical Relevance Hospital or clinics can send appropriate messages to patients via text message platforms in order to remind and encourage them to do shoulder exercises. [ABSTRACT FROM AUTHOR]

Purpose of Study - To compare the effect of Maitland technique and muscle energy technique in adhesive capsulitis. It is common in the age group of 35 to 60 years. In this the maximum disability has been measured by SPADI scale Methodology- 30 subjects were selected with adhesive capsulitis. Result- There is significant effect of muscle energy technique seen in group A. Conclusion - There is a statistically significant difference between both the group in improvement in group receiving muscle energy technique and Maitland technique. But there is a marked improvement seen in group A subjects with adhesive capsulitis. [ABSTRACT FROM AUTHOR]