Top

Clinical Orthopaedics and Related Research®

Published in:

01-07-2014 | Clinical Research

Effectiveness of Sustained Stretching of the Inferior Capsule in the Management of a Frozen Shoulder

Authors: Antony Paul, MPT, Joshua Samuel Rajkumar, MPT, Smita Peter, MPT, Litson Lambert, BPT

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2014

Abstract

Background

Physiotherapy treatment of frozen shoulder is varied, but most lack specific focus on the underlying disorder, which is the adhered shoulder capsule. Although positive effects were found after physiotherapy, the recurrence and prolonged disability of a frozen shoulder are major factors to focus on to provide the appropriate treatment.

Questions/purposes

We wished to study the effectiveness of a shoulder countertraction apparatus on ROM, pain, and function in patients with a frozen shoulder and compare their results with those of control subjects who received conventional physiotherapy.

Methods

A total of 100 participants were randomly assigned to an experimental group and a control group, with each group having 50 participants. The control group received physiotherapy and the experimental group received countertraction and physiotherapy. The total treatment time was 20 minutes a day for 5 days per week for 2 weeks. The outcome measures used were goniometer measurements, VAS, and the Oxford Shoulder Score.

Results

Improvements were seen in the scores for shoulder flexion (94.1° ± 19.79° at baseline increased to 161.9° ± 13.05° after intervention), abduction ROM (90.4° ± 21.18° at baseline increased to 154.8° ± 13.21° after intervention), and pain (8.00 ± 0.78 at baseline decreased to 3.48 ± 0.71 after intervention) in the experimental group. Sixty percent of the participants (n = 30) were improved to the fourth stage of satisfactory joint function according to the Oxford Shoulder Score in the experimental group compared with 18% (n = 9) in the control group (p < 0.001).

Conclusions

Incorporating shoulder countertraction along with physiotherapy improves shoulder function compared with physiotherapy alone for the treatment of a frozen shoulder. Additional studies are needed focusing on this concept to increase the generalizability of the counter-traction apparatus in various groups.

Level of Evidence

Level II, prospective comparative study. See the Instructions for Authors for a complete description of levels of evidence.

Balci N, Balci MK, Tuzuner S. Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes mellitus: association with diabetic complications. J Diabetes Complications.1999;13:135–140.PubMedCrossRef

Boone DC, Azen SP, Lin CM, Spence C, Baron C, Lee L. ( 1978) Reliability of goniometric measurements. Phys Ther. 58:1355–1360.PubMed

Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE (2008) Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 31:165–169.PubMedCrossRef

Brue S, Valentin A, Forssblad M, Werner S, Mikkelsen C, Cerulli G. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007;15:1048–1054.PubMedCrossRef

Bunker TD, Anthony PP. The pathology of frozen shoulder: a Dupuytren-like disease. J Bone Joint Surg Br. 1995;77:677–683.PubMed

Cleland J, Durall CJ. Physical therapy for adhesive capsulitis: systematic review. Physiotherapy. 2002;88:450–457.CrossRef

Dawson J, Fitzpatrick R, Carr A (1996) Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br. 78:593–600PubMed

Dawson J, Hill G, Fitzpatrick R, Carr A. The benefits of using patient-based methods of assessment: medium-term results of an observational study of shoulder surgery. J Bone Joint Surg Br. 2001;83:877–882.PubMedCrossRef

Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;331:1453–1456.PubMedCentralPubMedCrossRef

10.

Düzgün I, Baltaci G, Atay OA. Manual therapy is an effective treatment for frozen shoulder in diabetics: an observational study. Eklem Hastalik Cerrahisi. 2012;23:94–99.PubMed

11.

Frank C, Akeson WH, Woo SL, Amiel D, Coutts RD. Physiology and therapeutic value of passive joint motion. Clin Orthop Relat Res. 1984;185:113–125.PubMed

12.

Green S, Buchbinder R, Hetrick SE. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev.2003;2:CD004258PubMed

13.

Grey R. Brief note: the natural history of “idiopathic frozen shoulder”. J Bone Joint Surg. 1978;60:564.PubMed

14.

Gupta S, Raja K, Manikandan N. Impact of adhesive capsulitis on quality of life in elderly subjects with diabetes: a cross sectional study. Int J Diabetes Dev Ctries. 2008;28:125–129.PubMedCentralPubMedCrossRef

15.

Haggart GE, Dignam RJ, Sullivan TS. Management of the frozen shoulder. J Am Med Assoc. 1956;161:1219–1222.PubMedCrossRef

16.

Hannafin JA, Chiaia TA (2000) Adhesive capsulitis: a treatment approach. Clin Orthop Relat Res. 372:95–109.PubMedCrossRef

17.

Hjelm R, Draper C, Spencer S (1996) Anterior-inferior capsular length insufficiency in the painful shoulder. J Orthop Sports Phys Ther. 23:216–222.PubMedCrossRef

18.

Jewell DV, Riddle DL, Thacker LR. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther. 2009;89:419–429.PubMedCrossRef

19.

Johnson AJ, Godges JJ, Zimmerman GJ, Ounanian LL (2007) The effect of anterior versus posterior glide joint mobilization on external rotation range of motion in patients with shoulder adhesive capsulitis. J Orthop Sports Phys Ther. 37:88–99. PubMedCrossRef

20.

Jurgel J, Rannama L, Gapeyeva H, Ereline J, Kolts I, Paasuke M. Shoulder function in patients with frozen shoulder before and after 4-week rehabilitation. Medicina (Kaunas). 2005;41:30–38.

21.

Kelley MJ, McClure PW, Leggin BG (2009) Frozen shoulder: evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther. 39:135–148.

22.

Kurtais Gursel Y, Ulus Y, Bilgic A, Dincer G, van der Heijden GJ. Adding ultrasound in the management of soft tissue disorders of the shoulder: a randomized placebo-controlled trial. Phys Ther. 2004;84:336–343.PubMed

23.

Maitland GD. Peripheral Manipulation. 2^nd ed. London, UK: Butterworths; 1977.

24.

Maitland GD. Treatment of the glenohumeral joint by passive movement. Physiotherapy.1983;69:3–7.PubMed

25.

Mulligan BR. Manual Therapy: ‘NAGS’, ‘SNAGS’, ‘MWMS’, etc. 4th ed. Wellington, New Zealand: Plane View Services Ltd; 1999.

26.

Nevasier RJ, Nevasier TJ. The frozen shoulder: diagnosis and management. Clin Orthop Relat Res. 1987;223:59–64.

27.

Nicholson GG. The effects of passive joint mobilization on pain and hypomobility associated with adhesive capsulitis of the shoulder. J Orthop Sports Phys Ther. 1985;6:238–246.PubMedCrossRef

28.

Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4:193–196.PubMedCrossRef

29.

Rundquist PJ, Ludewig PM. Correlation of 3-dimensional shoulder kinematics to function in subjects with idiopathic loss of shoulder range of motion. Phys Ther. 2005;85:636–647.PubMed

30.

Safran MR, Garrett WE Jr, Seaber AV, Glisson RR, Ribbeck BM. The role of warmup in muscular injury prevention. Am J Sports Med.1988;16:123–129.PubMedCrossRef

31.

Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder: a long-term follow-up. J Bone Joint Surg Am. 1992;74:738–746.PubMed

32.

Tanaka K, Saura R, Takahashi N, Hiura Y, Hashimoto R. Joint mobilization versus self-exercises for limited glenohumeral joint mobility: randomized controlled study of management of rehabilitation. Clin Rheumatol. 2010;29:1439–1444.

33.

Thomas SJ, McDougall C, Brown ID, Jaberoo MC, Stearns A, Ashraf R, Fisher M, Kelly IG. Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elbow Surg. 2007;16:748–751.PubMedCrossRef

34.

Tyler TF, Nicholas SJ, Roy T, Gleim GW. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement. Am J Sports Med. 2000;28:668–673.PubMed

35.

van den Hout WB, Vermeulen HM, Rozing PM, Vliet Vlieland TP. Impact of adhesive capsulitis and economic evaluation of high-grade and low-grade mobilisation techniques. Aust J Physiother. 2005;51:141–149.PubMedCrossRef

36.

Vermeulen HM, Obermann WR, Burger BJ, Kok GJ, Rozing PM, van Den Ende CH. End-range mobilization techniques in adhesive capsulitis of the shoulder joint: a multiple-subject case report. Phys Ther. 2000;80:1204–1213.PubMed

37.

Vermeulen HM, Rozing PM, Obermann WR, le Cessie S, Vliet Vlieland TP. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial. Phys Ther. 2006;86:355–368.

38.

Yang JL, Chang CW, Chen SY, Wang SF, Lin JJ (2007) Mobilization techniques in subjects with frozen shoulder syndrome: randomized multiple-treatment trial. Phys Ther. 87:1307–1315.

Title: Effectiveness of Sustained Stretching of the Inferior Capsule in the Management of a Frozen Shoulder
Authors: Antony Paul, MPT
Joshua Samuel Rajkumar, MPT
Smita Peter, MPT
Litson Lambert, BPT
Publication date: 01-07-2014
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 7/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-014-3581-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness of Sustained Stretching of the Inferior Capsule in the Management of a Frozen Shoulder

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 7/2014

Obituary: A Remembrance: Gael R. Frank (1930–2012)

Sonication of Antibiotic Spacers Predicts Failure during Two-stage Revision for Prosthetic Knee and Hip Infections

Transverse Coronoid Fracture: When Does It Have to Be Fixed?

Erratum to: Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

Complications of Hinged External Fixation Compared With Cross-pinning of the Elbow for Acute and Subacute Instability

Two-stage Approach to Primary TKA in Infected Arthritic Knees Using Intraoperatively Molded Articulating Cement Spacers