Adhesive Capsulitis Of Shoulder Joint Research Articles

AVABAHUKA (ADHESIVE CAPSULITIS) IS MANAGED WITH SIROVIRECHANA AND UTTARBHAKTIKA SNEHAPANA: A CASE STUDY

Avabahuka is a disease considered under Vata Vyadhi. It is caused by Vata Dosha with anubandha of Kapha Dosha. In modern, it is similar to Adhesive capsulitis of shoulder joint which is usually known as Frozen shoulder. It is a chronic condition characterized by pain and loss of range of motion. It has a negative impact on quality of life and work performance. In this study, a case of 49 years old female patient complained with pain and restricted movement of the shoulder joint for 2 years. Treatment was given along with Panchakarma procedure for 1 month. She was treated with Udhvartana for 6 days followed by Snehana – Swedana and Shirovirechana with Mahamasha taila along with Uttarbhaktika snehapana. The improvement was assessed on the basis of grading of sign and symptoms and Range of motion (ROM) before and after the treatment.

Management of adhesive capsulitis of shoulder joint with arthroscopic release vs. manipulation under anaesthesia: a comparative study

Background: Shoulder stiffness is a manifestation of various pathologies or clinical scenarios variously described as scapula humeral periarthritis, frozen shoulder and adhesive capsulitis. Frozen shoulder is characterized by significant restriction of active and passive motion of the shoulder that occurs due to unknown factors. Adhesive capsulitis causes contracted, thickened joint capsule that seemed to be drawn tightly around the humeral head with a relative absence of synovial fluid and chronic inflammatory changes within the subsynovial layer of the capsule. In this study we did a comparison of 30 patients treated with arthroscopic release and manipulation under anesthesia. Methods: There were 30 patients in this study with 15 patients in each group of different age groups. All the patients were studied for a period of one year between July 2021 to July 2022. The functional outcomes were assessed using dash scoring system. Results: in this study of 30 patients with different age groups followed for 12 months and assessed by DASH scoring system. We had excellent results in arthroscopic group with postop dash score standard deviation is 5.87. Conclusions: The arthroscopic capsular release of shoulder joint in adhesive capsulitis was found to have a better functional outcome as compared to the manipulation of shoulder joint under anaesthesia. Currently no treatment protocols are universally effective which needs more and more research and developments for proper treatment strategies. Morbidity with this condition has caused significant loss both economically and psychologically.

Comparison of Effectiveness of Maitland’s Mobilizations at End-Range Versus Within Pain-Free Joint Range of Movement in Treatment of Patients with Frozen Shoulder RCT

Maitland’s mobilizations are an important treatment option for treating patients with Frozen shoulder or Adhesive capsulitis of shoulder joint. In this study we compared the efficacy of Maitland’s mobilization at end-range of tissue resistance with high intensity glides i.e. High Grade with low intensity glides i.e. Low grade within pain free range of joint movement. The study was conducted at OPD of Department of Physical Therapy, Mayo Hospital, Lahore. In this study total of 57 patients were taken and only 36 patients were selected after assessing on inclusion criteria. Those 36 patients were divided into 3 groups with 12 patients in individual group. With the joint close to its neutral position, translation and distraction techniques were used to begin mobilization techniques in the fundamental starting positions. Numeric Pain Rating Scale (NPRS) and SPADI scales were used for measuring pain and disability index. ROMs were measured before, during and after treatment course i.e. at Day 1, after 2 weeks and after 4 weeks respectively. Statistical analysis was done on SPSS using ANOVA. When the ranges were compared by using ANOVA on SPSS it was evident that Group A patients showed better treatment outcomes as compared to other two groups. P-value (0.000) less than 0.05 is considered significant for group A patient. Mean of demographic data also support the fact that AC is more common in women than man. As a result of this study we can conclude that all treatment options gave good results in enhancing range of motion (ROM) and decreasing pain in shoulder joint but high-grade mobilization techniques applied at end range gave a significant treatment outcome on Ranges when compared. Numeric Pain Rating Scale (NPRS) and SPADI scales

Comparison of Corticosteroids vs Conventional Physical Therapy for Management of Adhesive Capsulitis

Objective: To compare the role of corticosteroids and conventional physical therapy for management of adhesive capsulitis Methodology: This comparative study was conducted in Orthopedic Department, Combined Military Hospital Abbottabad. March 2022 to February 2023. Patient of active adhesive capsulitis of shoulder joint diagnosed by orthopedic surgeon were recruited. Patients in group A received single shot of methylprednisolone with local anesthesia with in the joint cavity while group B received conventional physical therapy at rehab department of our hospital. Pain scores via visual analogue scale and range of motion via goniometer was compared in both groups at baseline and at 8 weeks of treatment. Results: A total of 160 patients of adhesive capsulitis were recruited. Mean age was 42.55±10.96 years. 70 (43.7%) patients were female while 90 (56.3%) were male. Baseline pain scores and range of motion parameters were not statistically significant between the two comparison groups. At the end of 8 weeks mean pain scores were statistically significantly low in patients who took intra-articular corticosteroids as compared to those who underwent physiotherapy sessions (p-value<0.001). Range of motion parameters were also statistically significantly better in patients who took corticosteroids as compared to those who underwent physiotherapy (p-value<0.001). Conclusion: Use of corticosteroids emerged as a better option for treatment of pain and restricted range of motion in patients of adhesive capsulitis when compared to routine physiotherapy offered in our clinical settings. Keywords: Adhesive Capsulitis; Corticosteroids; Efficacy; Physiotherapy

Comparative study between suprascapular nerve block versus platelet rich plasma in the treatment of adhesive capsulitis of shoulder joint

Introduction: Adhesive capsulitis of shoulder is a condition characterised by painful restriction of active and passive glenohumeral range of motion in at least two directions most notably shoulder abduction and external rotation. [1] Therapeutic options for the management of adhesive capsulitis are NSAIDs, intra-articular steroid injections, Suprascapular nerve block (SSNB), platelet rich plasma Injection (PRP), manipulation under general anaesthesia or arthroscopic capsular release. SSNB is an old and effective method for the treatment of adhesive capsulitis. Recently USG guided nerve blocks have been found to be safer and more efficacious compared to blind, landmark guided nerve blocks. PRP is newer modality of treatment in regenerative medicine to enhance the healing process in adhesive capsulitis.AIM: To evaluate & compare the outcome of adhesive capsulitis after either injection of PRP or SSNB. Materials and Methods: Patients with Adhesive capsulitis either received single injection of SSNB (n=45) (40 mg methylprednisolone + 5ml 2% lignocaine) or PRP (n=45) after randomization. All participants were also advised to perform a home based 10 minute exercise therapy after injection. The outcome were measured by using Constant and Murley shoulder score. Participants were evaluated at 0 (post-procedure), 3rd day,1 and 6 month. One way ANOVA-F has been used to compare between groups. Results: PRP showed significant difference in improvement than SSNB. No major adverse effect were seen in both groups. Conclusion: Both treatment modalities are effective with better result in PRP group than SSNB in long term follow-ups.

Comparative efficacy of ultrasonically guided infiltration of single shot of platelet-rich plasma and triamcinolone acetonide in adhesive capsulitis of shoulder joint - a prospective clinical study

Background: Adhesive capsulitis is also termed periarthritis of the shoulder joint or frozen shoulder. It is the most common cause of pain in and around the shoulder joint, extending up to the insertion of the deltoid muscle in the middle of the arm. The incidence of adhesive capsulitis ranges from 2% to 5%. It is prevalent in the middle-aged (40–60 years) group. Females suffer more from this condition. In the recent past, the infiltration of steroids into the shoulder joint was the mainstay of the treatment. Platelet-rich plasma (PRP) has appeared as a new hope for such patients, as it is believed to enhance the revascularization of the soft tissue and also increase the concentration of growth factors to improve and accelerate tendon healing. Aims and Objectives: This present study was done to evaluate the relative efficacy of ultrasonically guided infiltration of PRP and triamcinolone acetonide. Materials and Methods: The present clinical prospective study was conducted on 50 patients in a tertiary institute in Punjab, India, from June 2018 to December 2020 to evaluate the comparative efficacy of ultrasonically guided infiltration through the posterior approach of PRP and triamcinolone acetonide in the outdoor patient department of the department of orthopedics. The patients selected for the intra-articular infiltration were in their middle age (40–60 years), diagnosed as having adhesive capsulitis with non-resolution of signs and symptoms for the last 12 weeks. Results: PRP was a superior alternative to triamcinolone acetonide in the management of adhesive capsulitis as it resulted in long-term improvement in the visual analog score and disability of arm, shoulder, and hand scores with significant margins. Conclusion: PRP is definitively a newer, effective, cost-effective, autogenously derived alternative to the corticosteroids used till date, as it not only provides a long lasting effect but also helps in regenerative medicine.

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

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

To evaluate the role of intra articular autologous platelet rich plasma injection in the management of adhesive capsulitis of shoulder joint

Adhesive capsulitis is defined as an idiopathic condition of shoulder joint, characterized by spontaneous onset of pain, stiffness & restriction of range of motion at the shoulder joint. 1 The prevalence found to be 3.06%. It has insidious onset with difficulty in sleeping on the affected side and in daily routine activities. Platelet rich plasma has been recently been an aspect of significant importance of interest 2–5 in the orthopaedic community, to extract the facts regarding basic science of in vitro effects of PRP. 6 As it is autologous content, so carries minimal risk for the patient. In study, we evaluate the efficacy of single intra-articular platelet rich plasma injection in the patients with adhesive capsulitis. 7 The study was conducted in thirty patients having established adhesive capsulitis of shoulder joint allocated for intra-articular injection of platelet rich plasma in the shoulder through anterior approach, All the concerned patients assessed pre-operative and post-operative period by using DASH, VAS and ROM at regular intervals. The study resulted in statistically significant improvement in pain in terms of DASH, VAS and functional ROM in patients with adhesive capsulitis. Keywords: Frozen shoulder, Adhesive capsulitis, PRP.

Role of intra articular steroid injection in the management of adhesive capsulitis of shoulder joint

Adhesive capsulitis, is an idiopathic condition characterized by stiffness and pain in shoulder joint. Signs and symptoms typically begin gradually, worsen over time and then resolve, usually within one to three years. The prevalence found to be 3.06%. It is condition of painful shoulder with insidious onset with difficulty in sleeping on the affected side and in daily routine activities. In this study we evaluate the efficacy of single intra-articular steroid injection in the patients with adhesive capsulitis. The study was conducted in twenty patients having established adhesive capsulitis of shoulder joint allocated for intra-articular injection of steroid in the shoulder through anterior approach.All the concerned patients assessed pre-operative and post-operative period by using DASH, VAS and ROM at regular intervals. The study resulted in gross, constant, risk free and statistically significant improvement in pain in terms of DASH, VAS and functional ROM in patients with Adhesive Capsulitis.

THE EFFICACY OF PLATELET RICH PLASMA IN THE TREATMENT OF PERIARTHRITIS OF SHOULDER JOINT IN DIABETICS VS NON-DIABETICS

Periarthritis of shoulder joint / adhesive capsulitis also commonly known as Frozen shoulder, occurs due to adhesion at the glenohumeral joint 1. The term “Frozen Shoulder” was first described in 1934 by Codman.2 The incidence of periarthritis of shoulder joint is around 3-5% in the general population3. It is more common in females4 and develops between the ages of 40 to 70 years3. The main cause of painful restriction of movement in frozen shoulder is an inflammatory contracture of the joint capsule5. A meta-analysis showed that patients with diabetes were 5 times more likely than non-diabetics to have adhesive capsulitis. Also, the overall prevalence of adhesive capsulitis in diabetics was estimated at 13.4%6. According to a population-based followup study, patients with diabetes had an increased risk of developing adhesive capsulitis of shoulder joint as compared to non-diabetics7. The increased incidence of adhesive capsulitis in diabetics might be due to the glycosylation of the collagen within the shoulder joint triggered by the presence of high blood sugar8.

Assessment of effectiveness of intra articular autologous platelet rich plasma injection in the management of adhesive capsulitis of shoulder joint

Background: It was reported that platelet rich plasma injection is effective in the management of pain in adhesive capsulitis. Platelet rich plasma injection has multiple uses in the field of medical sciences. Objectives: The present study was undertaken to observe the effectiveness of intra articular autologous platelet rich plasma injection in the management of adhesive capsulitis of shoulder joint. Methods: The present study involved 30 patients within the age group of 30 to 60 years of age were included. Both males (n=12) and females (n=18) were present in the study. DASH score and visual analogue scores were assessed in the patients with 8 weeks follow up. Data was collected pre injection, post injection after four weeks. Results: There was a significant decrease in the scores of DASH and Visual analogue scale scores followed by the intervention.

EFFECTIVENESS OF HIGH GRADE MAITLAND MOBILIZATION TECHNIQUE IN PATIENT WITH IDIOPATHIC ADHESIVE CAPSULITIS OF SHOULDER JOINT.

25Aug 2019 EFFECTIVENESS OF HIGH GRADE MAITLAND MOBILIZATION TECHNIQUE IN PATIENT WITH IDIOPATHIC ADHESIVE CAPSULITIS OF SHOULDER JOINT. A. K. M rezwan , Selim hossain , Ashraful alam , Azmol hossain , Mizanur Rahman and Samia Jannat. Lecturer- GonoBishwabidyalayNolam, Savar, Dhaka. Rehab specialist-Centre for disability in development,Ulail, Savar, Dhaka. Chief consultant-PT,Eastern care hospital ltd, Dhaka. Consultant and HOD ?PT,Nightingale Medical Collage hospital,Dhaka, iris 820. Student of Physiotherapy (BPT)GonoBishwabidyalay. Savar .Dhaka.

Comparison of Effectiveness of Mulligan ‘MWM’ Technique Versus Kaltenborn Mobilization Technique on Pain and End Range of Motion in Patients with Adhesive Capsulitis of Shoulder Joint : A Randomized Controlled Trial

Comparison of Effectiveness of Mulligan ‘MWM’ Technique Versus Kaltenborn Mobilization Technique on Pain and End Range of Motion in Patients with Adhesive Capsulitis of Shoulder Joint : A Randomized Controlled Trial

A Comparison of Ultra Sound Therapy and Micro Wave Diathermy on Patients with Adhesive Capsulitis of Shoulder Joint

Introduction: Adhesive capsulitis is one of the most common causes of pain and disability of the shoulder joint. Most patients are managed conservatively in a primary care setting with the expectation of a good outcome. There are many alternative forms of treatment for this condition. Several interventions are also used in combination for its management but most of it remained unclear. Ultra Sound Therapy (UST) is commonly employed as a first line agent for the management of adhesive capsulitis. But whether the UST (Ultra Sound Therapy) and MWD (Micro Wave Diathermy) therapy would produce a significant difference in out come was not yet settled.
 Objective: To compare the efficacy of ultra sound therapy (UST) and micro wave diathermy (MWD) for the management of patients with adhesive capsulitis of shoulder joint.
 Materials and Methods: This observational study was carried out in the Department of Physical Medicine at Combined Military hospital, Dhaka from 01 May 2015 to 30 November 2015. A total of eighty patients were enrolled in this study and they were divided into two equal groups. One group received counseling plus UST (Ultra Sound Therapy) (1MHz @ 1.0 Watt/cm2 area for 10 minutes for two weeks) with physical exercise. Another group received counseling, MWD (Micro Wave Diathermy) and physical exercise for same period. Each group received the above mentioned modalities on the basis of five days a week for 06 weeks.
 Results: The result was observed by applying VAS (Visual analog scale) pain scale and SPADI (Shoulder Pain And Disability Index) pain score. The highest significant improvement (P<0.005) was observed in group “A” throughout the whole treatment period.
 Conclusion: In this study, most patients with adhesive capsulitis were benefited with counseling plus Ultrasound therapy and physical exercise rather than counseling plus Microwave Diathermy with physical exercise.
 Journal of Armed Forces Medical College Bangladesh Vol.11(2) 2015: 30-35

Management of adhesive capsulitis of shoulder joint by single platelet rich plasma injection

Introduction: Adhesive capsulitis of shoulder is a condition characterized by painful and global restriction of active and passive glenohumeral range of motion in at least two directions, most notably shoulder abduction and external rotation. Platelet-rich plasma (PRP) is an emerging treatment option and its efficacy needs to be examined. Aim: The aim of the study is to assess the efficacy of PRP injection in the treatment of adhesive capsulitis of the shoulder joint. Materials and Methods: Patients with adhesive capsulitis received a single injection of PRP (4 ml) (n = 20). All participants were also advised to perform a home-based 10 min exercise therapy after injection. The outcome was measured using Constant and Murley shoulder score. Participants were evaluated at 0, 3rd day, and 1 month. Unpaired t-test tests were used to determine significant differences. Results: PRP treatment showed increase in pain for few participants at the 3rd day, causing decreased active range of motion. However, at 1 month, PRP treatment resulted in statistically significant improvements in constant score. No major adverse effect was seen in PRP injection. Conclusion: This study demonstrates that single injection of PRP improves both in pain and all range of motion of shoulder joint.

An observational study to compare the outcome of local steroid injections and ultrasonic wave therapy in frozen shoulder patients

Background: Frozen shoulder is described as a painful shoulder condition of insidious onset associated with stiffness and disturbance in sleep due to pain in shoulder on the affected side1. Frozen shoulder is associated with synovitis and capsule contracture though it is never associated with capsular adhesions. The condition leads to a loss of range of movements of shoulder joint3. FS is a self-limiting disease. Various management options are available and in this study we compared the effects of physiotherapy modality Ultrasonic wave therapy with intraarticular steroid injections. Steroids are known to reduce inflammatory cascade and manipulation in any of the modalities reduce the adhesions. Material and Methods: 100 patients of frozen shoulder were divided in 2 groups (50 patients each) with nonspecific pain and stiff shoulder not treated over a period of one month by conventional analgesics. In Group 1 Patients treated with two intraarticular steroid while in group 2 Patients treated with ultrasonic wave therapy. Diagnosis of frozen shoulder was confirmed by ultrasonography of shoulder. Outcomes were accessed with SPADI score & Pre and post treatment VAS (visual analog scale) for pain. Observations: Group I patients with intraarticular injections showed better improvement manifested as increased range of motion and significant improvement in SPADI score at Day 7 as compared to group 2. But at later stage that is at Day 21 and 60, improvement in both the groups was similar as shown in Table 1 and graphs. Internal rotation at the end of 60 days was upto D12 in group 1 & 2 both. External rotation was 80.4(±10.6) while in group 2 was 78.8 (±11.4) at the end of day 60. Abduction in group 1 was 169.2(±11.4) in group 2 it was 168.4 (SD±8.2) at day 60. SPADI score was 6.4% (SD±7.6) in group 1 while in group 2 it was 7.2% (SD±9.6). VAS score was 1.2 in group 1 while in group 2 it was 1.5 at day 60. Results and Conclusions: Immediate improvement is better with intra articular injections but overall long term results are very much similar in both the injection and physiotherapy groups. For any of the acute situations, intra articular injections may be tried to provide immediate relief but both the therapies are providing same degree of rehabilitation over a longer period. Otherwise also a long therapy with proper compliance of patient and supervised exercise protocol is mandatory for adhesive capsulitis of shoulder joint.

Evaluation of Efficacy of Intra-Articular Corticosteroid in Treatment of Early Stages of Adhesive Capsulitis of Shoulder Joint

Evaluation of Efficacy of Intra-Articular Corticosteroid in Treatment of Early Stages of Adhesive Capsulitis of Shoulder Joint

Randomized Clinical Trial for Efficacy of Mobilization with Movement versus End-Range Mobilization Techniques in the Treatment of Adhesive Capsulitis of Shoulder Joint

Randomized Clinical Trial for Efficacy of Mobilization with Movement versus End-Range Mobilization Techniques in the Treatment of Adhesive Capsulitis of Shoulder Joint

The role of capsular distention in adhesive capsulitis

Vad VB, Sakalkale D, Warren RF. The role of capsular distention in adhesive capsulitis. Arch Phys Med Rehabil 2003;84:1290–2. Objective: To explore the efficacy of capsular distension in the treatment of adhesive capsulitis of the shoulder joint. Design: Prospective study. Setting: Musculoskeletal clinic. Participants: Twenty-two patients (18 women, 4 men; mean age, 41.3y; range, 29–54y) with adhesive capsulitis of shoulder joint. Nineteen patients had Hannafin stage II and 3 patients had Hannafin stage III adhesive capsulitis. All patients had continuous pain and significant range of motion (ROM) limitations of the shoulder joint despite a minimum of 3 months of physical therapy (PT). Intervention: Capsular distension with saline under fluoroscopic control, followed by a PT program. Main Outcome Measures: L’Insalata Shoulder Rating Questionnaire (LSRQ) score and Hannafin ROM assessment protocol. Results: In the 19 patients with stage II adhesive capsulitis, the mean LSRQ score and range of abduction improved from predistention values of 49.8° and 87.2° to postdistension mean values of 88.1° and 117.6° at minimum of 1 year postdistention, respectively ( P<.05). However, in the 3 patients with stage III adhesive capsulitis, the mean LSRQ score and range of abduction changed from predistention values of 41.2° and 84.1° to postdistension mean values of 57.8° and 90.4° at minimum of 1 year postdistention, respectively ( P>.05). Conclusions: The treatment modality should be individualized on the basis of the stage of the adhesive capsulitis, and the distension procedure should be reserved for patients in stage II who do not progress despite participating in a PT program.