Management Of Adhesive Capsulitis Research Articles

Comparative Effectiveness of Proprioceptive Neuromuscular Facilitation Stretch Vs Spencer Muscle Energy Technique on Pain and Disability in Patients with Adhesive Capsulitis

Purpose: Adhesive capsulitis is a condition in which the tissues of the shoulder joint become tight and impede movement. It is characterized by gradual loss of both active and passive glenohumeral joint motion, resulting in fibrosis, scarring and contractures of the joint capsule. Patient with adhesive capsulitis usually have difficulty in performing overhead activities, as well as routine duties such as combing their hair, dressing themselves, and throwing a ball. The objective of this study was to determine the effectiveness of proprioceptive neuromuscular facilitation (PNF) stretch vs muscle energy technique (MET) on pain and disability in patients with adhesive capsulitis.
 Methodology: Study Design: This research employed a rigorous single-blinded randomized controlled trial design to investigate the comparative effectiveness of two manual therapy techniques in the management of adhesive capsulitis. The study was conducted in accordance with established ethical guidelines and principles. Participant Selection: A total of 30 participants, aged between 30 and 60 years, were recruited for this study. The selection process adhered to specific inclusion and exclusion criteria to ensure the homogeneity of the participant group. Inclusion criteria encompassed individuals in the 2nd and 3rd stages of adhesive capsulitis, both males and females, those with comorbid conditions such as diabetes and hypertension, and individuals experiencing painful restrictions in active and passive glenohumeral or periscapular motion. It was essential that participants had the ability to understand Punjabi or Urdu and were willing to participate. Exclusion criteria included individuals with a history of post-traumatic immobilization, cognitive impairment, previous surgery or arthroscopy, cervical pathology, neoplasm/tumor, or reflex sympathetic dystrophy. Informed Consent: Before the commencement of the study, informed consent was obtained from all participants. The participants were fully informed of the study's objectives, procedures, and potential risks and benefits. The rights of voluntary participation and the option to withdraw from the study at any time were emphasized. Participant data were anonymized and kept confidential throughout the research process to safeguard privacy. Randomization: To minimize bias, participants were randomly assigned to two distinct treatment groups, Group A and Group B. The randomization process was conducted using a computer-generated method, ensuring that each participant had an equal chance of being assigned to either group. Interventions: The study employed two distinct manual therapy techniques for the treatment of adhesive capsulitis. Group A received proprioceptive neuromuscular facilitation (PNF) stretching, while Group B underwent the Spencer muscle energy technique (MET). Both interventions were administered over a duration of one month. Baseline Treatment: In addition to the primary interventions, all participants received a hot pack as a baseline treatment. This standard treatment approach aimed to create a consistent baseline condition for all participants and to alleviate any discomfort. Data Collection: The collection of data was a crucial aspect of this study. Data were gathered through the utilization of structured data collection forms, designed to capture demographic information and adhere to the inclusion and exclusion criteria. Additionally, standardized assessment tools were used to quantify outcomes. The Shoulder Pain Assessment Disability Index (SPADI) was employed to evaluate both pain and functional disability, while the Numeric Rating Scale (NRS) was utilized to measure pain intensity.
 Findings: Statistical analysis was done by using statistical package for the social sciences (SPSS) version 28. The collected data was analyzed and presented using appropriate statistical techniques. The data were initially checked for normality using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Non-parametric tests were employed due to the non-normal distribution of the data. Qualitative data were analyzed for frequency and percentage. Intra-group differences were examined using the Wilcoxon signed-rank t-test, while inter-group differences were assessed with the Mann Whitney U-test. Spencer mean Mets treatment group has lower mean ranks in total SPADI pain as compared to PNF study group.
 Conclusion: the study concluded that Spencer Mets has been more effective in reducing the pain of the patients as compared to PNF treatment. Healthcare professionals involved in the treatment of patients with adhesive capsulitis should consider the incorporation of Spencer MET as a viable option for pain management. The superior pain reduction observed in this study suggests that this technique may yield favorable results in real-world clinical settings. While this study offers valuable insights, further research is warranted to explore the long-term effects and potential differences in functional outcomes between Spencer MET and PNF treatment. Comparative studies with larger sample sizes and extended follow-up periods can provide a more comprehensive understanding of the benefits of these techniques.

EFFECTIVENESS OF AXIAL RELEASE AND SUSTAINED MOBILIZATION ON SHOULDER ELEVATION IN INDIVIDUALS WITH ADHESIVE CAPSULITIS – A PROSPECTIVE AND COMPARATIVE STUDY

Objective: The aim of the study was to investigate the comparative effectiveness of axial release and sustained mobilization on shoulder elevation in individuals with adhesive capsulitis. Methods: The present study recruited total 30 participants diagnosed as adhesive capsulitis as per the inclusion and exclusion criteria. They were allocated into Group A and Group B according to convenient sampling. Participants in Group A were treated with conventional physiotherapy, axial release, and sustained mobilization technique and Group B received Maitland mobilization with conventional physiotherapy. The interventions were given for 4 weeks, 3 sessions/week for 30 min. The outcome measures used in the study were numerical pain rating scale, shoulder pain and disability index, and universal goniometer which was assessed before the intervention immediately after the first session and at 2nd week and on completion of 4th week. Results: When the data statically analyzed intragroup group comparisons found to be significantly reduced in terms of pain and shoulder pain and disability index and improvement in Shoulder range of motion (p<0.05). Intergroup comparisons also showed significant difference in both the groups, but the results were more significant in Group A (p<0.05). Conclusion: Both interventions in the form of articular and soft-tissue mobilization should be incorporated in the management of adhesive capsulitis.

Robotic training in the management of adhesive capsulitis: a randomized controlled trial protocol

Background: Adhesive capsulitis (AC) is characterized by pain and limitation of active and passive range of motion. Its development leads to functional limitation and cortical reorganization. There is no consensus regarding the treatment of this condition as the pathophysiology is not yet clearly understood. Rehabilitation focuses on functional tasks during physical therapy sessions to improve patient autonomy. The purpose of this study is to evaluate the efficacy of robotic training compared to conventional rehabilitation in patients with AC. Materials and methods: It’s a single-blind, randomized, controlled trial conducted at the Department of Physical Medicine and Rehabilitation, Rabat University Hospital, Morocco. This prospective analytical study compares robotic training with the Armeo® Spring device combined with passive continuous mobilization to conventional physical therapy in patients with AC. Participants will be evaluated prior to randomization and followed up at 3 weeks, 6 weeks, 3 months, 6 months, and 12 months. The main outcome is the Shoulder Pain and Disability Index (SPADI). Secondary outcomes are: pain, active and passive range of motion, SF-36 index.

Ultrasound-Guided Infiltrative Treatment Associated with Early Rehabilitation in Adhesive Capsulitis Developed in Post-COVID-19 Syndrome.

Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome. Materials and Methods: The method used was an interventional pilot study in which 16 vaccinated patients presenting with the clinical and ultrasound features of adhesive capsulitis (phase 1) developed during post-COVID-19 syndrome were treated with infiltrative hydrodistension therapy under ultrasound guidance associated with early rehabilitation treatment. Results: Sixteen patients with post-COVID-19 syndrome treated with ultrasound-guided infiltration and early rehabilitation treatment showed an important improvement in active joint ROM after 10 weeks, especially in shoulder elevation and abduction movements. The VAS mean score before the treatment was 6.9 ± 1.66. After 10 weeks of treatment, the VAS score was 1 ± 0.63. Conclusions: The study demonstrated that the management of adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome, as conducted by physiotherapists in a primary care setting using hydrodistension and a rehabilitation protocol, represented an effective treatment strategy.

Efficacy of Low-level Laser Versus High-intensity Laser Therapy in the Management of Adhesive Capsulitis: A Randomized Clinical Trial.

Low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are effective in alleviating pain and improving functionality in patients with adhesive capsulitis (AC); however, no study has compared the efficacy of these two laser treatments. To compare the effectiveness of LLLT and HILT in improving the shoulder joint range of motion and functional status and in reducing pain level in patients with AC. Prospective, randomized, parallel group, patient- and assessor-blinded. A total of 45 patients (aged: 18-65 years) with complaint of shoulder pain were evaluated for inclusion criteria, which included being aged 18-65 years and a diagnosis of AC based on physical examinations. Using computer-generated random numbers, eligible patients were randomized into two groups: HILT + stretching exercise and LLLT + stretching exercise groups. Both HILT and LLLT were performed three times/week for 3 weeks. Functional status and pain of the patients were evaluated with Shoulder Pain and Disability Index (SPADI) and Visual Analog Scale (VAS), while shoulder joint range of motion was measured with goniometry. All assessments were done before and 3 weeks after treatment. A total of 40 patients (20 in each group) completed the study. At baseline, there was no statistically significant difference in the demographic and clinical characteristics between both groups. Both the LLLT and HILT groups showed significant improvement in the VAS and SPADI scores 3 weeks after treatment; however, the improvement was significantly higher in the HILT group than the LLLT group. There was no significant improvement in goniometric scores in both groups compared with baseline. No injury or other musculoskeletal complications were recorded during or after the treatments. HILT + stretching exercise treatment was more effective than LLLT + stretching exercise for improving functional parameters and pain in patients with AC. ClinicalTrials.gov Identifier: NCT05469672. None.

Predictive Factors for Failure of Intraarticular Injection in Management of Adhesive Capsulitis of the Shoulder.

Intraarticular (IA) corticosteroid injections have been demonstrated to be an effective management for adhesive capsulitis in both the short- and mid-term. Yet, certain patients fail to improve both subjectively and clinically. This study aims to identify predictive factors for treatment failure of IA injections in management of adhesive capsulitis. A retrospective review found 533 patients undergoing IA corticosteroid or IA NSAID injection for adhesive capsulitis between June 2015 and May 2020 at a single healthcare institution. Patient demographics characteristics, comorbidities, pain scores, and range of motion were compared. Treatment failure was defined as need for subsequent IA injection within 6 months or progression to surgical management within 12 months. 152 patients (28.52%) experienced treatment failure of IA corticosteroid injection. Pre-injection pain scores were greater for those who experienced treatment failure (5.40 vs. 4.21, p < 0.05). Post-injection pain scores were greater for those who experienced treatment failure (3.77 vs. 2.17, p < 0.01). Reduced post-injection external rotation in abduction also predicted treatment failure (56.88° vs. 70.22°, p < 0.01). IA corticosteroid injections are associated with increased rates of failure and progression to surgical management when patients present with increased pain levels as well as with less improvement in pain levels and ROM following injection.

Role of homoeopathy in the management of adhesive capsulitis: A pretest-posttest study

Background: Adhesive capsulitis (AC) is an insidious and painful stiffening of the glenohumeral (shoulder) joint, resulting in compromised functional ability and quality of life (QoL). Objectives: Primary objective was to evaluate change in shoulder pain after individualised homoeopathy treatment for over 2 months. Secondary objective was to assess the change in the QoL and outcome related to impact on daily living (ORIDL). Methods: A single-arm, pretest-posttest, clinical study on AC was conducted on 40 participants recruited from the outpatient clinic of rheumatological disorders at Clinical Research Unit (Homoeopathy), Siliguri, West Bengal, India. Medicines were prescribed on the basis of the totality of symptoms. Changes in shoulder pain over 2 months were evaluated using the shoulder pain and disability index (SPADI). QoL was evaluated using SF-12v2 and ORIDL (participants and physician assessed), respectively. Results: Thirty-six participants completed the study and four participants dropped out. A protocol compliant sample of n = 36 was analysed. There was a statistically significant reduction of SPADI score (91.92 ± 10.22 vs. 34.14 ± 24.43; mean reduction 57.78, 95% CI 49.41–66.14, P < 0.001) and statistically significant increase in SF-12 v2 score (44.39 ± 9.70 vs. 72.27 ± 10.97; mean increase 27.87, 95% CI 23.89–31.85, P < 0.001). The Spearman’s correlation between the changes in physician assessment ORIDL scores and participants assessment ORIDL scores over 2 months suggested a statistically significant correlation (rs = 0.998, P < 0.01). Conclusion: The findings showed symptom alleviation, and improvement in the QoL after homoeopathic treatment. Randomised controlled trials are further warranted.

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

Objectives:The objective of the study was to identify the effect of Maitland mobilization with hand-eye coordination and hand function exercises in the prognosis of adhesive capsulitis.Methods:This non-randomized control trial was done with 40 patients with adhesive capsulitis referred to the OPD at UCA College of Physiotherapy, Chennai. The study was performed for 8 months duration from August 2018 to March 2019. After providing a sufficient explanation of the procedure, the patients were divided into Group-A and Group-B. Group-A were allocated to Maitland group (n=20) (MG) and Group-B, were assigned to the Maitland, Hand-eye coordination and Hand Function exercises group (n=20) (MHG), respectively. We measured Quality of life using SF36 to know whether these patients had poor QOL compared to normative. Each patient underwent testing before the experiment to evaluate the range of motion of the shoulder (Abduction and External rotation) measured using a 180º goniometer, Functional Disability assessed using SPADI index. Statistical analysis was applied using SPSS version 20.0. Before the study, data normality was tested. A parametric test was used to compare pre-and post-intervention data in each Group-And also compare the MG vs. MHG. An α < 0.05 is the level of significance in all analyses.Results:A total of 40 subjects accounted for the study results. Their quality of life was significantly lower from the normative values. Both groups were homogenous at baseline with no significant difference between the ROM and SPADI scores. Both groups showed a significant improvement in ER, abduction ROM and SPADI scores, however the between group posttest analysis revealed that the Group-B subjects progressed significantly better.Conclusions:The study concluded that the Maitland mobilization and hand-eye coordination and hand function exercises are an effective tool in improving shoulder abduction, external rotation and shoulder functions.

Comparison of combined intra-articular and sub-acromial injection with intra-articular injection in adhesive capsulitis

Background: The pain and limitation of shoulder function can disrupt daily activities of patients for months to years. Adhesive capsulitis is considered a self-limiting disease but the duration remains uncertain. The brunt of the disease is focussed on the inflamed joint capsule. On this basis, use of corticosteroid injection is justified. However, injection method is not conclusive. Objectives: To compare clinical benefits of intra-articular injection alone versus combined intra-articular and subacromial injections in management of adhesive capsulitis. Methods: Fifty-nine patients with diagnostic criteria for adhesive capsulitis were included in the study from March 2019 to September 2020. Patients were divided into two groups; patients who underwent intra-articular (IA) injection alone (Group 1) and those who received both intra-articular and sub-acromial (IA+SA) injection (Group 2). The injections were landmark guided. Patients were followed up at three, six, and 12 weeks. Pain was recorded using visual analogue scale (VAS) and subjective function using Constant-Murley score. Results: Twenty-eight patients were included in Group 1 (IA) and 31 in Group 2 (IA+SA). Thirty-six patients were female (18 each in Group 1 and Group 2) and 23 patients were male (Group 1 = 13; Group 2 = 10). In the twelfth week, VAS score was reduced in both the groups. On comparing the mean value of Constant-Murley score between the two groups there is significant difference in value recorded at the sixth and twelfth week. Conclusion: The IA+SA injection provides significant reduction in pain and better function in the short term over the IA injection.

MANAGEMENT OF ADHESIVE CAPSULITIS OF SHOULDER JOINT BY SINGLE PLATELET RICH PLASMA INJECTION

Introduction: Adhesive capsulitis is a painful impairment characterized by the restriction of movement of shoulder due to the adhesions across the glenohumeral joint, injection of platelet-rich plasma is effective treatment to reduce the pain and restore the movement of shoulder.&#x0D; Aim: To assess the effectiveness single PRP injection in management of adhesive capsulitis.&#x0D; Material and Methods: This study enrolled 12 patients experiencing the shoulder pain for at least 3 months and attending our medical college hospital. Patients with adhesive capsulitis were given a single injection of PRP (4 ml) and followed up for 12 weeks, VAS scores and Disability Index scores were recorded and compared with the baseline scores.&#x0D; Result: In present study majority of patients were females with mean duration of symptoms was 3 months. Post PRP treatment all the patients have shown significant improvement on pains VAS score, movement VAS score on 2nd, 6th, and 12th weeks follow up.&#x0D; Conclusion: Present studies conclude that the AC is more prevalent among females which can be treated effectively with PRP technique. PRP as is a simple, safe and cost-effective management of AC without any adverse effects.&#x0D; Keywords: Adhesive Capsulitis, Platelet-Rich Plasma, Corticosteroid, Intra-articular

Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

To determine which interventions optimize clinical outcomes in adhesive capsulitis by performing a network meta-analysis of randomized controlled trials. A systematic review was conducted of all clinical trials on adhesive capsulitis published since 2008. Patient cohorts were grouped into treatment categories; data collected included range of motion (ROM) and patient-reported outcome measures (PROMs). Interventions were compared across groups by means of arm-based Bayesian network meta-analysis in a random-effects model. Sixty-six studies comprising 4042 shoulders (57.6% female patients, age 54.8 ± 3.2 years [mean ± standard deviation]) were included. The most commonly studied interventions were physical therapy (PT) or shoulder injections. Network meta-analysis demonstrated that arthroscopic surgical capsular release was the most effective treatment in increasing ROM. This effect was apparent in forward flexion (effect difference [ED] versus placebo, 44°, 95% confidence interval [CI] 31° to 58°), abduction (ED 58°, 45° to 71°), internal rotation (ED 34°, 24° to 44°), and external rotation (ED 59°, 37° to 80°). Interventions most effective for pain relief included PT supplemented with either medical therapy (ED -4.50, -9.80 to 2.80) or ultrasound therapy (ED -5.10, -5.10 to -1.40). Interventions most effective for improvement of functional status included PT, manipulation under anesthesia (MUA), intra-articular or subacromial steroid injection, surgical capsular release, and supplementation of PT with alternative therapy. No one treatment emerged superior in regard to ROM, pain symptoms, and functional status. Surgery (after failure of conservative treatment) ranked highest across all ROM domains. Treatments that ranked highest for treatment of pain included PT supplemented with either medical therapy or ultrasound. Finally, treatments that ranked highest for improvements in functional status included MUA, PT with medical therapy, surgical intervention, PT with ultrasound, PT with injection, and injection alone. II, systematic review and network meta-analysis of level I and II studies.

Prevalence and Risk Factors of Adhesive Capsulitis in Asian Breast Cancer Patients Undergoing an Outpatient Community Cancer Rehabilitation Program

ObjectivesTo investigate the prevalence and risk factors for adhesive capsulitis in postoperative breast cancer patients up to 5 years after surgery who were attending an outpatient community cancer rehabilitation program, and to determine whether any significant relationship exists between arm lymphedema and adhesive capsulitis. DesignCross-sectional observational study. SettingNational cancer rehabilitation center. ParticipantsAsian women (N=135) who underwent breast surgery and were referred for an outpatient community cancer rehabilitation program. InterventionsNot applicable. Main Outcome MeasuresPresence of adhesive capsulitis, lymphedema. ResultsThe prevalence of adhesive capsulitis and lymphedema in this population was 22.2% and 33.3%, respectively. A history of mastectomy (odds ratio [OR], 3.93; 95% confidence interval [CI], 1.23-12.63; P=.021), mastectomy with reconstruction (OR, 2.72; 95% CI, 1.27-30.54; P=.024), and lymphedema (OR, 7.92; 95% CI, 2.73-22.95; P<.001) were found to be significantly associated with adhesive capsulitis on multivariate analysis. ConclusionsAdhesive capsulitis and lymphedema are common in breast cancer survivors. The design of cancer rehabilitation programs for breast cancer survivors should include surveillance and management of adhesive capsulitis, especially in the presence of lymphedema.

Management of adhesive capsulitis by combination of hydrodilatation, intra-articular steroid injection and manipulation under anaesthesia

Adhesive capsulitis is characterized by gradually progressive pain and stiffness of the shoulder. Different treatment modalities are available for the management of primary adhesive capsulitis. The aim of this study was to assess the efficacy of using a combination of Hydrodilatation, Intra-articular steroid injection and Manipulation under anaesthesia. The study group comprised of 20 patients with primary adhesive capsulitis with a mean age of 56.15 years. There was significant improvement in pain, range of motion and function in six months follow-up period. No complications were reported in our study.

Hydrodilatation: The effective treatment modality in adhesive capsulitis

Introduction: Adhesive capsulitis of the shoulder joint is the commonly seen condition by the orthopedic surgeon. Hydrodilatation (HD) has been used as one of the treatment options in the management of adhesive capsulitis but with variable results. The aim of this prospective interventional study was to assess the functional outcome using the HD technique. Materials and Methods: Forty-one patients with adhesive capsulitis who were managed with HD technique and were meeting the inclusion criteria were included in the study. Patients were evaluated before the intervention and at the regular follow-up after the treatment using the constant score for functional assessment and Visual Analog Scale (VAS) for pain. Results: Seventeen (41.5%) patients were male and 24 (58.5%) were female. The mean age of the patients was 54.75 years (range 29–75 years). Eight out of 41 (19.5%) were patient with diabetes. At the final follow-up of 13.48 months (range 12–16 months), the mean constant score improved significantly from the preintervention level of 29.85 ± 9.09 to 82.02 ± 8.147 (P = 0.001), whereas the median VAS improved from before the intervention level of 8 (range 05–10) to 1 (range 0–3), respectively. Conclusions: HD technique yield satisfactory functional outcome and is an effective treatment modality in the management of adhesive capsulitis.

Responsiveness and Minimal Clinically Importance Difference of Thai QuickDASH in Individuals with Adhesive Capsulitis

Objective: To explore consistency between clinical outcomes derived from patient self-assessment and physical therapy evaluation. Also, to determine the minimal clinically importance difference (MCID), responsiveness, and optimal cut-off point specific to adhesive capsulitis for conditions of high and low disability, using the Thai version of QuickDASH. Methods: A cohort study was conducted in two hospitals over six weeks of physical therapy. Eighty-seven adhesive capsulitis patients participated in this study. Clinical outcomes provided by participant self-assessment using Thai QuickDASH and Global Rating of Change (GRoC) scales were compared with irritability outcomes provided by a physical therapist. Thai QuickDASH is the validated outcomes measurement tool for adhesive capsulitis and GRoC is recommended as a standard external anchor. This anchor-based method and receiver-operating characteristics (ROC) were analysed to clarify MCID and responsiveness. Results: The highest correlation was between the Thai QuickDASH and pain during passive shoulder elevation (rho = 0.638). MCID scores ranged from 9.1 to 20.4. The optimal cut-off point between high and low disability was 31.8, attained by a combination of two references; one was a score of at least GRoC+1 and the other was irritability outcome defined by pain during passive shoulder elevation. Conclusion: Responsiveness and MCID measured by the Thai QuickDASH is specific to adhesive capsulitis. A combination of GRoC as a standard external anchor and irritability outcome gave a precise cut-off point for improvement. Overall management of adhesive capsulitis, including continuing evaluation, treatment justification, and decision planning, should be based on qualified confirmation of MCID and responsiveness.

Current management of shoulder adhesive capsulitis: a randomized, triple-blind placebo-controlled trial

This review is aiming to discuss both operative and non-operative current management of this adhesive capsulitis. The present review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) declaration standards for systematic reviews. A systematic search for the terms adhesive capsulitis, frozen shoulder, glucocorticoid, non-operative operative, current management, and management of systematic review in different databases, including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched up to March 2018 for published and unpublished studies and without language restrictions. The majority of the trials show level 2 [mid-level] evidence, positive results were found for intra-articular corticosteroid injections combined with shoulder mobility and stretching exercises are more effective in providing short-term (4-6 weeks) pain relief and improved function compared to shoulder mobility and stretching exercises alone. On the basis of current clinical evidence, this systematic review suggests that there is no strong evidence to support or refute the current practice in term of adhesive capsulitis management. As there is a need of further research in this issue and to have clear uniformed prospective about the adhesive capsulitis.

Single intra-articular steroid injection of the glenohumeral joint in management of adhesive capsulitis: a comparison between approaches

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Adhesive capsulitis is a common, painful musculoskeletal condition of the shoulder associated with loss of range of motion in the glenohumeral joint resulting from contraction of the glenohumeral joint capsule and adherence to the humeral head. Earlier stages of adhesive capsulitis can be treated by intra-articular steroid injections into the glenohumeral joint. This study was designed to study the role of long acting intra-articular corticosteroid injections in combination with simple therapeutic exercises while comparing the outcome of blinded anterior and posterior injection approaches in the management of adhesive capsulitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study comprised of 60 subjects aged 18 years and above who were diagnosed with primary adhesive capsulitis. They were randomly divided into 2 groups i.e., Group A who received blind intra-articular steroid injections via standard anterior approach and group B who received blind intra-articular steroid injection via standard posterior approach. Both groups followed up with a simple home based exercise program. Outcome measures assessed were visual analog scale (VAS) score, shoulder pain assessment disability index (SPADI) and passive shoulder range of motion (ROM).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At last follow up, both groups showed statistically significant improvements in all outcome measures i.e., VAS score, SPADI, shoulder ROM. However, comparison between groups did not reveal any statistically significant differences between the two groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intra-articular steroid injections into the glenohumeral joint in conjunction with simple physiotherapy are effective in improving pain, function and shoulder ROM in adhesive capsulitis. Both the anterior and posterior injection approaches provide good results.&lt;/p&gt;

Comparative Study of Effectiveness of Ultrasound-Guided Suprascapular Nerve Block Versus Intra-Articular Steroid Injection in the Management of Adhesive Capsulitis: A Randomised Controlled Trial in a Tertiary Care Hospital in Northeast India

Comparative Study of Effectiveness of Ultrasound-Guided Suprascapular Nerve Block Versus Intra-Articular Steroid Injection in the Management of Adhesive Capsulitis: A Randomised Controlled Trial in a Tertiary Care Hospital in Northeast India

COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value &lt;0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

Adhesive Capsulitis in Eight Dogs: Diagnosis and Management.

To describe clinical and diagnostic findings as well as management of adhesive capsulitis in dogs. Adhesive capsulitis, also known as frozen shoulder, is a syndrome defined by loss of range of motion of the shoulder and may be the end-stage manifestation of several primary conditions. This is a case series report of eight dogs with chronic forelimb lameness diagnosed with adhesive capsulitis. Medical records (June 1, 2010-September 1, 2015) including, physical examination findings, radiographic findings, magnetic resonance imaging (MRI) findings, arthroscopy findings, and treatment plans were reviewed. All dogs presented with a chronic, grade III-VI/VI forelimb lameness. On orthopedic examination, all dogs had moderate to significant discomfort on shoulder extension and flexion and severe restriction of range of motion. Six of the eight dogs had evidence of bone remodeling and sclerosis in the affected shoulder on radiographs. Six of the dogs had an initial diagnostic ultrasound performed, which revealed evidence of fibrous scar tissue. Five dogs had MRI performed that revealed moderate shoulder effusion and enhancement of the synovial lining of the shoulder. Arthroscopy was performed in five of the eight patients. Three were noted to have significant contracture, adhesions, and fibrous scar tissue of the joint capsule. Severe inflammation was noted throughout the synovium of two patients. All eight patients tried conservative management consisting of oral medications and rehabilitation therapy. Five of the eight patients received extracorporeal shockwave therapy. Three patients received regenerative medicine treatment in the affected supraspinatus and shoulder. Regardless of the treatment elected, none of the dogs were reported to have significant improvement. Adhesive capsulitis is an uncommon cause of chronic forelimb lameness. Further investigation is needed to describe the etiology and pathogenesis of adhesive capsulitis in dogs to evaluate the effectiveness of both non-surgical and surgical treatment modalities, establish treatment protocols, and evaluate short- and long-term clinical outcome of patients. Adhesive capsulitis should be considered in patients with chronic forelimb lameness and moderate to significant discomfort and restriction on shoulder range of motion.