Scapular Mobilization Versus Capsular Stretch

Official title

Scapular Mobilization Versus Posterior Capsular Stretch in Frozen Shoulder

Overview

The goal of this study is to compare the effect of scapular mobilization versus posterior capsular stretch on pain, function, range of motion, and posterior capsular tension in patient with frozen shoulder

Detailed description

Frozen shoulder is a musculoskeletal condition that is commonly encountered in physical therapy practice. It is characterized by a painful, gradual loss of both active and passive glenohumeral motion resulting from progressive fibrosis and ultimate contracture of the glenohumeral joint capsule. Frozen shoulder affects about 2% of the general population, with a higher prevalence in people between their 40s and 60s. Frozen shoulder occurs more in diabetic patient.

The traditional principles of treatment of frozen shoulder are to relieve pain, maintain range of motion, and ultimately to restore function. The physiotherapy treatment of frozen shoulder consists of different modalities such as Transcutaneous Electrical Nerve Stimulation (TENS), Interferential Therapy (IFT), Ultrasound, Short Wave Diathermy (SWD) etc., and the physical therapy exercises such as stretching, Codman exercise can be used.

Scapular-mobility exercises, or scapular-mobilization (SM) techniques is widely used in the management of musculoskeletal disorders of the shoulder. Scapular mobilization can cause pain reduction with improvement in the shoulder range of motion. Scapular mobilization can reduce the disability in patients with shoulder dysfunction.

Posterior capsular stretch is applied along with mobilization which causes significant improvement in increasing range of motion and functional disability. Capsular stretching showed a more significant reduction in pain when compared to general exercises.

Therefore, what are the possible effect of scapular mobilization versus posterior capsular stretch in treating patients with frozen shoulder?

Interventions

• Other Scapular mobilization with addition anterior, posterior ,caudal glenohumeral mobilization, infrared therapy, ultrasound therapy, pendulum exercises
  Scapular mobilization with addition anterior, posterior ,caudal glenohumeral mobilization, infrared therapy, ultrasound therapy, pendulum exercises
• Other Posterior capsular stretch with addition anterior, posterior ,caudal glenohumeral mobilization, infrared therapy, ultrasound therapy, pendulum exercises
  Posterior capsular stretch with addition anterior, posterior ,caudal glenohumeral mobilization, infrared therapy, ultrasound therapy, pendulum exercises

Primary outcome measures

• Shoulder flexion range of motion to measure shoulder joint active range of motion (flexion) by bubble inclinometer [Time frame: pre-intervention, after 2 weeks of treatment and post treatment 4 weeks]
• Shoulder abduction range of motion to measure shoulder joint active range of motion (abduction) by bubble inclinometer [Time frame: pre-intervention, after 2 weeks of treatment and post treatment 4 weeks]
• Shoulder internal rotation range of motion to measure shoulder joint active range of motion (internal rotation) by bubble inclinometer [Time frame: pre-intervention, after 2 weeks of treatment and post treatment 4 weeks]
• Shoulder external rotation range of motion to measure shoulder joint active range of motion (external rotation) by bubble inclinometer [Time frame: pre-intervention, after 2 weeks of treatment and post treatment 4 weeks]
• Shoulder pain and disability index to measure the shoulder pain the maximum possible score for the pain scale is 50 [Time frame: pre-intervention, after 2 weeks of treatment and post treatment 4 weeks]
• Shoulder pain and disability index to measure the disability level the maximum possible score for the disability scale is 80 [Time frame: pre-intervention, after 2 weeks of treatment and post treatment 4 weeks]
• poaterior capsular tension measurement by ruler [Time frame: pre-intervention, after 2 weeks of treatment and post treatment 4 weeks]

Eligibility criteria

Inclusion criteria

• Males and females aged from 40-65 years old.
• Diabetic and non-diabetic patients' diagnosis of stage 3 frozen shoulder (frozen phase) by an orthopedist.
• The presence of pain and limited movement in the shoulder for at least 2 months.
• Passive joint movements are limited when compared with the normal side.
• Unilateral involvement.

Exclusion criteria

• Recent joint infection or surgery.
• History of shoulder subluxation, dislocation, or ligamentous injury.
• Shoulder arthroplasty.
• Shoulder and cervical pathology.
• Recent trauma.
• Neurological disorders with muscle weakness in the shoulder joint.
• Infection, pregnancy, carcinoma patients, severe cardiac or psychiatric conditions.
• Previous shoulder surgeries to the affected shoulder.
• Previous manipulations under anesthesia of the affected shoulder.
• Radiological evidence for glenohumeral joint arthritis.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Ali SA, Khan M. Comparison for efficacy of general exercises with and without mobilization therapy for the management of adhesive capsulitis of shoulder - An interventional study. Pak J Med Sci. 2015 Nov-Dec;31(6):1372-6. doi: 10.12669/pjms.316.7909. PMID 26870099
• Duzgun I, Baltaci G, Atay OA. Manual therapy is an effective treatment for frozen shoulder in diabetics: an observational study. Eklem Hastalik Cerrahisi. 2012;23(2):94-9. PMID 22765488
• Duzgun I, Turgut E, Eraslan L, Elbasan B, Oskay D, Atay OA. Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization? J Musculoskelet Neuronal Interact. 2019 Sep 1;19(3):311-316. PMID 31475938
• 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 Apr;84(4):336-43. PMID 15049727
• Klauser AS, Tagliafico A, Allen GM, Boutry N, Campbell R, Court-Payen M, Grainger A, Guerini H, McNally E, O'Connor PJ, Ostlere S, Petroons P, Reijnierse M, Sconfienza LM, Silvestri E, Wilson DJ, Martinoli C. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol. 2012 May;22(5):1140-8. doi: 10.1007/s0033 PMID 22453857
• Laudner KG, Sipes RC, Wilson JT. The acute effects of sleeper stretches on shoulder range of motion. J Athl Train. 2008 Jul-Aug;43(4):359-63. doi: 10.4085/1062-6050-43.4.359. PMID 18668168
• Leung MS, Cheing GL. Effects of deep and superficial heating in the management of frozen shoulder. J Rehabil Med. 2008 Feb;40(2):145-50. doi: 10.2340/16501977-0146. PMID 18509580
• Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017 Apr;9(2):75-84. doi: 10.1177/1758573216676786. Epub 2016 Nov 7. PMID 28405218

Identifiers

NCT: NCT06705426 · P.T.REC/012/005349

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗