Effects of Deltoid Strengthening Exercises in Patients With Adhesive Capsulitis

Official title

Effects of Deltoid Strengthening Exercises on Pain, Range of Motion, Muscle Strength and Disability in Patients With Adhesive Capsulitis

Overview

Adhesive capsulitis, also known as frozen shoulder, is a musculoskeletal condition that causes significant shoulder pain and restricted joint mobility. It affects the glenohumeral joint and is commonly seen in individuals between the ages of 40 and 60 year. It affects 3 to 5% of the general population with a higher prevalence among females and patients with diabetes or thyroid disorders. Adhesive capsulitis progresses in four stages: painful, freezing, frozen, and thawing, and the condition may persist for 1 to 2 years. This study aims to determine the effects of Deltoid Strengthening Exercises on pain, range of motion, muscle strength and disability in patients with Adhesive Capsulitis.

Detailed description

This study will be a Randomized Controlled Trial and will be conducted in Physiotherapy Outpatient Department of Tehsil Head Quarter Hospital, Daska. Non-Probability Convenience Sampling will be used to collect the data. A sample of subjects aged 40 to 60 years with stage II and III adhesive capsulitis will be selected based on inclusion and exclusion criteria. Informed consent will be obtained from all participants. Outcome measures will include Numeric Pain Rating Scale (NPRS) for pain, Shoulder Pain and Disability Index (SPADI) for disability, Goniometer for Range of Motion, and Arm Abduction and Lowering Test for muscle strength. 48 subjects will be divided into two groups, 24 in each group by random number generator table. Both groups will receive a standard physical therapy protocol consisting of Ultrasound, Glenohumeral Mobilization and Home Exercises. In addition to standard physical therapy protocol, Group A will receive Deltoid Strengthening Exercises: Week 1: Isometric exercises (1×10 reps); Week 2 : Theraband exercises (1×10 reps); Week 3 - Dumbbell exercises with 1 kg (1×10 reps) and Week 4: Dumbbell exercises with 1.5 kg (1×10 reps), targeting anterior, middle, and posterior Deltoid. Group B will receive only the standard physiotherapy protocol without strengthening. Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 25.

Interventions

• Other Exercises
  a) Deltoid Isometrics The following isometrics of Deltoid will be performed: * Anterior Deltoid: Front Raise Isometrics Isometrics of Anterior Deltoid will be performed. The arm is raised to 90 shoulder flexion. The elbows are slightly flexed (5 degrees) while the subject is pushing isometric upward against manual resistance provided by the therapist * Middle Deltoid: Lateral Raise Isometrics The arm will be abducted to the horizontal position. The humerus is slightly flexed about thirty degre
• Other Standard Physical therapy
  Ultrasound Glenohumeral Distraction Manual therapy Codman's Pendulum Exercise Finger Ladder exercise Wand Exercise

Primary outcome measures

• Pain-Numeric Pain Rating Scale [Time frame: upto 4 weeks]
• Disability-Shoulder Pain and Disability Index [Time frame: upto 4 weeks]
• Range of motion-Universal Goniometer [Time frame: upto 4 weeks]

Eligibility criteria

Inclusion criteria

• • Both male and female gender

• Subjects with age ranging from 40 to 60 years
• Subjects with stage II and III adhesive capsulitis

Exclusion criteria

• • Subjects with rotator cuff tears

• Subjects with glenohumeral 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

• Nakandala P, Nanayakkara I, Wadugodapitiya S, Gawarammana I. The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review. J Back Musculoskelet Rehabil. 2021;34(2):195-205. doi: 10.3233/BMR-200186. PMID 33185587
• Seher Z, Goher N, Hamid A, Latif U, Bukhari A, Rafique H, et al. Prevalence of adhesive capsulitis among diabetics and non-diabetics with shoulder pain in general population: prevalence of adhesive capsulitis. Pakistan Journal of Health Sciences. 2023:67-71.
• Rawat P, Eapen C, Seema KP. Effect of rotator cuff strengthening as an adjunct to standard care in subjects with adhesive capsulitis: A randomized controlled trial. J Hand Ther. 2017 Jul-Sep;30(3):235-241.e8. doi: 10.1016/j.jht.2016.10.007. Epub 2016 Nov 21. PMID 27884497
• Sung JH, Lee JM, Kim JH. The Effectiveness of Ultrasound Deep Heat Therapy for Adhesive Capsulitis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2022 Feb 7;19(3):1859. doi: 10.3390/ijerph19031859. PMID 35162881
• Ramirez J. Adhesive Capsulitis: Diagnosis and Management. Am Fam Physician. 2019 Mar 1;99(5):297-300. PMID 30811157
• Heinecke ML, Thuesen ST, Stow RC. Graston technique on shoulder motion in overhead athletes. J Undergrad Kinesiol Res. 2014;10(1):27-39.
• Mustafa Z, Zafar MA, Zafar S, Aslam F, Nasir A, Ahmad M, et al. Prevalence of adhesive capsulitis in non-diabetic participants within age 50-70 years in Multan. International Journal of Natural Medicine and Health Sciences. 2024;3(2):40-2.
• Reinold MM, Macrina LC, Wilk KE, Fleisig GS, Dun S, Barrentine SW, Ellerbusch MT, Andrews JR. Electromyographic analysis of the supraspinatus and deltoid muscles during 3 common rehabilitation exercises. J Athl Train. 2007 Oct-Dec;42(4):464-9. PMID 18174934

Identifiers

NCT: NCT07644884 · REC/RCR&AHS/25/0115 Noha

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗