Responsiveness and Minimal Clinically Important Difference of the Canadian Occupational Performance Measure Among Patients With Frozen Shoulder.

IMPORTANCE: Patient-reported outcome measures provide insights into intervention effects on patients. The Canadian Occupational Performance Measure (COPM) emphasizes identifying priorities in daily activity engagement and evaluating an individual's perception of changes over time. OBJECTIVE: To assess the responsiveness of the COPM and the minimal clinically important difference (MCID) among patients with frozen shoulders. DESIGN: Prospective, single-blind, randomized controlled trial. SETTING: Two physical medicine and rehabilitation clinics. PARTICIPANTS: Ninety-four patients with frozen shoulders enrolled in a previous study. OUTCOMES AND MEASURES: Baseline and 3-mo evaluations of the COPM and other measures. Responsiveness was assessed using effect size (ES) and standardized response mean (SRM). The MCID values were determined through a distribution-based approach, which used the 0.5 standard deviation and ES methods, and an anchor-based approach, which used the receiver operating characteristic curve method. RESULTS: The ES and SRM results indicated that the COPM had high responsiveness. The distribution-based MCID values for COPM Performance and COPM Satisfaction were 1.17 and 1.44, respectively. The anchor-based MCID values were 2.5 (area under the curve [AUC] = 0.78, 95% confidence interval [CI] [0.64-0.91]) and 2.1 (AUC = 0.76, 95% CI [0.60-0.91]), respectively. CONCLUSIONS AND RELEVANCE: The findings suggest that the COPM is a responsive outcome measure for patients with frozen shoulder. The established MCID values for the COPM can be valuable for interpreting changes in patient performance and satisfaction, thus aiding clinical interventions and research planning. Plain-Language Summary: This is the first study to review the effectiveness of the Canadian Occupational Performance Measure (COPM) to determine the success of occupational therapy interventions for people with a frozen shoulder. The findings suggest that the COPM is an effective and valuable tool for clients with a frozen shoulder to understand their experiences and treatment priorities and to detect meaningful changes in their performance and satisfaction after an occupational therapy intervention.

Dynamics of disability and pain indicators under the influence of physical therapy for adhesives capsulitis and myofascial pain syndrome.

OBJECTIVE: Aim: To compare the effectiveness of end-range mobilization and therapeutic exercises, used in combination with ischemic compression, on disability and pain indicators among patients with adhesive capsulitis of the shoulder joint and thoracic myofascial pain syndrome. PATIENTS AND METHODS: Materials and Methods: The study involved 68 patients. Goniometry of the shoulder joint, assessment of pain in myofascial trigger points, and the Shoulder Pain and Disability Index questionnaire were used before and after physical therapy. The duration of physical therapy comprised 3 weeks. Physical therapy of the first group of patients consisted of end-range mobilization and ischemic compression. Patients of the second group performed therapeutic exercises and ischemic compression. RESULTS: Results: Both groups demonstrated positive dynamics of shoulder joint mobility, Shoulder Pain and Disability Index and pain in trigger points. However, the final results of the studied indicators were better in the first group of patients. CONCLUSION: Conclusions: Physical therapy based on the combination of end-range mobilization and ischemic compression had a more positive impact on disability and pain indicators for adhesive capsulitis of the shoulder joint and myofascial pain syndrome as compared to the combination of therapeutic exercises and ischemic compression.

Combined effect of graded Thera-Band and scapular stabilization exercises on shoulder adhesive capsulitis post-mastectomy.

PURPOSE: The main aim of the trial was to assess the combined impact of graded Thera-Band strengthening exercises and scapular stabilization exercises on shoulder pain, physical function, and quality of life (QoL) in post-mastectomy adhesive capsulitis (AC). METHODS: Seventy females with unilateral post-mastectomy AC partook in the trial. Participants were subdivided equally into two groups at random. Both groups obtained the traditional physical therapy program; in addition, the intervention group received graded Thera-Band exercises for shoulder muscles and scapular stabilization exercises 5 days a week for 8 weeks. Range of motion (ROM) and muscle power of shoulder were assessed by digital goniometer and handheld dynamometer, respectively. Disability of the Arm, Shoulder, and Hand questionnaire (DASH) was utilized for assessment of shoulder function and visual analogue scale (VAS) for pain measurement while short-form (SF-36) for QoL assessment. All evaluation data was recorded prior to the trial and at the eighth week of interventions for both groups. RESULTS: All participants achieved improvements in shoulder ROM, muscle power, pain, and all aspects of QoL; however, higher statistical improvements were reported in all measurements with respect to strengthening exercises group (p < 0.001). CONCLUSION: The addition of graded Thera-Band strengthening exercises and scapular stabilization exercises in post-mastectomy AC rehabilitation program has significant benefits in shoulder function and patients' QoL. TRIAL REGISTRATION: This study is retrospectively registered at ClinicalTrials.gov NCT05311839.

Effectiveness of acromioclavicular joint mobilization and physical therapy vs physical therapy alone in patients with frozen shoulder: A randomized clinical trial.

OBJECTIVES: The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. DESIGN: Single-blind randomized clinical trial. SETTING: Outpatient setting. SUBJECTS: Patients with frozen shoulder. INTERVENTION: Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. MAIN MEASURES: The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. RESULTS: Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [-4.63 (-5.58--3.67) vs. -2.22 (-2.96--1.47), P < 0.001 and -23.08 (-28.63--17.53) vs. -13.04 (-17.93--8.16), P = 0.008, respectively] and one month after the beginning of the treatment [-5.58 (-6.45--4.72) vs. -3.61 (-4.60--2.62), P < 0.001 and -33.43 (-40.85--26.01) vs. -20.03 (-26.00--14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy group [25.83 (11.45-40.13) vs. 10.17 (1.02-19.15), P = 0.025], however there were no significant differences between two groups concerning other measured range of motions. CONCLUSIONS: Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients.

Wearable Motion Sensor Device to Facilitate Rehabilitation in Patients With Shoulder Adhesive Capsulitis: Pilot Study to Assess Feasibility.

BACKGROUND: Adhesive capsulitis (AC) of the shoulder is a common disorder that painfully reduces the shoulder range of motion (ROM) among middle-aged individuals. Although physical therapy with home-based exercises is widely advised to restore ROM in the treatment of AC, clinical results vary owing to inconsistent patient compliance. OBJECTIVE: In this study, we aimed to verify the feasibility of a treatment model that involves applying a wearable motion sensor device to assist patients conduct home-based exercises to improve training compliance and the accuracy of exercises, with the ultimate goal of improving the functional recovery of patients with AC. METHODS: The motion sensor device was comprised of inertial measurement unit-based sensors and mobile apps for patients and physicians, offering shoulder mobility tracing, home-based exercise support, and progress monitoring. The interrater reliability of shoulder mobility measurement using the motion sensor device on 10 healthy participants and 15 patients with AC was obtained using an intraclass correlation coefficient analysis and compared with the assessments performed by two highly experienced physicians. A pilot prospective control trial was then carried out to allocate the 15 patients with AC to two groups: home-based exercise group and motion sensor-assisted rehabilitation group. Changes in active and passive shoulder ROM, pain and functional scores, and exercise completion rates were compared between the groups during a treatment period of 3 months. RESULTS: Shoulder ROM, as measured using the motion sensor device, exhibited good to excellent reliability based on the comparison with the measurements of two physicians (intraclass correlation coefficient range, 0.771 to 0.979). Compared with patients with AC in the home-based exercise group, those in the motion sensor-assisted rehabilitation group exhibited better shoulder mobility and functional recovery and a higher exercise completion rate during and after 3 months of rehabilitation. CONCLUSIONS: Motion sensor device-assisted home-based rehabilitation for the treatment of AC is a useful treatment model for telerehabilitation that enhances the compliance of patients through training, thus improving functional recovery. This helps overcome important obstacles in physiotherapy at home by providing comprehensible and easily accessible exercise instructions, enhancing compliance, ensuring the correctness of exercise, and monitoring the progress of patients.

The effect of electroacupuncture merged with rehabilitation for frozen shoulder syndrome: A single-blind randomized sham-acupuncture controlled study.

PURPOSE: Frozen shoulder syndrome (FSS) causes pain and reduces the range of motion in the shoulder joint. To investigate the short and medium-term effects of electroacupuncture in people with FSS, we evaluated the therapeutic effects of true and sham electroacupuncture on pain relief and improvement of shoulder function. METHODS: In this randomized, single-blind controlled clinical trial, 21 subjects with FSS were randomly assigned to two groups: a true electroacupuncture group (TEAG) and a sham electroacupuncture group (SEAG). The two groups underwent 18 sessions of treatment over approximately 6-9 weeks and were then followed up at 1, 3, and 6 months. Their effectiveness for alleviating the intensity of shoulder pain was evaluated with a visual analog scale (VAS), while improved shoulder mobility was evaluated by the active range of motion (AROM) and passive range of motion (PROM), and shoulder functional ability was evaluated using the Shoulder Pain and Disability Index (SPADI). RESULTS: It demonstrated that the TEAG or SEAG showed lasting effects at 1, 3, and 6 months, although with no significant difference between these two groups in the shoulder functional ability outcomes. However, the decline in the VAS occurred earlier in the TEAG than the SEAG. Also, there was much more improvement in AROM for flexion and abduction in the TEAG than the SEAG. An increase in the abduction angle after electroacupuncture and manual rehabilitation was also apparent. CONCLUSION: These results suggest that electroacupuncture plus rehabilitation may provide earlier pain relief for patients with FSS and could be applied clinically.

Evaluating the Outcome of Two Different Regimes in Adhesive Capsulitis: A Prospective Clinical Study.

OBJECTIVE: Adhesive capsulitis or frozen shoulder is a painful condition affecting up to 5% of the general population. We conducted this study with the aim of evaluating the results of physiotherapy plus intra-articular methylprednisolone injection versus physiotherapy alone in idiopathic frozen shoulder. METHODS: This prospective clinical study was conducted in a tertiary care center between August 2016 and August 2018. Patients who were diagnosed with idiopathic frozen shoulder were included in the study, and each patient was randomly allocated to one of two groups: physiotherapy alone (group A) and physiotherapy plus intra-articular steroid injection (group B). RESULTS: A total of 52 cases diagnosed with idiopathic frozen shoulder were included and treated with the two modalities. There was a significant improvement in group B compared to group A at 6 weeks and 3 months in the range of flexion, abduction, and external rotation. The Shoulder Pain and Disability Index showed improvement in both pain and disability score in group B -compared to group A, and improvement was significant at 6 weeks and 3 months. CONCLUSION: The results demonstrate the advantages of physiotherapy plus intra-articular steroid injection in idiopathic frozen shoulder. The predictability of results with physiotherapy plus intra-articular steroid injection in selected patients is excellent, and it is a better modality of treatment compared to physiotherapy alone.

Which method for frozen shoulder mobilization: manual posterior capsule stretching or scapular mobilization?

OBJECTIVES: This study aimed to compare the superiority of scapular mobilization, manual capsule stretching, and the combination of these two techniques in the treatment of frozen shoulder patients to evaluate the acute effects of these techniques on shoulder movements. METHODS: This study designed to a single-blinded, randomized, and pre-post assessment study. This study was included 54 patients diagnosed with stage 3 frozen shoulder. Group 1 (n=27) received scapular mobilization, and Group 2 (n=27) received manual posterior capsule stretching. After the patients were assessed, the interventions were re-applied with a crossover design to obtain results for the combined application (n=54). The range of motion, active total elevation, active internal rotation, and posterior capsule tensions of the shoulder joint were recorded before and immediately after mobilization. RESULTS: Statistical analysis showed an increase in all range of motion values (p<0.05), except for shoulder internal rotation (p>0.05), without significant difference among the groups (p>0.05). The posterior capsule flexibility did not change in any group (p>0.05). CONCLUSIONS: Scapular mobilization and manual posterior capsule interventions were effective in improving the acute joint range of motion in frozen shoulder patients.

Effect of smartphone application-supported self-rehabilitation for frozen shoulder: a prospective randomized control study.

OBJECTIVES:: To evaluate the clinical efficacy of smartphone-assisted self-rehabilitation in patients with frozen shoulder. DESIGN:: A single-center, randomized controlled trial. SETTING:: Orthopedic department of a university hospital. SUBJECTS:: A total of 84 patients with frozen shoulder were recruited. INTERVENTION:: Patients were randomly divided into two groups: a smartphone-assisted exercise group ( n = 42) and a conventional self-exercise group ( n = 42). The study was performed over three months, during which each group performed home-based rehabilitation. MAIN MEASURES:: Visual analogue scale for pain and passive shoulder range of motion were assessed at baseline and after 4, 8, and 12 weeks of treatment. Technology Acceptance Model-2 and Usefulness, Satisfaction, and Ease of Use scores were evaluated in the smartphone group. RESULTS:: Initial visual analogue scale for pain of the smartphone group was 6.0 ± 2.2 and ended up with 1.8 ± 2.5 after 12 weeks, whereas the self-exercise group showed 5.8 ± 2.3 for the baseline visual analogue scale for pain and 2.2 ± 1.7 at the end. Significant time-dependent improvements in all measured values were observed in both groups (all Ps < 0.001), but no significant intergroup difference was observed after 4, 8, or 12 weeks of treatment. In the smartphone group, Technology Acceptance Model-2 and Usefulness, Satisfaction, and Ease of Use scores showed high patient satisfaction with smartphone-assisted exercise. CONCLUSION:: There was no difference between home-based exercise using a smartphone application and a conventional self-exercise program for the treatment of frozen shoulder in terms of visual analogue scale for pain and range of motions.

Management of Concomitant Preoperative Rotator Cuff Pathology and Adhesive Capsulitis: A Systematic Review of Indications, Treatment Approaches, and Outcomes.

PURPOSE: Concomitant preoperative adhesive capsulitis (AC) and rotator cuff (RC) pathology pose therapeutic challenges in light of contrasting interventional and rehabilitative goals. The purposes of this systematic review were to assess the literature regarding the management and rehabilitation of patients with concomitant RC tears and preoperative AC and to compare overall clinical outcomes between strategies for this common scenario. METHODS: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched and screened in duplicate using predetermined criteria for studies on the aforementioned patient population. Descriptive statistics are presented. RESULTS: Of 952 studies, 17 involving 662 shoulders, with a mean age of 59.6 ± 3.5 years, 57.9% female patients, and a mean follow-up period of 18.6 months, were included. Capsular release (CR) (86.1%) and manipulation under anesthesia (MUA) (33.1%) were the most common co-interventions with RC repair. Across studies, mean preoperative American Shoulder and Elbow Surgeons scores ranged from 29.0 to 61.3, visual analog scale scores (pain) ranged from 5.3 to 8.0, and Constant scores ranged from 18.0 to 48.0. Mean postoperative American Shoulder and Elbow Surgeons scores ranged from 76.9 to 92.0, visual analog scale scores (pain) ranged from 0.3 to 2.5, and Constant scores ranged from 72.6 to 93.2. Postoperative rehabilitation comprised abduction braces and passive range of motion immediately postoperatively for mean durations of 5.0 weeks and 5.3 weeks, respectively, followed by active range of motion at a mean of 5.3 weeks and strengthening at 10.9 weeks. Postoperative complications included stiffness, RC retear, instability, glenoid fracture, and superficial infection. CONCLUSIONS: The results of this systematic review support treatment of patients with degenerative RC tears and concomitant AC with a combination of RC repair and MUA, CR, or both MUA and CR. Regardless of the treatment modality, accelerated postoperative rehabilitative protocols are beneficial in preventing postoperative persistence of AC and can be safely used in this scenario without a substantial increase in complication rates compared with patients undergoing RC repair alone with conservative rehabilitation. LEVEL OF EVIDENCE: Level V, systematic review of Level II, III, IV, and V studies.

Long-Term Outcomes After In Situ Arthroscopic Repair of Partial Rotator Cuff Tears.

PURPOSE: To analyze clinical outcomes, return to sports, and complications in a series of patients with painful partial-thickness rotator cuff tears treated with arthroscopic in situ repair with suture anchors who had a minimum of 8 years of follow-up. METHODS: Sixty-two patients who had undergone an arthroscopic in situ repair for partial-thickness rotator cuff tears were evaluated. All injuries involved the supraspinatus tendon. Clinical assessment consisted of glenohumeral range-of-motion measurement and the American Shoulder and Elbow Surgeons score. Pain was rated by using a visual analog scale. We assessed return to sports and the level of performance achieved after surgery. Postoperative complications were also assessed. RESULTS: Mean age was 52.4 years (range, 32 to 67 years), and mean duration of follow-up was 10.4 years (range, 8 to 12 years). All active range-of-motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons score improved from 45.6 to 85.1; and the visual analog scale scores improved from 6.4 to 1.6 (P < .0001). Thirty patients participated in sports before injury: 21 were recreational athletes and 9 were competitive athletes. Twenty-six (87%) were able to return to sports, and 24 (80%) returned to the same level they had achieved before injury. No significant difference regarding functional outcomes or return to sports was found between patients with articular-sided tears and those with bursal-sided tears. No revision surgeries were performed. Three patients had postoperative adhesive capsulitis that responded favorably to physical therapy. CONCLUSIONS: During long-term follow-up, arthroscopic in situ repair of partial-thickness rotator cuff tears produces excellent functional outcomes in more than 80% of patients, and revision rates are low. Most patients return to their chosen sport at the same level they had achieved before injury. The results are equally favorable for articular-sided and bursal-sided tears. LEVEL OF EVIDENCE: IV, therapeutic case series.

Effectiveness of Mulligan's Mobilization With Movement Techniques on Range of Motion in Peripheral Joint Pathologies: A Systematic Review With Meta-analysis Between 2008 and 2018.

OBJECTIVES: The purpose of this study was to provide an updated systematic review and meta-analysis regarding the effectiveness of mobilization with movement (MWM) techniques on range of motion (ROM). METHODS: An electronic search strategy of the Physiotherapy Evidence Database, PubMed, Cochrane Library, Embase, Google Scholar, and CINAHL was performed between August 2008 and January 2018. Two independent reviewers selected the studies. Only randomized controlled trials were included. The methodology was independently assessed by 2 reviewers using the Physiotherapy Evidence Database scale. The Z indicator was considered for the assessment of statistical significance of ROM change, whereas for each meta-analysis referring to a specific joint pathology, the total mean difference (95% confidence interval) was compared against minimum detectable change values from relevant studies conducted in similar populations to assess clinical significance. RESULTS: Included were 18 studies with 753 participants in 10 separate meta-analyses for ROM. All studies were classified as high quality or medium quality. Peripheral joint MWM seems to produce better therapeutic results in comparison to sham, passive, other active, or no therapeutic approach, regarding improvement of joint ROM in specific peripheral joint pathologies, consistently in all movement directions for shoulder adhesive capsulitis (mean improvement 12.30o-26.09o, P < .02) and hip pain (mean improvement 4.50o-14.80o, P < .0001). CONCLUSION: Mobilization with movement produced a statistically and clinically significant ROM increase consistently in all movement directions for shoulder adhesive capsulitis and hip pain. However, for shoulder impingement, shoulder pain/dysfunction, hamstring tightness, knee osteoarthritis, and chronic ankle instability pathologies, a therapeutic benefit regarding ROM could not be clearly established. Owing to the small number of individual studies included within the separate groups of pathologies examined in our systematic review, methodologically rigorous studies with longer follow-up periods are warranted to better inform the evidence base on the effects of MWM on ROM.

Capsule-Preserving Hydrodilatation With Corticosteroid Versus Corticosteroid Injection Alone in Refractory Adhesive Capsulitis of Shoulder: A Randomized Controlled Trial.

OBJECTIVE: To determine whether capsule-preserved hydrodilatation with corticosteroid improves pain and function in patients with refractory adhesive capsulitis (AC) better than intra-articular corticosteroid injection (IACI) alone. DESIGN: Prospective randomized controlled study. SETTING: University-affiliated tertiary care hospital. PARTICIPANTS: Subjects with primary AC (N=64) with shoulder pain level of visual analog scale (VAS) score ≥5, even after the initial administration of IACI alone. INTERVENTIONS: Participants randomly received ultrasound-guided IACI alone with 1mL of 40mg/mL triamcinolone acetonide and 3mL of 1% lidocaine (n=32) or ultrasound-guided capsule-preserved hydrodilatation with corticosteroid with a mixture of 1mL of 40mg/mL triamcinolone acetonide, 6mL of 1% lidocaine, and normative saline (n=32). MAIN OUTCOME MEASURES: The primary outcome measure was the Shoulder Pain and Disability Index score. Secondary outcomes were the VAS of shoulder pain level and angles of shoulder passive range of motion, including flexion, abduction, extension, external rotation, and internal rotation at pretreatment and weeks 3, 6, and 12 of posttreatment. RESULTS: There were no significant differences between the 2 groups in terms of demographic characteristics (age, sex, duration of symptoms, shoulder affected, and body mass index) at baseline. Repeated-measures analysis of variance showed significant effect of time in all outcome measurements in both groups. However, group-by-time interactions were not significantly different for any of the outcomes between groups. CONCLUSIONS: This study shows that compared with pretreatment, all outcome measures improved significantly in both groups by time; however, there was no significant difference between the 2 groups. Therefore, we recommend IACI alone over capsule-preserved hydrodilatation with corticosteroid when considering the corticosteroid injection as a secondary option after the initial IACI fails to improve symptoms for patients with refractory AC.

Activity- vs. structural-oriented treatment approach for frozen shoulder: a randomized controlled trial.

OBJECTIVE: To compare the short- and long-term effects of a structural-oriented (convential) with an activity-oriented physiotherapeutic treatment in patients with frozen shoulder. DESIGN: Double-blinded, randomized, experimental study. SETTING: Outpatient clinic. SUBJECTS: We included patients diagnosed with a limited range of motion and pain in the shoulder region, who had received a prescription for physiotherapy treatment, without additional symptoms of dizziness, a case history of headaches, pain and/or limited range of motion in the cervical spine and/or temporomandibular joint. INTERVENTIONS: The study group received treatment during the performance of activities. The comparison group was treated with manual therapy and proprioceptive neuromuscular facilitation (conventional therapy). Both groups received 10 days of therapy, 30 minutes each day. MAIN MEASURES: Range of motion, muscle function tests, McGill pain questionnaire and modified Upper Extremity Motor Activity Log were measured at baseline, after two weeks of intervention and after a three-month follow-up period without therapy. RESULTS: A total of 66 patients were randomized into two groups: The activity-oriented group ( n = 33, mean = 44 years, SD = 16 years) including 20 male (61%) and the structural-oriented group ( n = 33, mean = 47 years, SD = 17 years) including 21 male (64%). The activity-oriented group revealed significantly greater improvements in the performance of daily life activities and functional and structural tests compared with the group treated with conventional therapy after 10 days of therapy and at the three-month follow-up ( p < 0.05). CONCLUSIONS: Therapy based on performing activities seems to be more effective for pain reduction and the ability to perform daily life activities than conventional treatment methods.

Effectiveness of Occupational Therapy Interventions for Musculoskeletal Shoulder Conditions: A Systematic Review.

People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in meaningful occupational activities. The purpose of this systematic review was to evaluate the current evidence for interventions within the occupational therapy scope of practice that address pain reduction and increase participation in functional activities. Seventy-six studies were reviewed for this study-67 of Level I evidence, 7 of Level II evidence, and 2 of Level III evidence. Strong evidence was found that ROM, strengthening exercises, and joint mobilizations can improve function and decrease pain. The evidence to support physical modalities is moderate to mixed, depending on the shoulder disorder. Occupational therapy practitioners can use this evidence to guide daily clinical decision making.

Efficacy of Different Types of Mobilization Techniques in Patients With Primary Adhesive Capsulitis of the Shoulder: A Systematic Review.

OBJECTIVE: To systematically review the literature for efficacy of isolated articular mobilization techniques in patients with primary adhesive capsulitis (AC) of the shoulder. DATA SOURCES: PubMed and Web of Science were searched for relevant studies published before November 2014. Additional references were identified by manual screening of the reference lists. STUDY SELECTION: All English language randomized controlled trials evaluating the efficacy of mobilization techniques on range of motion (ROM) and pain in adult patients with primary AC of the shoulder were included in this systematic review. Twelve randomized controlled trials involving 810 patients were included. DATA EXTRACTION: Two reviewers independently screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All studies were assessed in duplicate for risk of bias using the Physiotherapy Evidence Database Scale for randomized controlled trials. DATA SYNTHESIS: The efficacy of 7 different types of mobilization techniques was evaluated. Angular mobilization (n=2), Cyriax approach (n=1), and Maitland technique (n=6) showed improvement in pain score and ROM. With respect to translational mobilizations (n=1), posterior glides are preferred to restore external rotation. Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization (n=1) had a superior effect on active ROM compared with sham ultrasound. High-intensity mobilization (n=1) showed less improvement in the Constant Murley Score than a neglect group. Finally, positive long-term effects of the Mulligan technique (n=1) were found on both pain and ROM. CONCLUSIONS: Overall, mobilization techniques have beneficial effects in patients with primary AC of the shoulder. Because of preliminary evidence for many mobilization techniques, the Maitland technique and combined mobilizations seem recommended at the moment.

Arthroscopic Transtendon Repair of Partial-Thickness Articular-Side Rotator Cuff Tears.

PURPOSE: To evaluate the clinical outcomes and complications in a series of patients with painful partial articular cuff tears treated with the arthroscopic transtendinous repair with a minimum 2-year follow-up. METHODS: Eighty patients with a mean age of 51 ± 5.4 years who had undergone an arthroscopic transtendon repair for a painful articular-sided rotator cuff tear with a minimum of 2-year follow-up were contacted. Clinical outcomes using a patient-based questionnaire, the University of California at Los Angeles score, the American Shoulder and Elbow Surgeons score, and the visual analog scale were evaluated. Postoperative complications were also assessed. RESULTS: After arthroscopic repair, the University of California at Los Angeles scores improved from 13.6 to 31.5; the American Shoulder and Elbow Surgeons scores improved from 44.4 to 76.1; and the visual analog scale scores improved from 6.3 to 1.3 (P < .0001). A total of 92.5% of patients were satisfied with their results. Only 5 patients developed a postoperative adhesive capsulitis that responded favorably to physical therapy. Eleven patients had concurrent procedures performed at the time of surgery. We found no difference between these patients and those who had an isolated tendon repair. CONCLUSIONS: Arthroscopic transtendon repair of partial-thickness articular-side rotator cuff tears is a reliable procedure that can be expected to produce satisfactory functional improvements and pain relief in most patients with a low rate of complications in the midterm follow-up. Concurrent procedures performed at the time of supraspinatus repair do not change functional outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

How to treat a frozen shoulder? A survey among shoulder specialists in the Netherlands and Belgium.

A frozen shoulder is a common cause of a painful and stiff shoulder. A web-based survey was conducted to obtain insight in the current preferences about the diagnosis and treatment of a frozen shoulder. A response rate of 54% was reached among shoulder specialized orthopaedic surgeons from the Netherlands and Belgium. Non-steroidal anti-inflammatory drugs and intra-articular corticosteroid injections are used frequently in the first phase of the condition. Physiotherapy is assumed to be more important in the final phase. The results of the survey indicate a wide variety of treatment strategies in the different phases of a frozen shoulder. Three out of four respondents considered that the management of a frozen shoulder could benefit from a written guideline. The development of a written guideline should lead to an improved level of consensus and a more standardized approach in the treatment of a frozen shoulder among shoulder specialists in the Netherlands and Belgium.

An activity recognition model using inertial sensor nodes in a wireless sensor network for frozen shoulder rehabilitation exercises.

This paper proposes a model for recognizing motions performed during rehabilitation exercises for frozen shoulder conditions. The model consists of wearable wireless sensor network (WSN) inertial sensor nodes, which were developed for this study, and enables the ubiquitous measurement of bodily motions. The model employs the back propagation neural network (BPNN) algorithm to compute motion data that are formed in the WSN packets; herein, six types of rehabilitation exercises were recognized. The packets sent by each node are converted into six components of acceleration and angular velocity according to three axes. Motor features such as basic acceleration, angular velocity, and derivative tilt angle were input into the training procedure of the BPNN algorithm. In measurements of thirteen volunteers, the accelerations and included angles of nodes were adopted from possible features to demonstrate the procedure. Five exercises involving simple swinging and stretching movements were recognized with an accuracy of 85%-95%; however, the accuracy with which exercises entailing spiral rotations were recognized approximately 60%. Thus, a characteristic space and enveloped spectrum improving derivative features were suggested to enable identifying customized parameters. Finally, a real-time monitoring interface was developed for practical implementation. The proposed model can be applied in ubiquitous healthcare self-management to recognize rehabilitation exercises.

Ultrasound-guided pulsed radiofrequency stimulation of the suprascapular nerve for adhesive capsulitis: a prospective, randomized, controlled trial.

BACKGROUND: The treatment of adhesive capsulitis (AC) is a well-known, complicated, and long process. Recent studies have shown that pulsed radiofrequency (PRF) lesioning of the suprascapular nerve (SSN) using a fluoroscopy- or computed tomography-guided technique can alleviate shoulder pain. However, there are no studies of PRF lesioning of the SSN in patients with AC using ultrasound-guided (UG) techniques, except for 2 case reports. In this study, we compared the effect of physical therapy alone with physical therapy and PRF lesioning of the SSN using a UG technique. METHODS: Sixty patients with AC were included in the study. Patients were randomized into the following 2 groups: the intervention group containing patients who received 12 weeks of physical therapy after 1 treatment of PRF lesioning of the SSN, and the control group containing patients who received 12 weeks of physical therapy alone. All outcome measurements including visual analog scale (VAS), shoulder pain and disability index, and passive range of motion (PROM) were performed at 1, 4, 8, and 12 weeks after treatment. RESULTS: Forty-two patients (21 patients in each group) completed the study. The intervention group had a notably shorter time to onset of significant pain relief (6.1 ± 3.4 vs 28.1 ± 9.2 days; P < 0.001) and noticeable reduction of VAS score at week 1 (40% vs 4.7%) than the control group (P < 0.001). All measured variables in the intervention group and most variables in the control group showed significant improvement from the baseline (P < 0.05). A comparison of the 2 groups indicated significantly greater improvement in the intervention group at all times in VAS and shoulder pain and disability index scores (all P < 0.05), and for most gain of PROM (P < 0.05). There were no serious adverse effects or complications in either group. CONCLUSIONS: This study indicates that the application of PRF lesioning of the SSN using a UG technique combined with physical therapy provided better and faster relief from pain, reduced disability, and improved PROM when compared with physical therapy alone in patients with AC, an effect that persisted for at least 12 weeks.