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IJCRR - 3(11), November, 2011

Pages: 190-195

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EFFECT OF THERAPEUTIC ULTRASOUND WITH END RANGE MOBILIZATION VS CRYOTHERAPY WITH
STRETCHING IN IMPROVING ACTIVE RANGE OF MOTION IN PATIENTS WITH ADHESIVE CAPSULITIS OF SHOULDER - A RANDOMIZED CLINICAL TRIAL

Author: Shahbaz Nawaz Ansari, I. Lourdhuraj , Nafeez Syed , Shikhsha Shah

Category: Healthcare

Abstract:Background: Effectiveness of any individualized therapeutic modality in improving the range of motion of shoulder in adhesive capsulitis is questionable and the combination of therapies
has contradictory results. Objectives: The purpose of this study was to check the effectiveness between the treatment modalities of Ultrasound and End range mobilization over Cryotherapy
and Stretching as a treatment program in improvement of active range of motion in patients
with adhesive capsulitis of shoulder. Methods: Forty subjects diagnosed to have adhesive capsulitis were randomly assigned to two groups. Subjects in Group I received Ultrasound and
End range mobilization of shoulder while subjects in Group II got Cryotherapy and Stretching
of shoulder. Both the groups were treated for 6 days a week for 4 weeks. ROM's of shoulder in
abduction and external rotation were the outcome measures considered. Results: Statistical analysis was done considering p< 0.05 as statistically significant and the?t' values were
estimated. It was found that ultrasound when combined with end range mobilization had a
value of 3.4498 in comparison to 1.7773 of cryotherapy combined with stretching group.
Conclusion: Ultrasound with end range mobilization produced a better result than cryotherapy
with stretching and therefore can be recommended in the treatment of second stage adhesive
capsulitis of shoulder.

Keywords: Adhesive capsulitis, ultrasound, end range mobilization, cryotherapy, stretching, abduction, external rotation.

Full Text:

INTRODUCTION

Adhesive capsulitis has been described as a condition of ?unknown etiology characterized by gradually progressive, painful restriction of all joint motion with spontaneous restoration of partial or complete motion over months to years?1 . Its clinical course is divided into stages of freezing, lasting from onset to between 10 and 36 weeks, characterized by severe pain and a gradual diminution of articular volume, frozen stage lasting between 4 and 12 months when pain decreases gradually but without appreciable improvement in motion and thawing stage which is marked by gradual return of motion and may last between 12 months to few years 2 . Ultrasound therapy (UST), one of the modalities used to treat adhesive capsulitis elevates tissue temperature to depths of more than 5 cm causing increased collagen tissue extensibility, pain threshold, and enzymatic activity. It also changes nerve conduction velocity, contractile activity of the skeletal muscle.3 Cryotherapy is another important modality which controls pain by directly and rapidly modifying the sensation of pain and controlling the pain transmission with the activity of cutaneous thermal reception 4Mobilization techniques applied close to the articular surface in ventral, dorsal and inferior directions of the gleno-humeral joint are frequently used by physical therapists as an intervention for limited joint range of motion.5 Passive stretching is a therapeutic maneuver designed to lengthen pathologically shortened soft tissue by using an external force, applied either manually or mechanically for about 30 seconds and thereby facilitate increase in range of motion.6 There are various studies supporting the individual effects of ultrasound, mobilization, cryotherapy and capsular stretching in patients with adhesive capsulitis. However, combination of modalities has been less explored. This study attempts to find out the combined effect of Ultrasound therapy (UST) and End range mobilization (ERM) over cryotherapy and capsular stretching in improvement of active range of motion in patients with adhesive capsulitis of shoulder.

CONCLUSION

Study concludes that the subjects treated with Ultrasound therapy (UST) along with End range mobilization (ERM) showed better improvement in the abduction and external rotation ROM of shoulder compared to those who received cryotherapy and stretching. The alteration in the extensibility parameters of the soft tissues around the joint due to cryotherapy could have contributed to the lower improvements in ROM both in SAB and SER of group II. This study was limited in its scope due to small sample size, lack of control group, shorter duration of treatment and only abduction and external rotation movements being estimated which the authors believe were less to comment on the prognosis of the patient. Future studies with longer treatment duration and subjects of stage III also included and the ROM measured using electro goniometer are recommended. However, this is just authors‘ hypothesis and could be investigated in detail by doing future trials involving larger sample.

References:

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2. Reeves B; The natural history of the frozen shoulder syndrome; Scand J Rheumatol 1975; 4(4): 193-196.

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5. Rizk TE, Christopher RP, Pinals RS, Higgins AC, Frix R; Adhesive capsulitis: a new approach to its management; Arch Physical Medicine Rehabilitation; 1983 Jan; 64 (1): 29 –33.

6. Available from http://www.physioroom.com/prevention /stretching3.php on 23rd Feb, 2006.

7. Vermeulen HM, Obermann WR, Burger BJ, Gea J Kok, Piet M Rozing, and Cornelia HM van den Ende; End-range mobilization techniques in adhesive capsulitis of the shoulder joint: a multiple-subject case report; Phys Ther; 2000; 80:1240-1213.

8. Grey RG. The natural history of ?idiopathic? frozen shoulder. J Bone Joint Surg Br. 1978;60:564.

9. Rowe CR, Leffert RD. Idiopathic chronic adhesive capsulitis (?frozen shoulder?). In: Rowe CR, ed. The Shoulder. New York, NY: Churchill Livingstone Inc; 1988:155–163.

10.Kay NR. The clinical diagnosis and management of frozen shoulders. Practitioner. 1981;225:164 –172.

11.Lewit K. Manuelle Medizin. Leipzig, Germany: Johann Ambrosius Barth; 1977.

12.Bulgen DY, Binder AI, Hazleman BL, et al. Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis. 1984;43:353–360.

13.Mens JM, de Wolf AN. Wat is de meest adequate behandeling van een zogenaamde frozen shoulder? Respons. 1991;2(10):1–3.

14.van der Korst JK. Periarthritis scapulohumeralis beschouwd vanuit de reumatologie. Nederlands Tijdschrift vor Fysiotherapie. 1980;9:260 –263.

15.Robertson VJ, Baker KG; A review of therapeutic ultrasound - effectiveness studies, Physical Therapy; 2001 July; 81(7): 1339-50.

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A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

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