The Effectiveness of Intensive Mobilization Techniques Combined with Capsular Distension for Adhesive Capsulitis of the Shoulder

Abstract

[Purpose] The aim of this study was to determine the synergistic effect of intensive mobilization techniques combined with capsular distension for patients with adhesive capsulitis (AC). [Subjects] The subjects were 53 patients with AC (mean age, 56.0 ± 7.6 years). [Methods] Patients were randomized to one of four treatment groups: intensive mobilization after one steroid injection with capsular distension (IMSID); intensive mobilization (IM); one steroid injection with capsular distension (SID); and general physical therapy only (GPT). The IMSID, IM, and SID groups also received general physical therapy for 20 minutes. All treatments were performed twice per week for 4 weeks. Patients were assessed using the Shoulder Pain and Disability Index (SPADI), Constant-Murley Shoulder Function Assessment Score (CS), Active Range of Motion (AROM), and Verbal Numeric Score (VNS). [Results] There were significant post-intervention differences in all the measured values in each of the groups, except for external rotation ROM in the SID group. The IMSID group showed the greatest differences among the groups. There were significant differences among the means of all the groups. [Conclusion] The most effective treatment for AC was the combination of the intensive mobilization and steroid injection with capsular distension, which helped to control inflammation, extend joint space, and recover ROM.

The clinical effect of hydraulic distension plus manual therapy on patients with frozen shoulder

“…There are few studies related to frozen shoulder treatment that included hydraulic distension with manual therapy and compared them prospectively. This study produced results similar to those of previous studies, that is, rapid onset of treatment effects and maintenance until 6 weeks after hydraulic distension plus manual therapy of the pain index, satisfaction level, and range of motion10 ) . These results occurred because hydraulic distension performed with manual therapy induced increased joint volume in a short time, permitting sufficient joint movement11 ) .…”

What is the most effective treatment for frozen shoulder?

“…• A randomised trial of 64 patients comparing fluoroscopy guided anterior distension with ultrasonography guided posterolateral capsular distension 21 • A randomised trial of 48 patients comparing ultrasonography guided and fluoroscopy guided capsular distension 22 • A four-armed study with 53 participants investigating intensive mobilisation techniques combined with capsular distension. 23 All the studies had a high risk of bias and seem to be inadequately powered.…”

Management of adhesive capsulitis

“…The authors hypothesized that the combination addressed inflammation with the corticosteroid, extended the joint space with capsular distension, and recovered range of motion with intensive mobilization. 81 To date, there is no consensus regarding the necessity of capsular rupture for the success of this procedure. Recently, studies have looked at whether preservation of capsular integrity leads to better outcomes.…”