Amit, Mohd Arafat
Department of Physiotherapy, Sharda University, Greater Noida, 201310, India
Frozen shoulder is the gradual loss of movement in the shoulder (glenohumeral) joint. When the shoulder is frozen, the joint has become stiff and its movement is limited. It is also called adhesive capsulitis and commonly treated by manual therapy and exercise, usually delivered together as components of a physical therapy intervention. The differential diagnosis includes biceps tendinopathy, glenohumeral osteoarthritis, neoplasm, rotator cuff tendinopathy or tear (with or without impingement), and subacromial and subdeltoid. The case report is based on use of combination therapy and shoulder glides to reduce the pain and improve the Range of motion of the joint. Combination therapy comprises of transcutaneous electrical nerve stimulation and ultrasonic therapy at different intensities according to different musculoskeletal conditions. Outcome measure used were Numerical Pain Rating Scale for pain and universal goniometer for measuring range of motion. In conclusion, the study supports the use of combination therapy and shoulder glides are beneficial in reducing pain and improve shoulder Range of motion in patients with case of Frozen shoulder.
Keywords: Frozen shoulder, transcutaneous electrical nerve stimulation, ultrasonic therapy, range of motion, numerical pain rating scale, pain.
Frozen shoulder is a known disorder that causes pain, stiffness, and loss of normal range of motion in the shoulder leads to disability that can be serious, and the condition tends to get worse with time if it’s not treated1. It affects mainly people ages 40 to 60, and women more often than men. Sometimes freezing occurs because the shoulder has been immobilized for a long time by injury, surgery, or illness2. The shoulder has greatest mobility and range of motion than any other joint in the body. It is ball and socket variety of joint, in which head of humerus attached to the glenoid cavity also called glenohumeral joint3. The questions of when and how to treat the frozen shoulder can present challenges. Most treatments are conservative; however, indications for surgery do exist4. The British Elbow and Shoulder Society/British Orthopedic Association (BESS/BOA) has published recommendations in a patient care pathway for frozen shoulder, with a step-up approach in terms of invasiveness advised5. Combination therapy is effective as seen in many researches6. Evidence of moderate quality shows that a combination of manual therapy and exercise for six weeks probably results in less improvement at seven weeks but a similar number of adverse events compared with glucocorticoid injection7. When used alone, manual therapy has limited efficacy in the management of frozen shoulder. conservative treatments such as injections and physiotherapy are ineffective for a small group of patients8. It would be fascinating to see if these patients with a protracted and resistant course of disease might be recognized sooner rather than later.
On Jan 5, 2023, a 50-year-old female patient who was housewife presented with a complaint of right shoulder pain and unable to lift her right hand for 2 months, unable to comb her hairs and squeezing the towel. Symptoms were reported as continuous pain in movement of hand and aggravated when she tried to do some activities in abduction and internal rotation shoulder movement. The NPRS was 8/10. She had history of fall on outstretch hand 5 years back. Earlier, she had taken 3 dose of corticosteroid injections through which she got some relief in pain.
Apley scratch test: Positive
NPRS Scale: 8/10
Diagnosis: Right Side Frozen Shoulder
PHYSIOTHERAPY TREATMENT PLAN
For treatment, it was planned to give Hot fomentation, Combination therapy, shoulder glides anterior, posterior, inferior glide) along with home exercise program.
The patient was asked to take 12 physiotherapy sessions, thrice in a week for four weeks. The patient was asked to lie in a supine position and hot pack was given for 10 minutes, after that 5 repetitions of shoulder glides (anterior, posterior and inferior). The patient was asked to Codman’s pendulum exercises(10 times in each direction) and lastly combination therapy of transcutaneous electrical nerve stimulation and ultrasonic therapy was given to patient in which US works as active electrode and TENS channel used as passive electrode was given for 7 minutes duration, having ultrasonic intensity of 1.5 W/cm2 and Tens frequency 200MHz.
Home Exercise Program
1. Towel stretch (10-15 reps)
2. Pendulum exercises (10 reps)
3. Finger ladder exercises in abduction and flexion (10 reps)
Outcome measures were collected at baseline and NPRS score found 1/10 after 12 session and patient was able to do her daily activities. Table 1 and Table 2 shows the Pre and Post NPRS and Rom.
Table 1: Shows the Pre and Post ROM of shoulder joint
Table B: Pre and Post Numerical Pain Rating Score
The effectiveness of combination therapy and shoulder glides are seems to be beneficial in patient to eliminate pain and improving ROM in Frozen shoulder patients.
· It can be done on large sample size to find out the effectiveness.
· Other parameters can also be used.
1. Ewald A. Adhesive capsulitis: a review. Am Fam Physician. 2011 Feb 15; 83(4): 417-22. PMID: 21322517.
2. Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: A systematic review and Meta-analysis. JAMA Netw Open. 2020 Dec 1; 3(12): e2029581. https://doi.org/10.1001/jamanetworkopen.2020.29581. PMID: 33326025; PMCID: PMC7745103.
3. Page MJ, Green S, Kramer S, Johnston RV, McBain B, Chau M, Buchbinder R. Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev. 2014 Aug 26;(8):CD011275. https://doi.org/ 10.1002/14651858.CD011275. PMID: 25157702.
4. Tasto JP, Elias DW. Adhesive capsulitis. Sports Med Arthrosc Rev. 2007; 15: 216-221 [PMID: 18004221 https://doi.org/ 10.1097/ JSA.0b013e3181595c22]
5. Zhang LH, Wang LX, Cui Q, Zhang GW. Efficacy of blood-letting puncture and cupping in the treatment of periarthritis of shoulder: a systematic review. TMR Integrative Medicine. 2018; 2(4): 175-91. https://doi.org/10.12032/TMRIM201802033.
6. Al-Bedah AMN, Elsubai IS, Qureshi NA, Aboushanab TS, Ali GIM, El-Olemy AT, Khalil AAH, Khalil MKM, Alqaed MS. The medical perspective of cupping therapy: Effects and mechanisms of action. J Tradit Complement Med. 2018 Apr 30; 9(2): 90-97. https://doi.org/10.1016/j.jtcme.2018.03.003. PMID: 30963043; PMCID: PMC6435947.
7. Matthew J Page, Sally Green, Manual therapy and exercise for adhesive capsulitis (frozen shoulder. Cochrane Database of Systematic Reviews; August 2014. https://doi.org/10.1002/14651858.CD011275.
8. Dr. Harish Babu J, Dr. Gadhamsetty Sai Ganesh, Dr. Shri Vishnu M, Dr. C Nissanth and Dr. Yeshwanth Subash; Comparison of functional outcome between corticosteroid injection alone vs combination with physiotherapy for frozen shoulder, Jan 2023. https://doi.org/10.22271/ortho.2023.v9.i1a.3272.
ARTICLE TYPE: Research Article; ORCID ID: Open Researcher and Contributor Identifier (ORCID) ID of corresponding author: https://orcid.org/0000-0001-5262-8578; ETHICAL: Institutional ethical committee and prior patient consent obtained; ACKNOWLEDGEMENT: None; FINANCIAL DISCLOSURE: The authors declare that there was no financial aid received.; CONFLICT OF INTEREST: No conflict of interest associated with this research work.; AUTHORS CONTRIBUTION: Mr. A., Idea and Conceptualization & M.A., Data Collection and Editing.; AUTHORS AFFILIATIONS: Amit, Tutor, Department of Physiotherapy, Sharda University, Greater Noida, 201310, India.; Mohd Arafat, Department of Physiotherapy, Sharda University, Greater Noida, 201310, India.; CORRESPONDING AUTHOR EMAIL: [email protected]; ARTICLE CITATION: Amit and Mohd Arafat. Effectiveness of combination therapy and shoulder glides on frozen shoulder: a case report. SALT J Sci Res Healthc. 2023 Sep 09; 3(2): 13-15.
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© Amit, Mohd Arafat
Originally published in the SALT Journal of Scientific Research in Healthcare (https://saltjsrh.in/), 09.09.2023.
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