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Effectiveness of Sustained Stretching of the Inferior Capsule in the Management of a Frozen Shoulder

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Physiotherapy treatment of frozen shoulder is varied, but most lack specific focus on the underlying disorder, which is the adhered shoulder capsule. Although positive effects were found after physiotherapy, the recurrence and prolonged disability of a frozen shoulder are major factors to focus on to provide the appropriate treatment.

Questions/purposes

We wished to study the effectiveness of a shoulder countertraction apparatus on ROM, pain, and function in patients with a frozen shoulder and compare their results with those of control subjects who received conventional physiotherapy.

Methods

A total of 100 participants were randomly assigned to an experimental group and a control group, with each group having 50 participants. The control group received physiotherapy and the experimental group received countertraction and physiotherapy. The total treatment time was 20 minutes a day for 5 days per week for 2 weeks. The outcome measures used were goniometer measurements, VAS, and the Oxford Shoulder Score.

Results

Improvements were seen in the scores for shoulder flexion (94.1° ± 19.79° at baseline increased to 161.9° ± 13.05° after intervention), abduction ROM (90.4° ± 21.18° at baseline increased to 154.8° ± 13.21° after intervention), and pain (8.00 ± 0.78 at baseline decreased to 3.48 ± 0.71 after intervention) in the experimental group. Sixty percent of the participants (n = 30) were improved to the fourth stage of satisfactory joint function according to the Oxford Shoulder Score in the experimental group compared with 18% (n = 9) in the control group (p < 0.001).

Conclusions

Incorporating shoulder countertraction along with physiotherapy improves shoulder function compared with physiotherapy alone for the treatment of a frozen shoulder. Additional studies are needed focusing on this concept to increase the generalizability of the counter-traction apparatus in various groups.

Level of Evidence

Level II, prospective comparative study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank M.J. Saji MS, Gaurav Sharma MS, and Kurian Zachariah DNB, of St. John’s Medical College & Hospital, Bangalore, India, for referring the study participants. We also thank Divya Joshua PT, of MV Hospital for Diabetes, Chennai, India, for assessing the study participants.

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Authors and Affiliations

  1. Department of PMR, St John’s Medical College & Hospital, John Nagar, Bangalore, Karnataka, India

    Antony Paul MPT, Smita Peter MPT & Litson Lambert BPT

  2. Research & Development, RECOUP Neuromusculoskeletal Rehabilitation Centre, # 312, 10th Block, Further Extension of Anjanapura Layout, Bangalore, 560062, Karnataka, India

    Joshua Samuel Rajkumar MPT

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  1. Antony Paul MPT
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  2. Joshua Samuel Rajkumar MPT
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Correspondence to Joshua Samuel Rajkumar MPT.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed in the Physiotherapy Outpatient Department of St John’s Medical College & Hospital, Bangalore, KA, India.

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Paul, A., Rajkumar, J.S., Peter, S. et al. Effectiveness of Sustained Stretching of the Inferior Capsule in the Management of a Frozen Shoulder. Clin Orthop Relat Res 472, 2262–2268 (2014). https://doi.org/10.1007/s11999-014-3581-2

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  • DOI: https://doi.org/10.1007/s11999-014-3581-2

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