Continuous passive motion provides good pain control in patients with adhesive capsulitis

Abstract

Painful stiffening of the shoulder, 'frozen shoulder' is a common cause of shoulder pain and disability. Continuous passive motion (CPM) is an established method of preventing joint stiffness and of overcoming it. A randomized, comparative prospective clinical trial was planned to compare the early response with different rehabilitation methods [CPM vs. conventional physiotherapy treatment (CPT) protocol] for adhesive capsulitis taking into consideration the clinical efficacy. A total of 57 patients with frozen shoulder were included in this study. Patients were assigned randomly to receive daily CPM treatments or CPT protocol. Parameters were measured at baseline, and at weeks 4 and 12. All patients were evaluated with respect to pain (visual anologue scale) at rest, pain at movement, pain at night, measurement of range of motion (shoulder flexion, abduction, internal-external rotation were assessed), constant functional shoulder score and the shoulder pain and disability index. The first group (n=29) (CPM group) received CPM treatments for 1 h once a day for 20 days during a period of 4 weeks. The second group (n=28) (CPT group) had a daily physiotherapy treatment protocol including active stretching and pendulum exercises for 1 h once a day for 20 days during a period of 4 weeks. All patients in both groups were also instructed in a standardized home exercise programme consisting of passive range of motion and pendulum exercises to be performed every day. In both groups, statistically significant improvements were detected in all outcome measures compared with baseline. Pain reduction, however, evaluated with respect to pain at rest, at movement and at night was better in CPM group. In addition the CPM group showed better shoulder pain index scores than the CPT group. CPM treatment provides better response in pain reduction than the conventional physiotherapy treatment protocol in the early phase of treatment in adhesive capsulitis.

Management of frozen shoulder: a systematic review and cost-effectiveness analysis

“…The mean duration of frozen shoulder at baseline ranged from 3 months to 6.8 years. The stage of frozen shoulder included was reported by few studies: stage 1 or 2 in the study by Dundar et al, 74 'stiff stage' in the studies by Yan 72 and Leung and Cheing 75 and late stage 2 or 3 in the study by Maricar and Chok. 76 Outcome was not reported separately by stage of frozen shoulder.…”

“…The remaining studies compared multiple active physical therapies. One compared ultrasound and physiotherapy with sham ultrasound and physiotherapy; 51 one compared 1-hour sessions of continuous passive motion with physiotherapy; 74 one compared osteopathy with physiotherapy and with breathing exercises, massage and range of movement exercises; 71 one compared 72 and one compared high-grade mobilisation techniques (HGMT) with low-grade mobilisation techniques (LGMT) (both followed by Codman pendular exercises). 40 All of the physiotherapy arms included an active mobilisation component.…”

“…40 No NSAIDs or other analgesics were allowed in one RCT, with a week washout period before the study commenced. 74 The inclusion criteria varied between the studies. All included patients with some limitation of movement, although the extent of this varied where reported.…”

“…Where specified the home exercise routines included daily Codman and stretching exercises, 66 Codman, stretching and active range of movement exercises, 51 daily passive range of movement and pendulum exercises, 74 pendulum and pain-free exercises 16 and daily stretches. 75 Home exercise was discouraged in one study.…”

“…40,71,72,[74][75][76]78 One of the studies had what was described as a 'supervised neglect' intervention. 73 This study by Diercks and Stevens was the only study identified that explicitly used a supervised neglect intervention; therefore, this study was included although it was not a RCT.…”