Efficacy and cost‐effectiveness of physiotherapy following glenohumeral joint distension for adhesive capsulitis: A randomized trial

Abstract

Objective. To determine whether an active physiotherapy program following arthrographic joint distension for adhesive capsulitis provides additional benefits. Methods. We performed a randomized, placebo-controlled, participant and single assessor blinded trial. A total of 156 participants with pain and stiffness in predominantly 1 shoulder for >3 months and restriction of passive motion >30°i n >2 planes of movement entered the study, and 144 completed the study. Following joint distension, participants were randomly assigned to either manual therapy and directed exercise or placebo (sham ultrasound), both administered twice weekly for 2 weeks then once weekly for 4 weeks. Pain, function, active shoulder movements, participant-perceived success, and quality of life were assessed at baseline, 6, 12, and 26 weeks. Costs were also collected. Results. Both groups improved over time with no significant differences in improvement between groups for pain, function, or quality of life at any time point. Significant differences favored the physiotherapy group for all active shoulder movements (e.g., pooled difference in mean change between groups across all time points for total shoulder abduction was 10.6°, 95% confidence interval [95% CI] 3.1, 18.1) and participant-perceived success (pooled relative risk 1.4, 95% CI 1.1, 1.65; number needed to treat ‫؍‬ 5). Net cost of physiotherapy was $136.8 Australian (95% CI ؊177.5, 223.1) over the 6 months. Conclusion. Physiotherapy following joint distension provided no additional benefits in terms of pain, function, or quality of life but resulted in sustained greater active range of shoulder movement and participant-perceived improvement up to 6 months.

Pain relief due to physiotherapy doesn’t change the motor function of the shoulder

“…Like other studies (Ainsworth, 2006;Buchbinder et al, 2007;Green et al, 1998Green et al, , 2003 our data shows pain relief by physiotherapy but gives no information about why pain is relieved. Because both devices clearly affect muscles surrounding the glenohumeral joint and the rotator cuff, the pain relief may correlate with change in muscle function.…”

“…Studies of exercise therapy for the shoulder-neck region claim all kinds of correlations between training, pain relief and a significant enhancement in physical parameters like strength and range of motion (Green et al, 2003(Green et al, , 1998(Green et al, , 2000Buchbinder et al, 2007;Ainsworth, 2006;Ylinen et al, 2003;Sokk et al, 2007). Therefore training patients to relieve shoulder pain does not seem an unrealistic goal.…”

Manipulative Therapy for Shoulder Pain and Disorders: Expansion of a Systematic Review

“…Three studies specifically excluded diabetes, 89,95,105 whereas another 3 did not mention diabetes at all. 27,42,88 Diabetes did not affect outcomes in the Vermuelen et al study, 87 but there are too few studies to state the effect of MMT for diabetic patients with FS; and how this disorder will affect MMT outcomes is not known (co-management is therefore recommended).…”

Chiropractic management of frozen shoulder syndrome using a novel technique: a retrospective case series of 50 patients

“…2,17 Interventions that physical therapists frequently use include moist heat, ultrasonography, passive stretching, and shoulder mobilization. [18][19][20][21] In addition, there is some evidence in the physical therapy literature to support manipulation of the cervical spine or cervicothoracic spine for shoulder complaints. [22][23][24][25][26] Patients may experience resolution when treated by these various methods, but some may have residual pain and reduced shoulder function even several years after treatment.…”