Manual therapy and exercise for adhesive capsulitis (frozen shoulder)

Abstract

The best available data show that a combination of manual therapy and exercise may not be as effective as glucocorticoid injection in the short-term. It is unclear whether a combination of manual therapy, exercise and electrotherapy is an effective adjunct to glucocorticoid injection or oral NSAID. Following arthrographic joint distension with glucocorticoid and saline, manual therapy and exercise may confer effects similar to those of sham ultrasound in terms of overall pain, function and quality of life, but may provide greater patient-reported treatment success and active range of motion. High-quality RCTs are needed to establish the benefits and harms of manual therapy and exercise interventions that reflect actual practice, compared with placebo, no intervention and active interventions with evidence of benefit (e.g. glucocorticoid injection).

Systematic Review of Nondrug, Nonsurgical Treatment of Shoulder Conditions

“…Three studies 5,6,21 were scored as high quality, and 3 were scored as acceptable quality. [39][40][41] Two of the high-quality studies were conducted by the same research team.…”

“…[39][40][41] Two of the high-quality studies were conducted by the same research team. 5,6 The first meta-analysis reviewed the evidence of electrotherapy modalities, delivered alone or in combination with other interventions, for the treatment of AC. 5 Nineteen trials (RCTs and controlled clinical trials, 1249 participants) were included in the review.…”

“…6 They found 32 studies (1836 participants). No studies compared a combination of MT and exercise with placebo or no intervention.…”

“…Meta-analysis was difficult because 7 trials compared a combination of MT and exercise with other interventions but were clinically heterogeneous in that a number of different interventions were used in the comparison groups. In the short term, the higher-quality studies in the Page et al meta-analysis 6 indicated that a combination of MT and exercise may not be as effective as glucocorticoid injection. They were unable to assess whether a combination of MT, exercise, and electrotherapy was an effective adjunct to glucocorticoid injection or oral nonsteroidal anti-inflammatory drugs.…”

“…4 Other conditions include those that are unspecified and adhesive capsulitis (AC). 5,6 Primary treatment options considered in usual care typically consist of analgesics or exercises and progress to secondary and tertiary options of steroid injections or surgery if necessary. 7,8 Compared with more conservative treatments, surgery is likely more costly and risky.…”