Overview
Frozen shoulder has been described as a painful condition associated with stiffness and difficulty in sleeping on the affected side. People with this condition have difficulty in dressing, overhead movements and sleep disturbance. It occurs in 2 - 5% of general adult population, 10 - 15% of the people with diabetes. It mainly affects the individuals of 35 - 65 years of age with female predominance. Frozen shoulder is characterized by fibroproliferative tissue fibrosis whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts, which is accompanied by inflammation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness.
There are two frozen shoulder syndromes, namely primary syndrome and secondary syndrome. In primary or idiopathic syndrome, frozen shoulder that occurs spontaneously or directly without knowing the causative factors. Primary syndrome occurs due to a chronic inflammatory response with fibroblast proliferation which can actually be a response from an abnormal immune system. Secondary syndromes occur due to several triggers such as trauma that can cause shoulder injuries or surgery associated with the onset of other conditions such as diabetes mellitus, autoimmune diseases and cardiovascular disorders.
The clinical presentation of frozen shoulder typically progresses through three stages: the freezing stage, where the shoulder becomes painful and progressively stiff over two to nine months; the frozen stage, characterized by significant stiffness and reduced pain over four to twelve months; and the thawing stage, where gradual improvement in shoulder mobility occurs over five to twenty-four months. The condition can be severely debilitating, impacting daily activities and overall quality of life.
Adhesive capsulitis treatment primarily consists of pain relief and physical therapy techniques. Anti-inflammatory medication is helpful in pain relief, so that mobility interventions can be initiated. Therapeutic modalities include Transcutaneous Electrical Nerve Stimulation (TENS), Interferential Therapy (IFT), Ultrasound, Short Wave Diathermy (SWD) etc, and the physical therapy exercises such as stretching, Codman exercise can be used. Exercises which may be active, passive or active assisted, play a crucial role in the early rehabilitation of these patients.
Description
Myofascial treatment is an emerging treatment in different musculoskeletal conditions although its clinical benefits is still not clearly understood. Myofascial release therapy (MRT) aims at restoring the normal length of a tight structure with the target goal of decreasing pain and improving function. Since patients with frozen shoulder presents with tightness of rotator cuff muscles, Stroking release technique can be effective in treatment of frozen shoulder.
Rotator cuff is the dynamic stabilizer of the glenohumeral joint (GHJ). It depresses and compresses the humeral head on the glenoid cavity and prevents superior translation of the humerus. Therefore, Rotator Cuff dysfunction, weakness, or rupture may reduce GHJ stability. Rotator cuff rupture also causes shoulder pain, muscle weakness, decrease of shoulder range of motion (ROM), and function. Additionally, fear of movement develops due to shoulder pain and affects ROM and function.
The scapulothoracic joint is not a true joint but functions as an integral part of the shoulder complex. Scapulothoracic movements that include rotation, elevation, depression, protraction, retraction, and circumduction are important for the normal functioning of the shoulder. Scapular mobilization is a widely used manual therapy technique for the management of musculoskeletal disorder of the shoulder, it involves the manual application of a sustained mobilization (in 4 directions) to the scapulothoracic joint.
Codman pendulum is a technique, in the form of arm swing movements with a bent body position and the self-mobilization technique. Scapular mobilization is a treatment technique used for the management of shoulder musculoskeletal disorders. Scapular mobilization aims to mobilize joints or distractions, thus providing scapulothoracic distance and muscles will be extended. By controlling movement from the position of the scapula can help the glenoid in its normal position.
Maitland mobilization (MM) is a manual technique commonly used in the physiotherapy management of FS. It applies passive oscillations, classified from Grade I-IV with respect to amplitude and intensity, to the shoulder in order to treat pain and stiffness. Grades I and II of Maitland mobilization techniques are primarily used for treating joints limited by pain. Whereas Grades III and IV are primarily used as stretching maneuver. There are few previous studies which prove the effect of MM on pain and ROM among FS patients .
Frozen shoulder is a condition with pain and limited range of motion. It is often managed with maitland mobilization. Rotator cuff muscle can contribute to persistent pain and limited function. Very few studies have examined the role of Stroking release technique of rotator cuff muscle in frozen shoulder treatment. This study aims to evaluate the added benefit of Stroking Release technique of Rotator cuff muscle in improving pain, ROM, and disability. The findings could guide clinicians toward more comprehensive and effective treatment protocols. In the future, this approach may lead to faster recovery and improved quality of life for patients.
Eligibility
Inclusion Criteria:
- Age between 40 to 60 years
- Stage 2 and 3 Frozen shoulder
- Positive capsular pattern
- Positive Apley's scratch test
- Unilateral Frozen Shoulder
Exclusion Criteria:
- Rotator cuff disease
- Post CABG
- Post stroke frozen shoulder
- Fracture of shoulder
