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Management of frozen shoulder(adhesive capsulitis)
- 1. MANAGEMENT OF ADHESIVE CAPSULITIS: - a evidence informed practice By K .H.Dhiwahar .MPT(SPORTS)
- 2. OBJECTIVES To know about evidence on management for adhesive capsulitis.
- 3. INTRODUCTION Adhesive capsulitis is a painful condition in which movement of the shoulder becomes severely restricted. The condition can vary in severity from mild to severe pain and/or from some to severe restriction in movement .
- 4. SYSTEMATIC REVIEW A review of the evidence on a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant primary research, and to extract and analyze data from the studies that are included in the review.” Cochrane Collaboration
- 5. HIERARCHY OF THE EVIDENCE
- 6. Formulating review questions The first and most important decision in preparing a review is to determine its focus. This is best done by asking clearly framed questions.
- 7. CLINICAL QUESTION Problem: In the patient with adhesive capsulitis will the conservative management will help to reduce pain ,increase ROM and physical function Intervention:corticosteroid injections, patient education ,modalities, joint mobilization ,translational manipulation ,stretching exercises Comparison: any of the above Outcomes: pain, ROM and physical function
- 8. SEARCH STATERGY The systematic reviews were searched from three electronic Database, COCHRANE, PUBMED and PEDRO
- 9. WHAT I FOUND IS Shoulder Pain and Mobility Deficits: Adhesive Capsulitis Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopedic Section of the American Physical Therapy Association J Orthop Sports Phys Ther 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302 - MARTIN J. KELLEY, DPT AND et al
- 10. GRADES OF EVIDENCE a4 | may 2013 | volume 43 | number 5 | journal of orthopedic & sports physical therapy . MARTIN J. KELLEY, DPT AND et al
- 11. LEVEL OF EVIDENCE a4 | may 2013 | volume 43 | number 5 | journal of orthopedic & sports physical therapy . MARTIN J. KELLEY, DPT AND et al
- 12. INTERVENTION CORTICOSTEROID INJECTIONS MODALITIES JOINT MOBILIZATION TRANSLATIONAL MANIPULATION STRETCHING EXERCISES PATIENT EDUCATION
- 13. CORTICOSTEROID INJECTIONS Author Type of study & n Inclusion criteria Outcome measure Level of evidence Carette et al RCT N = 93 >1yr LIMITED AROM & PROM >25% ROM.SPADI,SF-36 I Ryans et al RCT N=80 PAIN IN 5TH CERVICAL DERMATOME >4WKS,<6MO LIMITED AROM & PROM >25% SDQ,A&PROM, VAS FUNCTIONAL DISABLITY Q I Arslan and Çeliker RCT N=20 <50%OF NORMAL MO ROM ,VAS II De Jong etal RCT N=32 <45*EXT ROT,DIST OF SLEEP ON LYING POSITON DIST OF SLEEP ,ROM,VAS II Jacobs etal RCT N=53 NOT CLEARLY DEFINED VAS, SF-36 I
- 14. CORTICOSTEROID INJECTIONS Author Type of study & n Inclusion criteria Outcome measure Level of evidence bass & collegues rct limited arom & prom >25% vas sf-36 II - rct n=71 limit of arom,prom,abd,flx <100*,ext ,int rot <20* vas rom constant score I LORBACH ET AL rct n=25 stage 2 reeevs classifaction rom, ases, constant score IV blanchard et al Rct N=6 - - I bulgen et al RCT N=41 Pain in shouldr @ least 1mo, Sleep disturbance at night due to pain, inability to lie on the afft shoulder, limit in all arom,prom & a red in ext rot aleast 50%. II
- 16. PATIENT EDUCATION Author Type of study & n Inclusion criteria Outcome measure Level of evidence DIEWRCKS & STEVENS RCT N=77 >50% ROM REST GHJ,PERIOD OF 3 MO CONSTANT SCORE I
- 18. MODALITIES Author Type of study & n Inclusion criteria Outcome measure Level of evidence DOGRU et al RCT N=49 MIN 3MO,>25%REST MOVT IN ALL PLANES SF-36 SPADI ROM II Mao et al RCT N=12 H/O PAIN,STIF NESS,>MO,REST<140*FL EX,120*ABD,70*INT ROT,50*EXT ROT - IV Guler-Uysal and Kozanoglu RCT N=42 LOSS AROM.PROM SH.PAIN MIN 2MO, ROM II LEUNG & CHEING RCT N=30 IDOPATHI PAIN, LOSS AROM PROM FOR 8WK ASES, ROM II CHEING AND COLLEAGUES RCT N=70 PAIN IN SHOULDER, NIGHT PAIN, AND RESTR AROM PROM CONSTANT- MURLEY ASSESSMENT II
- 20. JOINT MOBILIZATION Author Type of study & n Inclusion criteria Outcome measure Level of evidence Vewrmeulan ewt al RCT N=100 Unilat.AC,50%loss PROM in 1 or more plane for 3mo SDQ,SHOULDWE R RATING Q,SF- 36,ROM,VAS II Nicholson RCT N=20 Shoulder pain, limit PROM ROM II Chen & colleagues RCT N=78 unilat.ac,<140*fle x,abd rom,>10cm hand behind neck VAS,ROM II Bulgen et al RCT N=41 Pain in shouldr @ least 1mo, Sleep disturbance at night due to pain, inability to lie on the afft shoulder, ROM,VAS II
- 21. JOINT MOBILIZATION Author Type of study & n Inclusion criteria Outcome measure Level of evidence Vermeulen et al RCT N=9 STIFF SHOULDER 3MO,50%RST ABD,FLEX ROM IV Yang & collwegues RCT N=28 PAIN 3MO,25%RST ROM ROM IV Tanaka et al RCT N=110 LIMIT SHOULDER MOTION ROM II Johnson et al RCT N=20 EXT ROT, ABD RST VAS,5-ITEM SELF ASSESMENT FUNCTION Q,ROM II
- 23. TRANSLATIONAL MANIPULATION Author Type of study & n Inclusion criteria Outcome measure Level of evidence Roubal et al RCT N=8 NOT SPECIFIED ROM IV Placzek et al RCT N=31 DEC FUNCTION,PAI NFUL AROM PROM VAS ,WOLFGAN G SCALE IV
- 25. STRETCHING EXERCISES Author Type of study & n Inclusion criteria Outcome measure Level of evidence Kivimaki et al RCT N=125 PAIN,<140*ELV,< 30*EXT.ROT. ROM,SDQ II Diercks & stevens RCT N=77 50%RST GHJ,IN ALL DIRT FOR 3MO CONSTANT SCORE II Griggs et al RCT N=75 STAGE 2 IDOPATHI AC SST,DASH,RO M,VAS,SF-36 II Lee et al RCT N=65 NOT SPECIFIED ROM II - RCT N=28 50% RST EXT ROT,ABD,FLX MODFIED CONSTANT SCORE ,VAS,ROM II Levine ewt IV
- 27. CONCLUSION
- 29. REFERENCE 1.American Physical Therapy Association. Guide to physical therapist practice. Second edition. Phys Ther. 2001;81:9-746. a4 | may 2013 | volume 43 | number 5 | journal of orthopedic & sports physical therapy . MARTIN J. KELLEY, DPT AND et al