Background To obtain full range of motion in shoulder scapular mobility has an important role and alternations in scapular mobility and posterior capsular thickening are thought to be problems leading abnormal movement pattern in frozen shoulder . Restoring the range of motion and function are treatment objectives and scapular mobilization and joint capsule stretching were recommended in frozen shoulder rehabilitation.
Objectives To investigate the acute effect of manual posterior capsule stretching, scapular mobilization and combination of these two manual therapy methods on range of motion in patients with frozen shoulder.
Methods Forty patients diagnosed with frozen shoulder (average age: 49.05±10 years, BMI: 25.2±3.1 kg/m2) were included to the study. Randomly subjects divided to 3 intervention groups; manual posterior capsule stretching group (n=8), scapular mobilization group (n=12) and combination of two methods (n=20). Before and immediately after mobilization shoulder flexion, abduction, external and internal rotation range of motion were evaluated by using standard goniometer. Posterior capsule tightness was assessed with ruler that the amount of shoulder horizontal adduction on fixed scapula in side lying position in according to show the effectiveness of intervention on posterior capsule tightness. The amount of active shoulder internal rotation and active total elevation performed as a functional test. Statistical comparisons were carried out by using Wilcoxon signed-rank test and for between-groups comparisons Kruskal-Wallis test was used.
Results Comparisons showed that there were statistically significant improvements in shoulder flexion (p=.003), external rotation (p=.009) and active total elevation (p=.005) after scapular mobilization, and shoulder flexion (p=.02), active total elevation (p=.02) and posterior capsule tightness (p=.01) after manual posterior capsule stretching. Combination of two methods resulted in improvements in shoulder flexion (p=.001), abduction (p=.005), external rotation (p=.004), internal rotation (p=.003), active total elevation (p=.003), active internal rotation (p=.003) and posterior capsule tightness (p=.001). There were no statistical differences in the amount of changes in studied parameters between three intervention groups (p>.05).
Conclusions Acute effect of manual posterior capsule stretching and scapular mobilization showed improvements in limited shoulder range of motion in frozen shoulder and combination of these two methods were showed additional gain in shoulder abduction, internal rotation and active internal rotation function. Applying such techniques in clinical setting is recommended, but the durability of these effects and long terms results of repetitive intervention are needed further research.
Loyd, J.A. and H.M. Loyd, Adhesive capsulitis of the shoulder: arthrographic diagnosis and treatment. South Med J, 1983. 76(7): p. 879-83.
Disclosure of Interest None Declared