Additional Effects of Thoracic Manipulation in Adhesive Capsulitis.
Condition: Frozen Shoulder
MeSH terms: Bursitis
Study type: Interventional

Summary: 
      The aim of this study is to measure the additional effects of thoracic manipulation on pain
      and restricted shoulder mobility and reducing disability in patients with adhesive
      capsulitis. A randomized control trail is conducting at Helping hand institute of
      rehabilitation sciences Mansehra. Patients diagnosed with frozen shoulder were randomized
      into 2 groups i.e. Group A (n=16) and Group B(n=16) with the help of lottery method. Group A
      would receive conventional therapy including hot pack, transcutaneous electrical nerve
      stimulation, stretches and facilitation techniques Group B would receive thoracic
      manipulation along with hot pack and TENS, stretches and facilitation techniques. The total
      treatment time is 2 weeks with three sessions per week making a total of 6 sessions.

      Baseline assessment on 1st visit. 2nd assessment on 6th visit. 3rd assessment on follow up
      after 3 weeks would be done. The study duration is 6 months. Purposive non probability
      sampling technique applied. Only 40 to 60 years participants with adhesive capsulitis are
      including in this trial. Tools use in this study are visual analogue scale (VAS), bubble
      inclinometer and (disability of arm, shoulder and hand) questionnaire. Data analyzed through
      statistical package of social sciences version 25.
    

Detailed description: 
      Frozen shoulder is a widespread disabling condition which causes significant disability. In
      spite of hundred years of treating this condition the clarity, diagnosis, pathology and most
      effectual treatments are still need to be explored.It is characterized by the impulsive onset
      of pain, inflexibility and restricted range of motion at the shoulder joint. The
      pathophysiology of frozen shoulder is not exactly known. However it is generally supposed
      that a combination of contracture of capsule, rotator cuff tendon fibrosis, sub-scapular
      depression and the coraco-humeral ligament lead to comprehensive movement restriction at the
      glenohumeral joint. Frozen shoulder is considered to have an occurrence of 3%-5% in the
      common population and up to 20% in those with diabetes mellitus. Between the ages of 40 and
      60 it is most prevalent and is almost not found in ages below that and in persons who work
      manually. It is somewhat more common in women then man. Bilateral frozen shoulder occurs in
      14% of population and up to 20% of population will develop some degree of related symptoms in
      the other shoulder. the most common associated risk factor for developing the frozen shoulder
      is diabetes mellitus, and a patient with diabetes has 10%-20% risk of developing frozen
      shoulder.

      Thoracic spine manipulation has received growing attention in treating the patients with
      shoulder pain. Recent studies have shown that thoracic manipulation is an effective
      combination therapy for patients with shoulder pain. The position of thoracic spine
      significantly have an effect on shoulder joint and shoulder kinematics during movement on
      different planes as there is decreased muscle force when a person is in a slouch position.
      Thoracic Spine manipulation is a treatment choice by the number of health professionals
      especially the physical therapist. Literature defines thoracic manipulation as highly
      practiced and skilled passive thrust to joints and adjacent structures and soft tissues at
      variable intensity consisting of small amplitude and high velocity therapeutic movements at
      thoracic spine including cervicothoracic junction. Much of the recent studies are focusing on
      the relationship of thoracic spine to other body regions such as neck and shoulder rather
      than thoracic spine itself this phenomenon is described as regional interdependence.although
      cervical spine manipulation has also improve pain and disability in patients with
      non-specific shoulder pain but have some evidence of thrust complications relating to
      cervical spine. Similar neurophysiologic associations are documented with thoracic spine
      manipulation in relation with shoulder pain with less complications and thrust risk.

      Spinal manipulation of the thoracic spine can be an effective intervention for treating
      patients with shoulder pain or dysfunctions. Treatment protocols focusing the thoracic spine
      must be added to the intervention of rehabilitation of patients with shoulder pain in
      clinical practice. In common clinical practice a series of thoracic hypomobility has been
      noticed at the T1-T3 spinal segments or the T3-T5 segments in patients with shoulder
      pathologies. In literature manipulation of thoracic regions has been shown to produce
      improvement in upper extremity blood flow and circulation. Researches related to thoracic
      spine manipulation is signifying a association between manipulation of the thoracic spine and
      enhancement in shoulder function and potency. Thus the purpose of the study is to evaluate
      the possible effect of thoracic manipulation on shoulder range of motion and function in
      combination with conventional intervention for the individuals with frozen shoulder.

      Thoracic spine thrust manipulation provided a statistically significant decrease in
      self-reported pain measures and disability in patients with Shoulder impingement syndrome.
      Thoracic spine and upper rib manipulative therapy is associated with improvement in shoulder
      pain and ROM immediately following intervention in patients with a primary complaint of
      shoulder pain. Thoracic spine manual therapy accelerated recovery and reduced pain and
      disability in patients having nonspecific shoulder pain (NSSP). Thoracic and rib manipulation
      is effective in relieving pain and improving range of motions and reducing disability in
      frozen shoulder patients. Cervical thoracic junction and upper thoracic spine manipulations
      in combination with traditional physical therapy will decrease pain, increase range of
      motion, and increase function in patients suffering from internal impingement syndrome more
      than patients who received traditional physical therapy treatment and posterior and inferior
      mobilization.
    

Intervention name(s): Thoracic manipulation; Conventional physical therapy Program
Intervention type(s): Other; Other
Intervention description(s): hot pack ,transcutaneous electrical nerve stimulation and manipulation along with stretching'; hot pack ,transcutaneous electrical nerve stimulation and stretching
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Frozen Shoulder; Thoracic Manipulation