Effects of Combining Mobilization With Movement and Spencer's Technique in Diabetic Adhesive Capsulitis Patients
Condition: Adhesive Capsulitis
MeSH terms: Bursitis
Study type: Interventional

Summary: 
      This study will be a randomized control trial conducted on 44 patients diagnosed as adhesive
      capsulitis in headquarter hospital Gujar khan. Subjects will be divided equally into 4 groups
      (n=11 in each group) that are Group A, B, C and D by sealed envelope method. Pre-intervention
      assessment will be done by using data collection tools and then intervention will be applied.
      Group A will receive mobilization with movement (MWM) technique along with Spencer's muscle
      energy technique (MET) with conventional therapy. Group B will receive MWM along with
      conventional therapy. Group C will receive Spencer's MET along with conventional therapy.
      Group D will receive conventional therapy alone. All subjects will be given a home exercise
      plan. Assessment will be done after 1st session, 1st week, 2nd week, 3rd week and finally
      after 2 weeks on follow up using data collection tool. Data collection tools are
      semi-structured questionnaire (informed consent, demographic details, goniometric
      measurements), Visual analogue scale (VAS), shoulder pain and disability index (SPADI) and
      universal goniometer.
    

Detailed description: 
      One of the numerous disorders that causes pain and increase resistance to the active and
      passive movements of shoulder is the adhesive capsulitis. The pathology of the shoulder can
      be the extrinsic or intrinsic that induces pain and stiffness that is why the treatment
      should be according to the actual cause of pathology. Another term which is used for these
      pathology is 'Frozen Shoulder' which is used by the Codman for the first time in history.
      Adhesive capsulitis does not represent a single pathology rather it is applicable to most of
      the conditions that causes myospasm most specifically adhesion that forms in the bursa or
      joint capsule and rotators of the shoulder. Most specifically the term adhesive capsulitis is
      actually a pathology that includes the capsule's inflammation which results in thickness and
      fibrosis and consequently adherence to the shoulder as well as the neck of humerus.

      About 2%-5% of the global population is affected by the adhesive Capsulitis that's why it is
      considered as a common condition. Frozen shoulder the alternative term for adhesive
      capsulitis affect the 2% of the total world population because of the absent of most accurate
      criteria for diagnosis and sometime due to the over diagnosis. It is uncommon in people under
      the age of 40, peak prevalence is in people elder than 40 and younger than 60 and is uncommon
      in people above 70years except for secondary cause and in the manual workers as according to
      a cumulative incidence of 2.4 persons per 1000 in a year. Economically the impact of adhesive
      Capsulitis is underscored i-e 8.2% for men and 10.1% for women for adults in working age. It
      is more prevalent in women as compared to the men. It cannot develop in the same shoulder
      after the first time but in 20% of people it is seen to develop in the opposite Shoulder.14%
      of patients have seen to develop in both shoulders at one time, and 80% are those who develop
      this condition on opposite side within the next five years.

      Frozen shoulder is mostly common in patients suffering from diabetes mellitus. 71.5% of the
      people are estimated to have the diabetes and frozen shoulder at the same time half of them
      are previously diagnosed with type I or type II diabetes mellitus and remaining have high
      glucose tolerance test or increased fasting glucose level.The suspected risk of having frozen
      shoulder have increased a 10% to 20% in people who are diabetic, having 4% point prevalence,
      and 2-4 times on greater risk as compared to normal population.
    

Intervention name(s): Mulligan's Mobilization with movement; Spencer's muscle energy technique; Conventional Therapy
Intervention type(s): Other; Other; Other
Intervention description(s): The Mulligan's technique will be performed as described by Brian Mulligan. 3 sets of 10 repetitions with 1 minute rest between sets.; Muscle energy technique that is composed of 7 stages repeated on after the other will be performed. Each movement will be repeated 10 times with 1 minute rest between each set.; Electrotherapy-Ultrasound (5-10 mins), Exercise therapy program (isometric, capsular stretching, pectoral stretch and scapular stabilization exercises)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment