Shoulder Mobilization Following Supra Scapular Nerve Block in Adhesive Capsulitis
Condition: Adhesive Capsulitis
MeSH terms: Bursitis
Study type: Interventional

Summary: 
      Those shoulder patients who fulfill inclusion criteria are divided into two groups.
      Supervised exercises will be performed by both groups. Kaltenborn mobilization will be
      applied to patient in experimental group only. Assessment will be done on baseline, 7th and
      post visit. A total 38 subjects were included in study who met inclusion criteria. Number of
      patients in both groups was 19.
    

Detailed description: 
      Adhesive capsulitis is one of the most common debilitating musculoskeletal complaints seen in
      physiotherapy practice. Adhesive capsulitis is a benign, self-limiting condition of unknown
      etiology characterized by painful and limited active and passive gleno-humeral range of
      motion of ≥ 25% in at least two directions most notably shoulder abduction and external
      rotation. Prevalence of adhesive capsulitis is 2% - 5% in general population.1 Primary
      adhesive capsulitis and frozen shoulder are current terms used to describe an insidious onset
      of painful stiffness of the gleno-humeral joint. Secondary adhesive capsulitis, on the other
      hand, is associated with a known predisposing condition of the shoulder (eg, humerus
      fracture, shoulder dislocation, avascular necrosis, osteoarthritis, or stroke.

      The range of motion (ROM) impairments associated with primary adhesive capsulitis can impact
      a patient's ability to participate in self-care and occupational activities. Even though this
      condition is considered self-limiting, with most patients having spontaneous resolution
      within 3 years, some patients can suffer long-term pain and restricted shoulder motion well
      beyond 3 years. A disability of this duration places severe emotional and economic hardship
      on the afflicted person. Most patients are unwilling to suffer this pain, prolonged
      disability, and sleep deprivation without seeking treatment.

      Currently, no standard medical, surgical, or therapy regimen is universally accepted as the
      most efficacious treatment for restoring motion in patients with shoulder adhesive
      capsulitis. While physical therapy is commonly prescribed for this condition, some studies
      have found little treatment benefit. Rehabilitation programs consisting of exercise, massage,
      and modalities have been shown to improve shoulder ROM in all planes except external and
      internal rotation. There is evidence, however, that joint mobilization procedures can lessen
      the associated gleno-humeral rotational deficits characteristic of this condition, especially
      external rotation. The optimal direction of force and movement application for the joint
      mobilization to restore external rotation, however, is not clear. Traditionally, physical
      therapists have used an anterior glide of the humeral head on the glenoid technique to
      improve external rotation ROM, a choice based on the "convex-on-concave" concept of joint
      surface motion. In contrast, Roubal et al used a posteriorly directed glide manipulation
      based on the "capsular constraint mechanism" to restore external as well as internal rotation
      ROM.Supra-scapular nerve block (SSNB) is a safe and effective method to treat pain in chronic
      diseases that affect the shoulder. The technique consists of injecting anaesthetics in
      supraspinatus fossa of affected shoulder, with the patient sitting down and upper limbs
      pending beside the body.The technique consists of injecting anesthetic in supraspinatus fossa
      of affected shoulder, with the patient sitting down and upper limbs pending beside the body.3
      In this study keltenborn joint mobilization will be use as intervention is to restore the
      joint play and in order to normalize the rolling and gliding of any joint, which are
      necessary for the active normal and non-painful movement. Some general exercises also help us
      to treat adhesive capsulitis.
    

Intervention name(s): Shoulder mobilization Group; Conventional Treatment Group
Intervention type(s): Other; Other
Intervention description(s): Suprascapular nerve block administered every week to both groups. Joint mobilization (3 sets / 40 seconds hold / 30 seconds interval) Stretching exercises (3 sets / 30 seconds hold / 10 seconds interval) Strengthening exercises ( 3 sets / 15 reps); Suprascapular nerve block administered every week to both groups. Daily Stretching exercises (3 sets / 30 seconds hold / 10 seconds interval) Daily Strengthening exercises ( 3 sets / 15 reps)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Experimental
Masking: Single (Participant)
Primary purpose: Other
Keywords: Adhesive capsulitis; suprascapular nerve; shoulder mobilization