Physiotherapeutic Case Studies in Frozen Shoulder Pathology
Condition: Articular; Rigid
MeSH terms: Bursitis
Study type: Interventional

Summary: 
      The stiff shoulder presents symptoms such as pain, loss of mobility and strength, being more
      common the idiopathic origin associated to the female gender. The definitive diagnosis
      presents complications due to the number of etiologies that can cause it. Epidemiologically,
      it presents from 2 to 5% of medical incapacities in the working population. Objective: To
      investigate the efficacy of percutaneous Neuromodulation together with Orthopedic Manual
      Therapy (Maitland and Mulligan) in comparison with Orthopedic Manual Therapy (Maitland and
      Mulligan) used in stiff shoulder.Design: Experimental clinical trial in 30 patients aged 21
      to 76 years from a physiotherapy center divided into two groups: Group 1 (n=15) Percutaneous
      Neuromodulation + Orthopaedic Manual Therapy (Maitland and Mulligan) Group 2 (n=15)
      Orthopaedic Manual Therapy (Maitland and Mulligan).
    

Detailed description: 
      The stiff shoulder is a pathology characterized by a biomechanical restriction of the active
      and passive movement of the shoulder, showing clinical pictures of local inflammation with a
      notorious hyper vascularization that helps the clinical manifestations painful flexion,
      stiffness, limitation of external rotation, pain over the lower cervical area or near the
      insertion of the deltoid muscle and pain when supporting the affected limb with body weight.

      Etiologically there are idiopathic and external factors that cause disorders such as
      osteoarthritis, chronic subacromial bursitis, or rotator cuff tendinopathy. Likewise, trauma
      is involved in a secondary way as well as diseases such as Parkinson's, diabetes, thyroid
      disorders among others. These clinical factors present two types of diagnosis: primary
      idiopathic stiff shoulder and extrinsic stiff shoulder secondary to trauma or surgery.

      Among the physiotherapeutic treatments provided are joint mobilizations, therapeutic
      exercises, deep Cyriax massage, osteopathic techniques, cryotherapy (inflammatory phase),
      thermotherapy (chronic phase), electrotherapy for pain and ultrasound.

      From the economic point of view, it presents from 2 to 5% of the medical incapacities in the
      working population, being this disease one of the first 20 sick leaves that reaches up to 12
      months, generating high public hospital expenses and difficulties for the business area. Due
      to the above, many patients enter the operating room as a quick option to return to
      normality. However, this option does not seem to be the best for this disease, since the
      hypomobility of the movement increases gradually and chronically, caused by the fibrotic
      processes in the anterior face of the capsule, generating long-term inability for the
      external rotation of the joint.

      The aim of this study is to investigate the efficacy of Percutaneous Neuromodulation together
      with Orthopaedic Manual Therapy (Maitland and Mulligan) compared to Orthopaedic Manual
      Therapy (Maitland and Mulligan) used in the stiff shoulder.
    

Intervention name(s): First data analysis; Second data analysis; database
Intervention type(s): Diagnostic Test; Procedure; Other
Intervention description(s): A series of questions were asked to a number of patients with diagnoses related to primary idiopathic stiff shoulder and/or extrinsic stiff shoulder secondary to trauma or surgery. These patients are part of the physiotherapy clinic receiving the research. This questionnaire answers basic questions for the structure of the study such as age and sex, physical behaviour during the week, endurance, athletic disability, reason for attending the clinic, exploratory motor tests, etc. Subsequently, physiotherapeutic tests related to the pathology within the research were performed consisting of joint range, percentage of shoulder disability and pain scale.; Three treatment sessions of Percutaneous Neuromodulation (PNM) and Orthopaedic Manual Therapy (OMT) (Maitland and Mulligan) (group 1) and three treatment sessions of Orthopaedic Manual Therapy (OMT) (Maitland and Mulligan) (group 2) were performed at a rate of two sessions per month for three months. These therapies were compared with the clinical examination performed prior to each new session to verify changes in joint range, percentage of shoulder disability, strength and pain scale.; Age and sex were expressed as mean ± standard deviation (SD). The rest of the variables were expressed as mean, absolute and relative frequency. The chi-square test was used to analyse the differences between the examinations in terms of the time taken and the treatments used in the two groups. A confidence level of 95% was established, considering a value of p<0.05 as statistically significant.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: 30 divided into two groups: Group 1 (n=15) percutaneous neuromodulation together with orthopaedic manual therapy (Maitland and Mulligan) Group 2 (n=15) orthopaedic manual therapy (Maitland and Mulligan).
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Stiff shoulder.; Neuromodulation.; Manual therapy.; Rotator cuff.; Physiotherapy.