PNF Technique in Adhesive Capsulitis

Study Overview
=================
Brief Summary
-----------------
Adhesive capsulitis is painful movement restricted condition linked with pain, restricted range of motion and difficulty in performing daily life activities. Multiple treatment options are there for its treatment. However, role of peripheral neuromuscular facilitation in this regimen is still under consideration.

Detailed Description
-----------------
Adhesive Capsulitis or peri-arthritis or Frozen Shoulder is self-limiting condition of unknown etiology that usually affects middle aged population of 40-70 years and rarely it occur secondary to rheumatoid arthritis, osteoarthritis, trauma or immobilization of shoulder joint. It is characterized by development of dense adhesions, capsular thickening and restrictions which limits active and passive shoulder range of motion (ROM) with scapular dyskinesia.The aim of the of the study is to investigate the effects of scapular proprioceptive neuromuscular techniques with routine physical therapy on pain, scapular dyskinesia, shoulder ranges of motion and functionality in patients with adhesive capsulitis. Proper functioning of upper extremities requires both motion and stability of scapula on thorax. Prolonged immobilization of shoulder joint leads to ankylosis of joint and scapular dyskinesia. This study will help with a positive effect by using a non-invasive, less painful, cost effective and time saving approach of scapular proprioceptive neuromuscular facilitation techniques among joint mobilization and other therapeutic approaches like intra articular injections and manipulation under anesthesia on alleviating pain, muscle strength, shoulder ranges of motion and early restoration of normal functioning of shoulder joint.

Official Title
-----------------
Effects of Scapular Proprioceptive Neuromuscular Facilitation Techniques in Addition to Routine Physical Therapy on Clinical Outcomes in Patients With Adhesive Capsulitis:a Randomized Controlled Trial

Conditions
-----------------
Adhesive Capsulitis

Intervention / Treatment
-----------------
* Other: conventional physiotherapy
* Other: PNF technique


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Diagnosed cases of stage II & III adhesive capsulitis Referred by orthopedic physician Duration of stage approximately 1 month Both male and female Age: 40-70 years Exclusion Criteria: Recent history of trauma Dislocation or fractures of shoulder History of diabetes and hypertension Congenital shoulder deformity Previous surgery patients Patients with diagnosed cardiovascular disease Patients with malignancy

Ages Eligible for Study
-----------------
Minimum Age: 40 Years
Maximum Age: 70 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: conventional physiotherapy<br>routine physical therapy for adhesive capsulitis | Other: conventional physiotherapy<br>* Control group receivewill routine physical therapy including modalities like ultrasound (3 MHz continuous type; duration 10 minutes), heat modalities (apply to the involved region of shoulder joint shoulder for 10 minutes), shoulder ROM exercises, capsular stretching, and joint mobilization 5 times per week for four weeks. Duration of session will be 40 minutes. All Maitland mobilization will be given in supine position. After giving glenohumeral (GH) joint distraction, GH caudal glide, GH dorsal glide, and GH ventral glide were given at a rate of 2-3/second oscillations for 1-2 minutes to patients. Grade I or II rhythmic oscillations will be applied in pain free movement.<br>|
| Experimental: PNF techniques<br>PNF techniques along with conventional physiotherapy | Other: PNF technique<br>* Group will receive scapular PNF techniques with routine physical therapy explained above For PNF techniques, patients will be lying on unaffected shoulder. In this group, 20 repetitions of diagonal scapular Pattern (Anterior Elevation and Posterior Depression and Posterior Elevation and Anterior Depression) with 20 sec rest period will be given to patients. Preparatory instructions for the desired movement will be given to patients at the start of procedure. PNF facilitation techniques of RI (Rhythmic initiation) & repeated contractions will be used in all patterns<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in pain intensity | pain measured by visual analogue scale where o represents no pain and 10 represents severe pain | Baseline data will be collected and then at 2nd week and 4th week. | 
| change in shoulder Range of motion | shoulder range of motion through goniometer | Baseline data will be collected and then at 2nd week and 4th week. | 
| change in shoulder functional activities | shoulder functional activities by simple shoulder function test | Baseline data will be collected and then at 2nd week and 4th week. | 
| change in scapular mobility | scapular mobility through lateral scapular slide test | Baseline data will be collected and then at 2nd week and 4th week. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
adhesive capsulitis, scapular PNF technique, shoulder range of motion