Effects of Scapular Proprioceptive Neuromuscular Facilitation on Pain and Range of Motion in Patients With Adhesive Capsulitis

Study Overview
=================
Brief Summary
-----------------
The term ''frozen shoulder'' is defined as a clinical condition with restricted active and passive range of motion (ROM) in all directions, including flexion, abduction, and rotation.The objective of the study is to determine the effects of Scapular proprioceptive neuromuscular facilitation and conventional physical therapy among patients with adhesive capsulitis.The study will be a randomized controlled trial (single-blinded parallel study), consisting of 2 groups- interventional group A and interventional group B.Group A will be given conventional physical therapy and group B will be given conventional physical therapy alongwith scapular PNF.Scapular PNF exercises are not included in our routine PT treatment programs and there is limited literature related to the PNF techniques. These techniques help develop muscular strength and endurance, joint stability, mobility, neuromuscular control and coordination all of which are aimed at improving the overall functional ability of patients.

Official Title
-----------------
Effects of Scapular Proprioceptive Neuromuscular Facilitation on Pain and Range of Motion in Patients With Adhesive Capsulitis

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

Intervention / Treatment
-----------------
* Procedure: Conventional Physical Therapy
* Procedure: PNF techniques


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Cases diagnosed with adhesive capsulitis, both primary and secondary origin. Stage two and stage three of adhesive capsulitis. Unilateral adhesive capsulitis. Both males and females of the age group 40 years and above. Exclusion Criteria: History of shoulder surgery or manipulation under anesthesia, Local corticosteroid injection administration to the affected shoulder within the last 3 months. Severe musculoskeletal, neurological and cardiovascular conditions.

Ages Eligible for Study
-----------------
Minimum Age: 40 Years
Maximum Age: 80 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
Interventional Model Description: This is a randomized controlled trial having two groups. One group will receive conventional physical therapy and the other group will receive scapular PNF with conventional physical therapy. Both groups will be recruited concurrently.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional PT Group<br>Conventional group will receive routine physical therapy including 10 ultrasound(1.5w/cm2 ,3 MHz continuous type, duration 10 minutes),hot packs (on affected region of shoulder for 10 minutes),shoulder ROM, stretching exercises, and joint mobilization five times per week for two weeks with 40 minutes duration of each session. Maitland mobilization will be given in supine position. · After giving glenohumeral joint distraction, caudal, dorsal, and ventral glides will be given at a rate of 2-3 oscillation/second for 1 to 2 minutes to patients. Grade I or II rhythmic oscillations will be applied in free range. | Procedure: Conventional Physical Therapy<br>* group A will receive conventional physical therapy including 10 ultrasound(1.5w/cm2 ,3 MHz continuous type, duration 10 minutes),hot packs (on affected region of shoulder for 10 minutes),shoulder ROM, stretching exercises, and joint mobilization five times per week for two weeks with 40 minutes duration of each session. Maitland mobilization will be given in supine position. · After giving glenohumeral joint distraction, caudal, dorsal, and ventral glides will be given at a rate of 2-3 oscillation/second for 1 to 2 minutes to patients. Grade I or II rhythmic oscillations will be applied in free range.<br>|
| Experimental: Scapular PNF + Conventional PT Group<br>This group will receive scapular PNF techniques along with routine physical therapy (same as above). In this group 20 repetitions of diagonal scapular pattern (anterior elevation and posterior depression, posterior elevation and anterior depression) with 20 seconds rest period will be given to subjects. PNF techniques of rhythmic initiation and repeated contractions will be used in all patterns, applied for 40 minutes. | Procedure: Conventional Physical Therapy<br>* group A will receive conventional physical therapy including 10 ultrasound(1.5w/cm2 ,3 MHz continuous type, duration 10 minutes),hot packs (on affected region of shoulder for 10 minutes),shoulder ROM, stretching exercises, and joint mobilization five times per week for two weeks with 40 minutes duration of each session. Maitland mobilization will be given in supine position. · After giving glenohumeral joint distraction, caudal, dorsal, and ventral glides will be given at a rate of 2-3 oscillation/second for 1 to 2 minutes to patients. Grade I or II rhythmic oscillations will be applied in free range.<br>Procedure: PNF techniques<br>* In this group 20 repetitions of diagonal scapular pattern (anterior elevation and posterior depression, posterior elevation and anterior depression) with 20 seconds rest period will be given to subjects. PNF techniques of rhythmic initiation and repeated contractions will be used in all patterns, applied for 40 minutes.<br>|

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

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder Pain | Shoulder Pain will be measured on the basis of visual analogue scale of 0-100mm. A higher score signifies greater pain. | 2 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Shoulder range of motion (ROM) | Shoulder range of motion (ROM) will be measured through goniometer. A higher score signifies greater range. | 2 weeks | 
| Scapular mobility | scapular mobility will be measured through lateral slide test (LSST) | 2 weeks |