Frozen Shoulder [Disease]

Introduction:

Frozen shoulder also called “adhesive capsulitis” is a medical situation that restricts movement in the shoulder joint, making it difficult to perform everyday activities. Wang et al. (2017) describe it as a debilitating condition. The condition was initially identified clinically by Duplay in 1872 and was referred to as "peri arthritis scapula-humeral (MOHAMED et al., 2022). In contrast to Duplay's early description, Codman, in 1934, proposed the term "frozen shoulder" to describe the condition's potential for developing shoulder stiffness and pain without external influence (Codman & PELTIER, 1990).“ The term "adhesive capsulitis" was coined by Dr. Richard Neviaser to describe the pathology in the glenohumeral capsule that causes a frozen shoulder or restricted shoulder movement (Makki et al., 2021). Frozen shoulder is a prevalent reason for shoulder joint pain in middle-aged and elderly individuals. While the exact cause of this condition is not yet fully understood, it is believed to affect females and the non-dominant hand more commonly (Nakandala, Nanayakkara, Wadugodapitiya, & Gawarammana, 2021).

Adhesive capsulitis is more commonly seen in individuals between the ages of 40 and 70, with an estimated prevalence of 2-3% in the general population (N. Nakandalaa, Nanayakkarab, Wadugodapitiyaa, & Gawarammanac, 2020). The condition is typically divided into 2 types: primary and secondary. Primary adhesive capsulitis develops gradually without a specific cause and is characterized by pain and stiffness in the glenohumeral joint (Nakandala et al., 2021). According to their nature, the predisposing factors for secondary adhesive capsulitis may be divided into systemic, intrinsic, and extrinsic variables. Intrinsic causes include rotator cuff diseases, forearm tendon, progressive degeneration tendinitis, and acromioclavicular arthritis, whereas systemic factors include ailments like hypoadrenalism, thyroid dysfunction, and diabetes mellitus. Cardiorespiratory defects, patients with the cervical disease, stroke, Psoriatic arthritis, and humeral fractures are examples of extrinsic causes (Buchbinder et al., 2007). Some patients may recover naturally within two to three years, while others may experience disability for up to seven years, as reported by various studies (D’Orsi, Via, Frizziero, & Oliva, 2012).

The four phases of adhesive capsulitis commonly include aggressive, freezing, locked, and thawing. The sufferer may have strong, critical pain at rest and the end of their range of motion during the inflamed stage, which can last up to three months. They may also have sleep disruptions as a result of the discomfort. Stage 2, sometimes known as the "freezing stage," can persist for 3 to 9 months. At this time, the patient may only be able to move in the forward, abducted, internal, and exterior rotational planes with some degree of difficulty. Stage three is sometimes called to as the "frozen stage" and can stay anywhere between one year and three months. At this time, the patient may bear the pain at the extremities of their motion and have a restricted range of motion. Pain may diminish in stage four, sometimes known as the "thawing stage," as mobility gradually gets better (Pajareya et al., 2004). Although the precise course of treatment for adhesive capsulitis is unknown, several non-operative treatment options, such as conservative treatment, oral medications, electroshock treatment modalities, stretching workouts, joint mobilization, and muscle energy techniques, have been studied in the literature (MET) (Pajareya et al., 2004). As there is no agreement on the most effective single therapeutic intervention, a variety of treatment techniques are frequently used. The goal of this review is to objectively assess the caliber of recently published research and comprehensively examine the effectiveness of physiotherapy therapies in the care of individuals with adhesive capsulitis.

Review of literature:

Gerami et al. (2009) conducted a study to determine if physical therapy interventions could predict significant short-term improvements in four physical health measures, including pain and function, for patients diagnosed with adhesive capsulitis. 2,370 patients with the ICD-9 code 726.0 who had finished an outpatient physiotherapy episode were included in the research (average age 55.3 years, standard error 12.4; 65% female, 35% male). The Physical Component Summary-12 (PCS-12), physical performance (PF), bodily pain (BP), and hybrid function (HF) scores were examined using a statistical regression model to determine the intervention categories that predicted a 50% or more change. A 50% or more improvement in PCS-12 scores wasn't attained by any of the patients, though. Patients who received joint mobility interventions were more likely to improve in BP scores (odds ratio=1.35, 95% confidence interval=1.10–1.65), while those who received exercise interventions were more likely to improve in HF scores (odds ratio=1.50, 95% confidence interval=1.03–2.17). The use of iontophoresis, phonophoresis, ultrasound, or massage decreased the likelihood of improvement in these three outcome measures by 19 percent to 32 percent.

Blanchard, Barr, and Cerisola (2010) conducted a study to compare the effectiveness of corticosteroid injections and physiotherapeutic interventions for the treatment of adhesive capsulitis/frozen shoulder. They searched multiple electronic databases up to Week 23 2009, including MEDLINE, EMBASE, CINAHL, AMED, Cochrane Central Register of Controlled Clinical Trials, Physiotherapy Evidence Database (PEDro), National Research Register, and National Recognition Information Centre. Participants with adhesive capsulitis, a frozen shoulder, or a limitation of mobility in two or more planes were eligible for participation. The PEDro scale was used for the quality evaluation, and the main important results were pain, external rotation, and shoulder function. The study found that corticosteroid injections had a medium effect on pain, passive external movement, and shoulder disability at 6 weeks compared to physiotherapeutic interventions. For discomfort, shoulder impairment from passive external motion, and pain at 13 months, there was a minor impact in favor of corticosteroid inclusions at twelve to sixteen weeks and 26 weeks. Jason, Ganesh Sundaram, and Venkata Subramani (2015) aimed to carry out a thorough analysis of the different physiotherapy therapeutic strategies for shoulder adhesive capsulitis. Up to September 2015, they searched the Medical Key, Lexisnexis, and PEDro databases for relevant publications. Systematic reviews and patients who were controlled by random trials with patients with adhesive capsulitis, reporting outcomes on pain and function, and having a study length of at least two weeks met the inclusion criteria. The articles were assessed using the Jadad and PEDro scales, and a score of 50 percent on the Jadad scale and a PEDro rating of 5 out of 10 were defined as high quality. The study included a total of 17 studies, and it found sufficient evidence for physiotherapy in the treatment of adhesive capsulitis of the shoulder. The study suggested that manual treatment should be combined with commonly indicated exercise or conventional physiotherapy as it remains the standard care.

Elshiwi et al. (2019) did a web meta-analysis to assess the outcomes of various pharmaceutical treatments for the main therapy of adhesive capsulitis, whether they were given alone or after shoulder capsule distension. The analysis included studies that investigated the effects of various pharmacological therapies and used self-administered questionnaires to assess pain alleviation as the major outcome. The study investigated various composite tools that rated function and pain as ancillary outcomes. After back-transforming the standardized differences between the means into effect sizes in simple instruments, the data were clinically interpreted. The quality of the source papers was evaluated using the Cochrane "risk of bias" method. The findings showed that, when compared to the control group, intra-articular corticosteroids and shoulder capsule distension with steroids were both significantly more effective at reducing pain in the short term (mean difference in visual analog scale (VAS): -1.4 [95% CI, -2.5 to -0.4] and -1.7 [95% CI, -3.2 to -0.1], respectively). While this intervention was only taken into account in one experiment, the study likewise discovered that rotator-interval injections were more effective than a placebo (mean difference in VAS: -7.2; 95% CI, -10.1 to -4.4). Finally, multiple-site corticosteroid injections were found to be statistically significantly more effective than placebo in providing pain relief in both short- and intermediate-term assessments.

Cogan et al. (2022) found a cross-sectional study to analyze the current trends in the utilization of diagnostic and therapeutic modalities for patients with adhesive capsulitis. They tracked patients' utilization of various treatments from 2010 to 2020 by identifying individuals with adhesive capsulitis in the Marine database. The study found a high prevalence of comorbidities, such as diabetes, thyroid disorder, and Dupuytren contracture among patients with adhesive capsulitis. Within two years of diagnosis, the utilization of diagnostic and therapeutic modalities included radiography, opioids, physical therapy, injection, MRI, arthroscopic surgery, and manipulation under anesthesia. Over 68% of these modalities were administered within 3 months before or after diagnosis. Patients suffering from comorbidities, including sugar, disorders of the thyroid, increase use of tobacco, and obesity, had a higher likelihood of receiving methods with physiotherapy, opioids, radiography, and injection than patients who are not suffering from these diseases. The results summarized that there is an important utilization of various treatment options for adhesive capsulitis and that certain comorbidities increase the likelihood of receiving treatment.