Abstract: Frozen shoulder is a very common condition with a prevalence of 2%–5% in the general population. Decrease in joint volume as a result of fibrosis and hyperplasia of the joint capsule leads to painful and restricted glenohumeral motion. Frozen shoulder is a self- limiting disease with a chronic character, and is mostly treated in a primary care setting. In this review, we set out to address the current evidence-based literature on management of this disabling disease using a PubMed search. Many non-surgical and surgical therapeutic options are described, including supervised neglect, intra-articular corticosteroid injections, physical therapy, manipulation under anesthesia, capsular distension, and arthroscopic capsular release. In the literature, the long-term outcome shows a significant decrease in pain and improvement of shoulder function for all treatment modalities without clear evidence of superiority of one over the other. This possibly indicates that a self-limiting character is the most important factor in the course of the disease. Management of frozen shoulder is primarily conservative. Supervised neglect is combined with analgesia and stretching exercises as the pain subsides. In the early painful phase, intra-articular corticosteroid injections are recommended for pain relief. When the patient has persistent pain and glenohumeral stiffness after adequate conservative treatment, invasive options can be considered, like arthroscopic capsular release, manipulation under anesthesia, or capsular distension.
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Frozen shoulder is a painful and disabling condition that often causes great frustration for patients and care givers due to slow recovery. Apabahuka is a vatavyadhi affects the amsa sandhi .Patients present with amsa sandhi shoola , amsa sandhi sthabdata and bahupraspanditahara, which can be paralleled with the condition Frozen shoulder in the contemporary science which affects the shoulder joint causing restricted range of movements. Apabahuka being a bahushirshagata roga, nasya karma should be the first and foremost treatment of choice. Hence the present clinical study was carried out to assess the effect of masha saindhava taila nasya karma in the management of Apabahuka w s r to Frozen shoulder.
The types of treatment have included benign neglect, chiropractic manipulation, oral corticosteroids, physical therapy exercises and modalities, brisement, manipulation under anesthesia and arthroscopic and open releases of the contracture. Recent studies have emphasized the surgical management of recalcitrant shoulder stiffness. Many of these studies have been flawed because they have lacked objective and subjective outcome criteria.10 Non-steroidal anti-inflammatory drugs, local anaesthetic and corticosteroid injections into the glenohumeral joint, calcitonin and antidepressants, distension arthrography, closed manipulation, physical therapy modalities and stretching exercises can be listed among the most common non-surgical approaches to treatment in frozen shoulder.
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This is to certify that the dissertation work entitled “Efficacy of sustained passive stretching along with counter traction on the inferior capsule of the shoulder joint in the management of a frozen shoulder’’ was carried out by the candidate bearing the Register No. 271710002 (May 2019) in College of Physiotherapy, SRIPMS, Coimbatore, affiliated to the Tamil Nadu Dr. M.G.R Medical University, Chennai towards fulfillment of the Master of Physiotherapy (Orthopaedics) under my direct supervision and guidance.
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Idiopathic frozen shoulder is characterised by spontaneous, often severe pain of sudden onset, and may follow minor trauma. Sleep is often disturbed and the differential diagnoses include infection, fractures and rotator cuff tears. It is painful and stiff shoulder condition of varying aetiologies, some of which remain poorly defined and termed ‛idiopathic’. The rotator interval between supraspinatus and subscapularies is affected, as is the shoulder capsule. In the early stages, the shoulder is difficult to examine owing to pain but, as the disease progresses, the range of motion reduces, both atively and passively. Local tenderness is often felt anteriorly over the rotator interval. The disease most commonly affects females in their fifth decade, and is more common in diabetics and patient with heart and thyroid disease.
Total 30 patients having typical clinical features pertaining to the Frozen Shoulder like: Pain, Stiffness, Tenderness, Restricted Active and passive range of movements, were randomly selected for the study, with ages ranging from 40 yrs. to 60 yrs., irrespective of sex, religion etc. from OPD and IPD of Post Graduate Department of Shalya Tantra, National Institute of Ayurveda, Jaipur. Written informed consent were taken before starting the trial. The patients were divided in 2 equal groups having 15 patients in each group.
may pacify vata by its posaka and snehana guna. As Avabahuka takes place in shoulder region (amsasan- dhi) so vyana vayu is mainly responsible for the genesis of the disease. So nasyakarma has been taken into consideration. Aggravated vayu dried up the slesmak kapha of amsandhi and leads to avaba- huka. In consideration gunakarmayog snehanaguna and nasyakarma could pacify vata by reducing ruk- shaguna.
Symptoms associated with frozen shoulder include: localised pain, pain with movement, night pain (render- ing the patient unable to sleep on the affected side), marked limitation of active and passive range of move- ment (particularly external rotation) and normal shoul- der radiograph findings . However, the absence of definitive diagnostic criteria imposes challenges for clin- ical diagnosis and management and research . This diagnostic challenge is further complicated by the clin- ical overlap in signs and symptoms between frozen shoulder and other conditions, such as; rotator cuff ten- dinopathy, calcific tendonitis or early glenohumeral ar- throsis [13, 14]. A recent narrative review suggested thickening of the coracohumeral ligament (CHL), joint capsule and synovium to be diagnostic features for fro- zen shoulder . However no systematic review has yet collated the data from imaging studies to specify the intra and peri-articular changes that are associated with the condition.
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Mulligan’s mobilization-with-movement (MWM) is a manual therapy treatment technique in which a manual force, usually in the form of a joint glide, is applied to a motion segment and sustained while a previously impaired action (e.g. painful reduced movement, painful muscle contraction) is performed. The technique is indicated if, during its application the technique enables the impaired joint to move freely without pain. The direction of the applied force (translation or rotation) is typically perpendicular to the plane of movement or impaired action and in some instances it is parallel to the treatment plane. Studies have described the success of MWM in the management of various musculoskeletal conditions. It has been proposed that the MWM treatment technique produces its effects by correcting positional faults of joints that occur following injuries or strains . The Mulligan’s mobilization-with-movement (MWM) end range passive over-pressure is applied by patient or assistant for shoulders with limited range of motion because of pain, it was found that there is an improvement in range of motion and pressure pain threshold .
Abstract: Several rheumatologic manifestations are more pronounced in subjects with diabetes, ie, frozen shoulder, rotator cuff tears, Dupuytren’s contracture, trigger finger, cheiroarthropathy in the upper limb, and Achilles tendinopathy and plantar fasciitis in the lower limb. These conditions can limit the range of motion of the affected joint, thereby impairing function and ability to perform activities of daily living. This review provides a short description of diabetes-related joint diseases, the specific pathogenetic mechanisms involved, and the role of inflammation, overuse, and genetics, each of which activates a complex sequence of biochemical alterations. Diabetes is a causative factor in tendon diseases and amplifies the damage induced by other agents as well. According to an accepted hypothesis, damaged joint tissue in diabetes is caused by an excess of advanced glycation end products, which forms covalent cross-links within collagen fibers and alters their structure and function. Moreover, they interact with a variety of cell surface receptors, activating a number of effects, including pro-oxidant and proinflammatory events. Adiposity and advanced age, commonly associated with type 2 diabetes mellitus, are further pathogenetic factors. Prevention and strict control of this metabolic disorder is essential, because it has been demonstrated that limited joint motion is related to duration of the disease and hyperglycemia. Several treatments are used in clinical practice, but their mechanisms of action are not completely understood, and their efficacy is also debated.
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Published literature has indicated limitation of allopathic treatment of frozen shoulder. Nearly all patients suffering from frozen shoulder recover, but full range of movement may never return.  Varmam is a specialized field of Siddha pertained to cure neurological weakness, neuromuscular problems, migraine headaches, convulsions, arthritis, spinal problems, muscle wasting and to wail away intense pain. By enhancing the bio-energetic flow, varmam therapy retails a feeling of wellness. Varmam therapy along with individualised Siddha medicine plays a vital role for the management of frozen shoulder. As Kumbhavatham comes under Vatha Noi, which in general is difficult to cure, when it is devoid of complications it can be managed very well. Since it comes under Vata Noi but symptoms like heaviness, coldness are features of kapham it should be treated as vatha kapam disorder and the line of treatment internally the combination chooranam of Amukara chooranam, Silasathu parpam and Arumugam chendooram was given, Laguvidamuti thilam was given to apply externally and Varmam therapy was given weekly 2 times to regulate energy channels and for fast recovery. Warm Laghuvidamuti thilam was advised to apply for good absorption in skin. Internal Medicine Amukara combination chooranam posses anti-inflammatory and analgesic action and Laguvidamuti thilam may have nourished joints of shoulder region, which pacified the dosham and helps to relive from pain and stiffness in shoulder. Patient was strictly advised to follow healthy dietary and lifestyle regimen. Thus the internal medicines and healthy dietary and lifestyle regimen used helped in management of Kumbhavatham. After 2 months patients reported significant improvement in all subjective and objective parameters. The results of Pain scale score, Disability score, before and after treatment were highly significant which is evident from the P value = <0.0001. The results of this study gives hope to take this study to higher level.
Shoulder ROM limitation and pain are the most dis- turbing problems in patients with FS. Our results indi- cated that muscle release intervention immediately enhanced both active and passive ROM and decreased pain (Table 5). There are some possible explanations for the intervention effect. Application of local heat and the manual muscle release treatment might improve the cir- culation and modulate the local chemical circulation. The mechanical stimulation (heat and pressure) of this intervention might reduce the pain sensation by provid- ing pre-synaptic inhibition at the dorsal horn of the spinal cord and [15, 16]. The improvement in pain might help ease muscle spasms and thus result in the increase in shoulder mobility [15, 16]. However, we were unable to discount the placebo effect as there was no control group involved in this study design. Nevertheless, the in- creases in both active and passive shoulder mobility were greater than the SEM and MDC 95 of our goniom-
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Hanchard, NCA, Goodchild, L, Brealey, Stephen Derek orcid.org/0000-0001-9749-7014 et al. (2 more authors) (2019) Physiotherapy for primary frozen shoulder in secondary care: Developing and implementing stand-alone and post-operative protocols for UK FROST and inferences for wider practice. Physiotherapy. ISSN 0031-9406
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Frozen shoulder, which is also known as ‘adhesive capsulitis’ is a painful condition of the shoulder joint in which there is an inflammation of articular shoulder capsules, restricting the mobility of the shoulder joint. It commonly affects the people who are above the 40 years of age. The incidence of surgery for frozen shoulder in England was calculated by Kwaees and Charalambous as 2.67 procedures per 10,000 general population per year in their study, and at 7.55 for those aged 40-60. 1
LH returned to see Dr. S several days later, who, upon learning of the complications, indicated that “it would take a long time, but he would be able to reverse what he had done and would now treat in the opposite direction”. The chiropractor’s assistant performed ultrasound on the pa- tient’s shoulder, and Dr. S performed the same type of MAD maneuver, only “in the left direction”. This did not provide the patient with any pain relief. She went to the office sev- eral days later, and received the same form of treatment, again without benefit.
Some scholars have suggested that inflamma- tion and fibrosis may be the main reason for joint pain and joint movement disorders in patients with frozen shoulder [10, 14]. Lots of imaging data and the pathological data also have confirmed that inflammation and fibrosis are observed in tissues of rotator cuff in pati- ents with frozen shoulder, resulting in contrac- ture and thickening of joint capsule . There- fore, this article explores whether increased inflammatory factors and fibrogenic cytokines in the joint fluid can lead to the development of frozen shoulder. TGF-β plays a major regulatory role in many diseases related to fibrosis, such as hepatic fibrosis, renal fibrosis, pulmonary fibrosis [16, 17]. Hence, TGF-β, representing fibrogenic cytokines, is selected. Secreted by a variety of human cells, TGF-β is found in various tissues of human body. During the formation of fibrosis, TGF-β can not only promote the synthe- sis of extracellular matrix by fibroblasts, but also promote the transformation of epithelial cells into fibroblasts . Interleukin is a cellu- lar target inflammatory factor secreted by a
neuro-musculoskeletal complications in T2DM .The total participants were 500. The result shows high prevalence of neuro-muscular skeletal complications inT2DM patients. Mostly patients have positive family history of diabetes. Age groups of 61-65 years were affected mostly having sugar level 251-300 and have T2DM more than 3 years ago. Moreover, 90% patients use allopathic medicines but mostly patients have fluctuations in blood pressure besides the use of medicines. The prevalence of neuro-musculoskeletal complication in type II Diabetes mellitus was 100 %, while the frozen shoulder, tingling sensations and ants crawling sensations (61%) were equally the most common neuro-musculoskeletal complications, and followed by knee pain (53%), low back pain (43%). Long-term duration of T2DM shows high prevalence with frozen shoulder, altered sensations, knee pain and back pain.
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As many of these treatments improve pain but not necessarily ROM, or offer a limited bene ﬁ t in terms of ROM, there is a need to consider conservative treatments that may impact on both pain and function in the long term. A previous randomised controlled pilot study in 60 participants with AC had demonstrated that 53 participants improved their ROM after a series of collagenase Clostridium histolyticum (AA4500) injections. 1 Collagenase Clostridium histolyticum (CCH) is a combi- nation of two collagenases (CCH-I and CCH-II) and is an FDA-approved enzymatic injection treatment for Dupuytren ’ s contracture. It was postulated that the effects of CCH seen in Dupuytren ’ s contracture may be similar if used for management of AC, providing in this case a clinically signi ﬁ cant increase in the ROM.
Methods: This is a prospective, single center, randomized controlled trial. Eligible patients will be allocated to either the manipulation (MUA) group or the physiotherapy alone (PT) group. In the MUA group manipulation will be performed under interscalene block, directly followed by an intensive physiotherapy treatment protocol, with the goal to maintain the obtained range of motion. Patients allocated to the PT group are given advice and education and receive a written protocol to hand out to their physical therapist based on the recent guideline of the Dutch Shoulder Network for the treatment of frozen shoulders. Descriptive statistics will be used to describe the sample size, patients demographics, presence of diabetes mellitus, range of motion, duration of symptoms till randomization and will be presented for each treatment group. The SPADI is used as primary functional outcome parameter. Secondary outcome parameters are; OSS, NPRS, EQ-5D 3-L, passive range of motion, WORQ-UP, duration of symptoms, usage of analgesics and adverse events. A sample size of 41 subjects in each group was calculated. Follow up is planned after 1,3 and 12 months. The length of physiotherapy treatment in both groups is variable, depending on individual progression. Differences between groups in outcome parameters will be analysed using the linear mixed modelling and the restricted maximum likelihood ratio technique for estimating the model parameters.
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For shoulder abduction, therapist applied a posterolateral gliding force over the head of the humerus, while patient actively abducted his arm. For shoulder flexion, the therapist applied a posterolateral glide as patient flexed his shoulder. For shoulder internal rotation, therapist applied an inferior shoulder glide and stabilized the scapula as the patient internally rotated his shoulder, and adducted his upper arm. As the therapist pushed the shoulder into adduction in this way, the head of the humerus was distracted laterally. Therapist hand in the axilla acted as a fulcrum.