International Journal of Physiotherapy and Research,

Int J Physiother Res 2015, Vol 3(6):1318-25. ISSN 2321-1822

Review Article DOI: http://dx.doi.org/10.16965/ijpr.2015.198

PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF

SHOULDER: A SYSTEMATIC REVIEW
Jacob Isaac Jason *, Ganesh Sundaram S, Vengata Subramani M.
Department of Physiotherapy, Faculty of pharmacy and health sciences, Universiti Kualalumpur -
Royal College of Medicine Perak, Malaysia.
ABSTRACT
Objective: The purpose of this study was to conduct a systematic review on various physiotherapy management
for adhesive capsulitis of shoulder.
Methods: A search of the literature was conducted using Clinical Key, ProQuest and PEDro databases up to
September 2015. Search limits included the English language and human studies. Search terms included adhesive
capsulitis, frozen shoulder, Physical therapy, Physiotherapy etc.
Inclusion criteria: Systematic reviews and randomised controlled trials (RCTs) in English language were included
if they fulfilled the following criteria: (a) patients with adhesive capsulitis were included, (b) results on pain
and function were reported, and (c) a study period of at least two weeks was reported. Articles were assessed
using the Jadad (1) scale and Physiotherapy Evidence Database (PEDro) scale. ‘High-quality’ was defined as a
“yes” score of 50% in Jadad scale and a PEDro rating of 5 out of 10. Totally 17 studies were selected for this
systematic review.
Conclusion: This study has found sufficient level of evidence for physiotherapy in the treatment of adhesive
capsulitis the shoulder. In particular, manual treatment must be combined with commonly indicated exercise
or conventional physiotherapy, as it remains the standard care.
KEY WORDS: Adhesive capsulitis, frozen shoulder, Physiotherapy.
Address for correspondence: Mr.Jacob Isaac Jason, MPT, Lecturer, Department of Physiotherapy,
Faculty of pharmacy and health sciences, Universiti Kualalumpur - Royal College of Medicine
Perak, Malaysia. E-Mail: jisaacjason@gmail.com

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Quick Response code International Journal of Physiotherapy and Research

ISSN 2321- 1822
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Received: 13-10-2015 Accepted: 16-11-2015
Peer Review: 13-10-2015 Published (O): 11-12-2015
DOI: 10.16965/ijpr.2015.198
Revised: None Published (P): 11-12-2015
INTRODUCTION
9 months  and  is  characterized  by  an  acute
Adhesive capsulitis is one of the most common
synovitis of the gleno-humeral joint [1,2].
problems of the arm. This condition is a
challenge for Physiotherapists, as it is difficult The second stage is called the frozen or
to treat and may last for several weeks. It is a transitional stage. During this stage use of the
painful and disabling condition and the aetiology arm may be limited. The frozen stage lasts
is unclear. Adhesive capsulitis is caused by anywhere 4 to 12 months. The capsular pattern
tightening of the joint capsule and results in is reduced external shoulder rotation followed
stiffness and pain. Adhesive capsulitis occurs by shoulder flexion, and internal rotation [2].
in three distinct stages. The first stage is called The third stage begins when ROM begins to
the freezing stage. As the symptoms progress, improve and is called the thawing stage. This
pain becomes worse and ROM becomes more stage lasts from 12 to 42 months and is defi-
restricted. This phase lasts between 3 to nedby a gradual return of shoulder mobility [2].
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 Jacob Isaac Jason et al. PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF SHOULDER: A SYSTEMATIC REVIEW.

Prolonged immobilization of a joint has been Search terms included adhesive capsulitis,
shown to cause several detrimental pathophys- frozen shoulder, Physical therapy and
iologic findings including decreased collagen Physiotherapy. Case studies, duplications,
length, ligament atrophy resulting in decreased conference proceedings, and discussion papers
stress absorption, collagen band bridging across were removed. The articles were then assessed
recesses, random collagen production, and for quality using the Jadad scale and
altered sarcomere number in muscle tissue [3]. Physiotherapy Evidence Database (PEDro) scale.
Possible causes of secondary adhesive capsulitis Inclusion criteria: Systematic reviews and
are of systemic, extrinsic, or intrinsic nature. randomised controlled trials (RCTs) were
Systemic causes include diabetes mellitus, included if they fulfilled the following criteria:
thyroid dysfunction, and hypoadrenalism. (a) patients with adhesive capsulitis were
Extrinsic causes include cardiopulmonary included, (b) results on pain and function were
conditions, cervical spine diseases, and stroke, reported, and (c) a study period of at least two
Parkinson’s disease, and humerus fractures. weeks was reported. Studies in English language
Possible intrinsic factors are rotator cuff only were included due to lack of resources to
pathologies, biceps tendinitis, calcific tendinitis, translate.
and acromio-clavicular joint arthritis. Likewise, Study selection: Two reviewers independently
the presence of recent surgery, immobilization, selected potentially relevant studies from the
trauma, and even Dupuytren’s disease has also full-text articles. A consensus method was used
been associated with the development of to solve disagreements regarding inclusion of
secondary adhesive capsulitis [4]. studies.
Early diagnosis of this condition can be difficult Categorization of the literature: The selected
and patients visit the clinic belatedly, often with articles are categorized as Systematic reviews
a prior diagnosis of rotator cuff pathology. Some and randomised controlled trials (RCTs).
patients have even undergone prior surgical Randomised controlled trial category contains
procedures to treat sub acromial pathology [3]. all RCTs published up to the search date of the
The most efficient treatment for this common systematic review (September 2015).
disease is still under debate, and no standard Methodological quality assessment: Two
treatment has been established yet. Several reviewers assessed the methodological quality
treatment options have been proposed, such as of each RCT using the 5 quality criteria of Jadad
rest, physical therapy, medication with [1] (Table 1) and Physiotherapy Evidence
nonsteroidal anti-inflammatory drugs, calcium Database (PEDro) scale. ‘High-quality’ was
deposit needling, localized injection of defined as a “yes” score of 50% in Jadad scale
anaesthetics or corticosteroids, and extracorpo- and a PEDro rating of 5 out of 10.
real shock wave therapy. ESWT has been Table 1: JADAD Scale for methodological quality [1].
recommended as a second-line therapy before
How points are awarded:
surgery is performed [5].
1) Is the study randomised? If yes, + 1 point.
The treatment protocols for adhesive capsulitis Is the randomisation procedure appropriate and reported in the study?
and number of sessions required for a If yes, +1 point. If no, delete all points awarded for randomisation.
therapeutic effect have not been adequately 2) Is the study double blind? If yes, + 1 point.
addressed by the literature. The aim of this study Is the double blinding method appropriate and reported in the study?
If yes, +1 point. If no, delete all points awarded for double blinding.
was to analyse the scale of research into the
3) Are the reasons for patient withdrawals and dropouts described, for each treatment
management of adhesive capsulitis by group? If yes, +1 point
systematically determining what research has
The minimum score possible for inclusion of a
been done before this review.
study in the review was 2 (one point each for
METHOD randomisation and double blinding). The
Search strategy: A literature search regarding maximum score possible was 5 (2 points for
adhesive capsulitis treatment was performed on descriptions of randomisation, 2 points for
Clinical Key, ProQuest and PEDro databases. descriptions of double blinding, and 1 point for
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 Jacob Isaac Jason et al. PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF SHOULDER: A SYSTEMATIC REVIEW.

descriptions of withdrawals). adhesive capsulitis of the shoulder.

RESULTS Low-power laser treatment: In a study by
Characteristics of the included studies: The Stergioulas A [9] sixty-three patients with frozen
literature search resulted in 5 RCTs from the shoulder were randomly assigned into two
PEDro database. Via ProQuest (11) RCTs, via groups. Compared to the placebo group, the
Clinical Key 1 systematic review and 4 RCTs were active laser group had significant decrease in
found. Totally 17 studies were included for this pain scores at the end of 4 and 8 week of
systematic review. treatment, and at the end of 8 week follow-up,
Methodological quality: Out of the 5 RCTs from a significant decrease in shoulder pain and
PEDro one study focussed on economic disability index (SPADI) scores and Croft shoulder
evaluation and one study included arthroscopy. disability questionnaire scores, a significant
So only 3 studies from PEDro were included in decrease in disability of arm, shoulder, and hand
this review. Of the 11 RCTs from ProQuest 1 was questionnaire (DASH) scores at the end of 8 week
a case report and 1 study did not have a control of treatment, and at 16 week post treatment;
group. So 2 RCTs from ProQuest were excluded and a significant decrease in health-assessment
from this review. questionnaire (HAQ) scores at the end of 4 week
and 8 week of treatment. The results suggested
Systematic review: Manipulative therapy for that laser treatment was more effective in
shoulder pain and disorders: a systematic review: reducing pain and disability scores than placebo.
Brantingham et al. 2011 [6] conducted a search
of the literature using the Cumulative Index of Ultrasound with end Range Mobilization Vs
Nursing Allied Health Literature. PubMed; Cryotherapy with end Range Mobilization: Ansari
Manual, Alternative, and Natural Therapy Index SN et al. [10] conducted a study to check the
System; Physiotherapy Evidence Database; and effectiveness of Ultrasound with end range
Index to Chiropractic Literature dating from mobilization in alleviating pain of patients with
January 1983 to July 7, 2010. There is fair frozen shoulder. Forty subjects with frozen
evidence for the treatment of adhesive shoulder were randomly assigned to two groups.
capsulitis, and soft tissue disorders using MMT Subjects in Group 1 received Ultrasound and End
to the shoulder. range mobilization of shoulder while subjects
in Group 2 got Cryotherapy and End range
Randomised Controlled Trials mobilization of shoulder. Both the groups were
Effects of whole-body Cryotherapy: Ma et al. [7] treated once a day, 6 days a week for 4 weeks.
compared two different treatment approaches - Response to pain was the outcome measure.
physical therapy modalities, and joint Ultrasound with end range mobilization
mobilization Vs whole-body cryotherapy for produced better pain relief compared to
symptoms of adhesive capsulitis of the shoulder cryotherapy with end range mobilization.
(N=30). Significant difference between groups Effect of axillary ultrasound and laser combined
was found for all the outcome measures with with post-isometric facilitation: Elhafez HM et
greater improvements in the whole-body al. [11] conducted a randomized clinical trial
cryotherapy group (Ps<.01). study on Fifty-nine participants. They were
Effects of extracorporeal shockwave therapy: assigned into three equal groups of fifteen. The
Chen C Y et al. conducted a clinical trial [8], subjects were blinded to their group allocation.
(n=40) on primary adhesive capsulitis to find Standard care group (A) received traditional
whether extracorporeal shockwave therapy can physical therapy treatment in the form of pulsed
improve primary adhesive capsulitis better than ultrasound, scanning laser, supervised exercise
oral steroid therapy. Patients were allocated to program and home exercise program; Group B
the oral steroid group or ESWT group. Outcome received the same physical therapy program as
measures are the Constant Shoulder Score and Group A except that the ultrasound and scanning
Oxford Shoulder Score. Results showed that laser were applied to the axillary region of the
ESWT group showed significant improvement painful shoulder (the new technique); Group C
and can be an alternative treatment for primary received the same modified physical therapy
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 Jacob Isaac Jason et al. PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF SHOULDER: A SYSTEMATIC REVIEW.

program as Group B plus post-isometric group, with each group having 50 subjects. The
facilitation technique to the painful shoulder. control group received physiotherapy and the
The results concluded that combining axillary experimental group received counter-traction
ultrasound and laser with post-isometric and physiotherapy for 2 weeks. The outcome
facilitation had a greater (short term) effect in measures used were ROM, VAS, and the Oxford
reducing pain and improving shoulder ROM Shoulder Score. Results indicate that shoulder
inpatients with shoulder adhesive capsulitis. counter-traction along with physiotherapy
Continuous passive motion: Dundar U et al. [12] improves shoulder function in frozen shoulder
conducted a study to compare the response with patients.
different treatment methods [CPM vs. Stretch Glides for patients with Primary Adhesive
conventional physiotherapy treatment] for Capsulitis: In this study by Joshi P et al. [16] 30
adhesive capsulitis. Patients were assigned subjects were divided into two groups - Anterior
randomly for CPM treatment or CPT protocol and stretch glide (ASG) and Posterior stretch glide
parameters were measured. All patients were (PSG). Each group received ultrasound, exercise
evaluated for pain at rest, movement, night, protocol and their designated glides for 2 weeks.
measurement of range of motion constant It is found that anterior stretch glide is very
functional shoulder score and the shoulder pain effective in reducing pain and increasing
and disability index at baseline, and at weeks 4 external rotation range of motion in patients with
and 12. CPM treatment provides better response primary adhesive capsulitis.
in pain reduction than the conventional Effectiveness of Soft Tissue Mobilization
physiotherapy treatment in the early phase of Preceding Joint Mobilization Technique:
treatment in adhesive capsulitis. Deshmukh SS et al. [17] compared the efficacy
Static progressive stretch device plus traditional of treatment strategies - Myofascial release
therapy Vs traditional therapy alone: Ibrahim M Arm-pull technique and Maitland’s joint
et al. [13] conducted a study to compare the mobilization technique in patients with adhesive
effect of static progressive stretch device plus capsulitis. 30 subjects fulfilling the inclusion
traditional therapy with traditional therapy alone criteria were selected and randomly allocated
for the treatment of adhesive capsulitis. After into 2 Groups, Group I: Control Group - Maitland’s
the intervention, there were significant (P < 0.05) mobilization + Exercises, Group II: Experimental
difference between the groups for all outcome Group - MFR Arm pull + Maitland’s mobilization
parameters: 0.3 for mean VAS scores [95% + Exercises. Statistical analysis showed
confidence interval (CI) -0.6 to 1.1], -10.1 for significant difference in Myofascial release Arm
DASH scores. pull technique preceding Maitland’s mobilization
Effectiveness of PNF Stretching and Self with respect to pain, function and ROM.
Stretching: In a study by Mehta H et al. [14] 30 Joint mobilization versus self-exercises: The
subjects having adhesive capsulitis of shoulder purpose of this study conducted by Tanaka K et
with restriction of external rotation and al. [18] was to find the management for limited
abduction were included and subjects were gleno-humeral joint mobility (LGHM) due to
randomly divided into two groups. Group A: adhesive capsulitis based on the frequency of
(n=15) treated with PNF stretching. Group B: sessions for joint mobilization and the self-
(n=15) Treated with self-stretching. Analysis was exercise compliance. Patients (n=120) were
based on ROM and Shoulder Pain and Disability divided randomly into high-frequency session
Index scores. PNF Stretching was more effective group (HF group, more than two times a week),
in improving gleno-humeral joint mobility and moderate-frequency session group (MF group,
reducing disability as compared to Self- once a week), and low-frequency session group
Stretching. (LF group, less than once a week). Results
Effectiveness of Sustained Stretching of the indicated that the effectiveness of self-exercise
Inferior Capsule: In this study by Paul A et al. depends on the frequency of treatment.
[15] a total of 100 participants were randomly Significant improvements seen in the dominant-
assigned to experimental group and a control handedness group, in which patients would use
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 Jacob Isaac Jason et al. PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF SHOULDER: A SYSTEMATIC REVIEW.

Table 2: Summary of published studies on the physiotherapy management of adhesive capsulitis.

Author Intervention Control Duration Result
Manipulative therapy Jan. 1983 to July 7,
Brantingham et al. 2011 -            Fair level of evidence for MMT
(Systematic review) 2010
Physical therapy modalities and Significant improvement in WBC
Ma et al. 2013 Whole-body cryotherapy 4 weeks
joint mobilization group (Ps <.01).

Significant improvement in EST for

Extracorporeal shockwave
Chen et al. 2014 Oral steroid therapy 12 weeks both the CSS and OSS (P = .041
therapy
and P = .045, respectively) 

Significant improvement in all

Stergioulas 2008 Low-power laser Placebo laser treatment 8 weeks
outcome measures
Significant difference between the
Ultrasound with end range End range mobilization of two groups to infer the
Ansari & Shah 2013 4 weeks
mobilization shoulder effectiveness of UST and ERM over
Cryotherapy  
Significant improvement in
Axillary ultrasound and laser
Supervised exercise program experimental group after
Elhafez & Elhafez 2015 with post-isometric 4 weeks
and home exercise program treatment and after 4 weeks
facilitation
follow up (P < 0.05)
CPM group showed better
Conventional physiotherapy
Dundar et al. 2009 Continuous passive motion 12 weeks shoulder pain index scores than
treatment
the CPT group
Static progressive stretch (P < 0.05) Significant
Ibrahim et al. 2014 Traditional therapy 4 weeks
device improvement for SPSD

 PNF Stretching showed significant 
Mehta et al. 2013 PNF Stretching Self-stretching 4 weeks
improvement in ROM and SPADI

Sixty percent of the participants (n

= 30) were improved to the fourth
stage of satisfactory joint function
Paul et al. 2014 Counter-traction Conventional Physiotherapy 2 weeks
according to the Oxford Shoulder
Score in the experimental group
(p < 0.001)
Anterior stretch glide is more 
Ultrasound, same exercise effective in improving
Joshi & Jagad 213 Stretch Glides 2 weeks
protocol shoulder external rotation and 
pain.
 Myofascial release Arm pull 
Myofascial release Arm-pull Maitland's mobilization + technique showed significant
Deshmukh et al. 2014 3 weeks results in reducing symptoms as
technique Exercises
well as improving functional
abilities
High frequency of sessions in the
Conventional Physiotherapy
Tanaka et al. 2010 High-frequency session 5 months hospital setting may be effective
Protocol
to increase the compliance level.

Statistically significant
High-grade mobilization Passive mobilization techniques
Vermeulen et al. 2006 12 weeks improvement found in the HGMT
techniques (HGMT) within the pain-free zone
group for passive abduction

Significant ROM improvement was

Maitland Mobilization Moist pack, active ROM seen in Maitland mobilization
Shah & Misra 2013 2 weeks
Technique exercises group and reduction in pain was
seen in MET group

Statistically significant
End-range mobilization, mid-
improvements were found in ERM
range mobilization, and Pendular exercises and scapular
Yang et al. 2012 12 weeks and MWM. Additionally, MWM
mobilization with setting
corrected scapula-humeral rhythm
movement
significantly

End-range mobilization/
Subjects in the EMSMTA group
scapular mobilization
Standardized physical therapy experienced greater improvement
Yang et al. 2012 treatment 8 weeks
program in outcomes compared with the
approach
criteria-control group at 4 weeks
(EMSMTA)

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 Jacob Isaac Jason et al. PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF SHOULDER: A SYSTEMATIC REVIEW.

the affected shoulder in everyday life. The mobilization with movement (MWM) was
finding suggests that high frequency of sessions applied on subjects (n= 28) with frozen shoulder
may be effective to increase the compliance syndrome. The duration of each treatment was
level. 3 weeks, for a total of 12 weeks. Outcome
Effectiveness of high-grade mobilization measures included the functional score and
techniques (HGMT) Vs low-grade mobilization shoulder kinematics. Statistically significant
techniques (LGMT): Vermeulen HM et al. [19] improvements were found in ERM and MWM.
compared high-grade mobilization techniques MWM corrected scapula-humeral rhythm
(HGMT) with that of low-grade mobilization significantly better than ERM.
techniques (LGMT) in subjects with adhesive Effectiveness of the end-range mobilization and
capsulitis of the shoulder. 100 subjects with scapular mobilization approach: In this study by
unilateral adhesive capsulitis lasting 3 months Yang J et al. [22] 34 subjects with FSS (Frozen
or more and 50% or more decrease in passive shoulder syndrome) were included. Eleven
joint mobility were enrolled in this study. Subjects subjects were assigned to the control group, and
randomly assigned to the HGMT group were 23 subjects were randomly assigned to the
treated with intensive passive mobilization criteria-control group with a standardized
techniques in end-range positions, and subjects physical therapy program or to the EMSMTA
in the LGMT group were given passive (end-range mobilization/scapular mobilization
mobilization techniques within the pain-free treatment approach) group. The treatment
zone. The duration of treatment was 12 weeks. session is twice a week for 8 weeks. Range of
Subjects were assessed at baseline and at 3, 6, motion (ROM), disability score, and shoulder
and 12 months. Primary outcome measures complex kinematics were measured at the
included active and passive range of motion and beginning, 4 weeks, and 8 weeks. Subjects in
shoulder disability (Shoulder Rating the EMSMTA group experienced greater
Questionnaire [SRQ] and Shoulder Disability improvement than criteria-control group at 4
Questionnaire [SDQ]). HGMT are more effective weeks.
in improving gleno-humeral joint mobility and DISCUSSION
reducing disability than LGMTs.
Maitland Mobilization Technique Vs Muscle Various treatments have been suggested for
Energy Technique: In this study by Shah AS et al. adhesive capsulitis. The purpose of this
(20) 30 subjects with adhesive capsulitis were systematic review was to analyse the literature
selected and were assigned in two groups with about various physical therapy treatment
15 subjects each. Group A received moist pack, available for adhesive capsulitis. We identified
active ROM exercises and Maitland mobilization. seventeen studies that studied the effectiveness
Group B received moist pack, active ROM of physiotherapy modalities for the treatment
exercises and Muscle Energy Technique (MET). of adhesive capsulitis. One possible limitation
Both the groups were treated 6 times a week of our study is the importance given for RCTs.
for 2 weeks. All the subjects were measured for When selecting a physical treatment method for
pain by VAS, ROM on first day before start of adhesive capsulitis, it is extremely important to
treatment and on 15th day after treatment. There consider the patient’s  symptoms,  stage of
was significant improvement in pain and ROM the condition,  and  recognition  of different
in both groups. ROM improvement was seen patterns of motion loss.
more in Maitland mobilization group and pain There is a fair level of evidence for manual
reduction was seen more in MET group. mobilisation techniques with exercise for
Comparing 3 mobilization technique-end-range adhesive capsulitis. Generally, the greatest
mobilization (ERM), mid-range mobilization change noted with MMT indicated a change or
(MRM), and mobilization with movement (MWM: increase in ROM and function rather than pain.
In this comparative study by Yang J et al. [21] 3 The study on the effect of scapular mobilisation
mobilization techniques-end-range mobilization [22] also suggest that insufficient scapula-
(ERM), mid-range mobilization (MRM), and humeral rhythm and posterior tipping of the
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 Jacob Isaac Jason et al. PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF SHOULDER: A SYSTEMATIC REVIEW.

scapula during arm elevation are important to recovery of patients with shoulder adhesive
consider in rehabilitation of patients with capsulitis. Adding post-isometric facilitation
adhesive capsulitis. Usage of a static progressive technique along with the above treatments may
stretch device has a beneficial long-term effect give better recovery.
on shoulder range of motion, pain and functional However it should also be noted that aggressive
outcomes in patients with adhesive capsulitis physical therapy can exacerbate pain and
of the shoulder. Robertson [23] reported diminish adherence to the treatment plan. So
the usage of ultrasound  therapy in treatment  of caution should be exercised in patients who
patients  with frozen shoulder. According to him, have a high degree of pain and stiffness.
active therapeutic ultrasound is used for
treating people with pain and musculoskeletal CONCLUSION
injuries to promote  soft  tissue  healing.  Both
This study has found sufficient level of evidence
thermal and non-thermal effects of UST are
for physiotherapy in the treatment of adhesive
proven beneficial in reducing inflammation and
capsulitis the shoulder. In particular, manual
improve tissue extensibility. The increased
treatment must be combined with commonly
pliability of the tissue along with the reduction
indicated exercise or conventional physio-
 of  inflammation   as a part of thermal effects
therapy, as it remains the standard care. This
of UST paves  way  for  aggressive mobilization
study is intended to guide Physiotherapists in
of shoulder with low  perception of  pain.
the appropriate use of MMT, soft tissue
Continuous passive motion (CPM) is also an
technique, exercise, and/or electrotherapy for
established method of preventing joint stiffness
the treatment of adhesive capsulitis in the
and of overcoming it.
context of available evidence. More studies are
Treatment strategies targeting abnormal also needed for more definitive conclusions
shoulder kinematics may prevent stiffness or if about long-term outcomes.
stiffness develops, shorten its duration.
Shoulder motion  occurs in multiple  planes ABBREVIATIONS
 of movement.  Loss of  shoulder mobility  can
RCT: Randomised Controlled Trial
result in significant  functional  impairment.
ESWT: Extra Corporeal Shockwave Therapy
The traditional  treatment approach to  restore
CPT: Conventional Physiotherapy Treatment
shoulder mobility emphasizes mobilization  of
SPADI: Shoulder Pain And Disability Index
the shoulder. But forced elevation in a stiff and
painful shoulder can be painful and potentially Conflicts of interest: None
destructive to the gleno- humeral joint. Mc Clure
REFERENCES
et. al [24] suggested that to make improvements
in the mobility of a stiff shoulder, treatment [1]. Hinett K. Quality and assessment. Qual Assur Educ.
should be aimed towards applying tension 1996;1(1):53–10.
to the capsule, extra  capsular  ligaments,  and [2]. Manske RC, Prohaska D. Diagnosis and manage-
tendons of  the rotator  cuff, in an  effort  to ment of adhesive capsulitis. Curr Rev Musculoskelet
Med. 2008;(May):1–10.
elongate the restricting  tissues.  Low-load
[3]. Mangine RE, Heckmann T E-MM. Alternative
stretches had been advocated as an effective techniques for the motion-restricted shoulder. J A,
technique to increase extensibility of the GH K W, editors. The athletes shoulder. Churchill
capsule. Livingstone; 1994.
[4]. Struyf F, Meeus M. Current evidence on physical
In a study on the effect of ESWT [8] patients therapy in patients with adhesive capsulitis: What
showed functional outcome improvement are we missing? Clin Rheumatol. 2014;33(5):593–
regardless of whether they were treated with 600.
ESWT or oral steroids, but those who received [5]. Kim Y-S, Lee H-J, Kim Y, Kong C-G. Which method is
ESWT had faster and better improvements. Also more effective in treatment of calcific tendinitis in
the shoulder? Prospective randomized comparison
it is found that the axillary application of between ultrasound-guided needling and
ultrasound and laser could replace the traditional extracorporeal shock wave therapy. J Shoulder
application (above the shoulder) for faster Elbow Surg 2015 Sep 15; 23(11):1640–6.
Int J Physiother Res 2015;3(6):1318-25. ISSN 2321-1822 1324
 Jacob Isaac Jason et al. PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF SHOULDER: A SYSTEMATIC REVIEW.

[6]. Brantingham JW, Cassa TK, Bonnefin D, Jensen M, [16]. Joshi P, Jagad B. Comparison of Stretch Glides on
Globe G, Hicks M, et al. Manipulative therapy for External Rotation Range of Motion in patients with
shoulder pain and disorders: Expansion of a Primary Adhesive Capsulitis. Indian Journal of
systematic review. J Manipulative Physiol Ther physiotherapy and occupational therapy.
2011;34(5):314–46. 2013;7(1):202–8.
[7]. Ma SY, Je HD, Jeong JH, Kim HY, Kim HD. Effects of [17]. Deshmukh SS, Salian SC, Yardi S. A Comparative
whole-body cryotherapy in the management of Study to assess the effectiveness of Soft Tissue
adhesive capsulitis of the shoulder. Arch Phys Med Mobilization Preceding Joint Mobilization
Rehabil. 2013;94(1):9–16. Technique in the Management of Adhesive
[8]. Chen C-Y, Hu C-C, Weng P-W, Huang Y-M, Chiang C- Capsulitis. Indian Journal of physiotherapy and
J, Chen C-H, et al. Extracorporeal shockwave therapy occupational therapy. 2014;8(1):93–9.
improves short-term functional outcomes of [18]. Tanaka K, Saura R, Takahashi N, Hiura Y, Hashimoto
shoulder adhesive capsulitis. J Shoulder Elb Surg. R. Joint mobilization versus self-exercises for
Elsevier Ltd; 2014;23(12):1843–51. limited glenohumeral joint mobility: Randomized
[9]. Stergioulas A. Low-power laser treatment in patients controlled study of management of rehabilitation.
with frozen shoulder: preliminary results. Photomed Clin Rheumatol. 2010;29(12):1439–44.
Laser Surg 2008 Apr; 26(2):99–105. [19]. Vermeulen HM, Rozing PM, Obermann WR, le Cessie
[10]. Ansari SN, Shah S. A Comparative Study to Find out S, Vliet Vlieland TPM. Comparison of high-grade
the effect of Ultrasound with end Range and low-grade mobilization techniques in the
Mobilization Over Cryotherapy with end Range management of adhesive capsulitis of the shoulder:
Mobi lization on Pain in Frozen Shoulder. randomized controlled trial. Phys Ther.
2013;7(4):213–8. 2006;86(3):355–68.
[11]. Elhafez HM, Elhafez SM. Axillary ultrasound and [20]. Shah AS, Misra A. Comparative Study on the
laser combined with post-isometric facilitation in effectiveness of Maitland Mobilization Technique
treatment of shoulder adhesive capsulitis: a Versus Muscle Energy Technique in Treatment of
randomized clinical trial. Physiotherapy. The Shoulder Adhesive Capsulitis. Indian J Physiother
Chartered Society of Physiotherapy; 2015; Occup Ther - An Int J. 2013;7(4):1.
101(May):e353: [21]. Yang J, Chang C, Chen S, Wang S-F, Lin J. Mobilization
[12]. Dundar U, Toktas H, Cakir T, Evcik D, Kavuncu V. techniques in subjects with frozen shoulder
Continuous passive motion provides good pain syndrome: randomized multiple-treatment trial.
control in patients with adhesive capsulitis. Int J Phys Ther. 2007 Oct;87(10):1307–15.
Rehabil Res. 2009 Sep;32(3):193–8. [22]. Yang J, Jan M-H, Chang C, Lin J. Effectiveness of the
[13]. Ibrahim M, Donatelli R, Hellman M, Echternach J. end-range mobilization and scapular mobilization
Efficacy of a static progressive stretch device as an approach in a subgroup of subjects with frozen
adjunct to physical therapy in treating adhesive shoulder syndrome: a randomized control trial.
capsulitis of the shoulder: a prospective, Man Ther. 2012 Feb;17(1):47–52.
randomised study. Physiotherapy. 2014 [23].Robertson VJ, Baker KG. A review of therapeutic
Sep;100(3):228–34. ultrasound: effectiveness studies. Phys Ther.
[14]. Mehta H, Joshi P, Trambadia H. Effectiveness of PNF 2001;81(7):1339–50.
Stretching and Self Stretching in Patients with [24]. McClure PW, Blackburn LG, Dusold C. The use of
Adhesive Capsulitis-A Comparative Study. Indian splints in the treatment of joint stiffness: biologic
Journal of physiotherapy and occupational therapy. rationale and an algorithm for making clinical
2013;7(1):47–52. decisions. Phys Ther. 1994 Dec;74(12):1101–7.
[15]. Paul A, Rajkumar JS, Peter S, Lambert L. Effectiveness
of sustained stretching of the inferior capsule in
the management of a frozen shoulder. Clin Orthop
Relat Res. 2014 Jul;472(7):2262–8.

How to cite this article:

Jacob Isaac Jason, Ganesh Sundaram S, Vengata Subramani M.
PHYSIOTHERAPY INTERVENTIONS FOR ADHESIVE CAPSULITIS OF
SHOULDER: A SYSTEMATIC REVIEW. Int J Physiother Res 2015;3(6):1318-
1325. DOI: 10.16965/ijpr.2015.198

Int J Physiother Res 2015;3(6):1318-25. ISSN 2321-1822 1325