To investigate and compare the effects of Mulligan mobilization versus shock wave therapy in patients with adhesive capsulitis on Pain intensity level, Range of motion, Functional disability level, Ultrasonographic changes (soft tissue thickness) and Hand grip strength.
sixty patients of both genders according to sample size calculation, referred from orthopedist, diagnosed adhesive capsulitis patients. they screened according to inclusion and exclusion criteria. Their age between 40 and 60 years was randomly allocated to three treatment groups. * Group A (study group) (n=20) will receive mulligan technique and conventional treatment. * Group B (study group) (n=20) will receive extracorporeal shockwave therapy and conventional treatment. * Group C (control group) (n=20) will receive conventional treatment only. Inclusion criteria: patients that will be included in the study will be referred from orthopedic physician with: 1. Patients referred from orthopedist and diagnosed as frozen shoulder 2. The age of the participant will be from 40-60 (Agarwal S., et al.2016). 3. Body mass index from 25- 30 kg/m2. 4. having a painful stiff shoulder for at least 3 months 5. having limited ROM of a shoulder joint (ROM losses of 25% or greater compared with the noninvolved shoulder in at least 2 of the following shoulder motions: glenohumeral flexion, abduction and lateral rotation. 6. ability to complete Disabilities of the Arm, Shoulder and Hand questionnaires (DASH). Exclusion criteria: 1. history of surgery on the particular shoulder 2. Rheumatoid arthritis 3. painful stiff shoulder after a severe trauma 4. fracture of the shoulder complex 5. rotator cuff rupture 6. tendon calcification.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
From sitting with shoulder abducted at 45 degree and elbow flexed and the forearm rested on flat surface, The patients in the intervention group B received shock wave therapy once a week for 4 weeks. The focus probe sets were used and, in each session, patients received ESWT from anterior and posterior directions (on the average 1200 shocks between 0.1 and 0.3 mJ/mm2) up to the maximum threshold of pain tolerance in the shoulder
Mobilization with movement (MWM) is the concurrent application of sustained accessory mobilization applied by a therapist and an active physiological movement to end range applied by the patient. Passive end-of-range overpressure, or stretching, is then delivered without pain as a barrier
Faculty of Physical Therapy
Giza, Egypt
Pain intensity level.
measured by Visual analog scale
Time frame: 4 weeks
Range of motion.
measured by digital goniometer
Time frame: 4 weeks
Functional disability level.
Determined by Disabilities of the arm, shoulder and hand questionnaire (DASH)
Time frame: 4 weeks
Soft tissue thickness (Capsule thickness)
measured by musculoskeletal ultrasonography
Time frame: 4 weeks
Hand grip strength
Measured by hand dynamometer
Time frame: 4 weeks
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Conventional treatment will be axillary ultrasound and laser ,low loading stretching exercise and home program exercises