Adhesive capsulitis, also known as frozen shoulder, is a musculoskeletal condition that causes significant shoulder pain and restricted joint mobility. It affects the glenohumeral joint and is commonly seen in individuals between the ages of 40 and 60 year. It affects 3 to 5% of the general population with a higher prevalence among females and patients with diabetes or thyroid disorders. Adhesive capsulitis progresses in four stages: painful, freezing, frozen, and thawing, and the condition may persist for 1 to 2 years. This study aims to determine the effects of Deltoid Strengthening Exercises on pain, range of motion, muscle strength and disability in patients with Adhesive Capsulitis.
This study will be a Randomized Controlled Trial and will be conducted in Physiotherapy Outpatient Department of Tehsil Head Quarter Hospital, Daska. Non-Probability Convenience Sampling will be used to collect the data. A sample of subjects aged 40 to 60 years with stage II and III adhesive capsulitis will be selected based on inclusion and exclusion criteria. Informed consent will be obtained from all participants. Outcome measures will include Numeric Pain Rating Scale (NPRS) for pain, Shoulder Pain and Disability Index (SPADI) for disability, Goniometer for Range of Motion, and Arm Abduction and Lowering Test for muscle strength. 48 subjects will be divided into two groups, 24 in each group by random number generator table. Both groups will receive a standard physical therapy protocol consisting of Ultrasound, Glenohumeral Mobilization and Home Exercises. In addition to standard physical therapy protocol, Group A will receive Deltoid Strengthening Exercises: Week 1: Isometric exercises (1×10 reps); Week 2 : Theraband exercises (1×10 reps); Week 3 - Dumbbell exercises with 1 kg (1×10 reps) and Week 4: Dumbbell exercises with 1.5 kg (1×10 reps), targeting anterior, middle, and posterior Deltoid. Group B will receive only the standard physiotherapy protocol without strengthening. Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 25.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
48
a) Deltoid Isometrics The following isometrics of Deltoid will be performed: * Anterior Deltoid: Front Raise Isometrics Isometrics of Anterior Deltoid will be performed. The arm is raised to 90 shoulder flexion. The elbows are slightly flexed (5 degrees) while the subject is pushing isometric upward against manual resistance provided by the therapist * Middle Deltoid: Lateral Raise Isometrics The arm will be abducted to the horizontal position. The humerus is slightly flexed about thirty degrees while the elbows are kept in a static, slightly flexed position. The arms are lifted isometric upward against resistance provided by the therapist * Posterior Deltoid: Reverse Fly Isometrics The participant sits on a chair with trunk bent from the horizontal with the arms pointing toward the floor. The arms are raised until the upper arms are horizontal, while the elbows were in a static, slightly flexed position. The subject pushes upward against resistance provided by the therapist
Ultrasound Glenohumeral Distraction Manual therapy Codman's Pendulum Exercise Finger Ladder exercise Wand Exercise
Pain-Numeric Pain Rating Scale
In current study, patients with Adhesive Capsulitis having Numeric Pain Rating Scale (NPRS) score of greater or equal to 3 and less than 7 will be included. Numeric Pain Rating Scale (NPRS) is used to measure pain levels in all subjects. NPRS is self-reported, single-dimensional 11 point scale between 0 and 10. The NPRS has a moderate test-retest reliability in patients with a primary complaint of shoulder pain with ICC=0.74, MCID of 1.1 points and MDC of 2.5 points.
Time frame: upto 4 weeks
Disability-Shoulder Pain and Disability Index
Patients with Adhesive Capsulitis having Shoulder Pain and Disability Index (SPADI) score of 41 to 60 will be included in the current study. The Shoulder Pain and Disability Index (SPADI) is used for measuring the level of disability in patients. This self-administered index consists of 13 items divided into two subscales: 5 items for pain and 8 items for disability. It is a practical outcome measure that will be completed by patients in less than 5 min and will be scored by clinician. It has a high internal consistency with Cronbach α typically exceeding 0.90 and a good test-retest reliability with ICC values ranging from 0.84 to 0.95. When the SPADI is used more than once on the same subject i.e. at initial consultation and then at discharge, the minimal detectible change (MDC 95%) is 18 points
Time frame: upto 4 weeks
Range of motion-Universal Goniometer
Adhesive capsulitis' patients have a capsular pattern of restriction of glenohumeral joint. Universal goniometer (UG) will be used to measure external rotation, internal rotation, abduction and flexion. Universal Goniometer is defined as a high-resolution plastic goniometer that permits observation of the axis of motion and ROM of the joint being measured. UG has been considered the gold standard for clinical assessment of ROM. It has a good reliability for AROM with ICC ranging from 0.53 to 0.65, and SEM calculated to be 14-25.
Time frame: upto 4 weeks
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