Restriction of glenohumeral (GH) mobility in patients with adhesive capsulitis (AC) was known owing to capsular adhesion. There is a little evidence about the involvement of neural restriction in limiting range of motion (ROM) of the GH joint in patients with AC. Objectives: The purpose of this study is to investigate the combined effect of median nerve mobilization and capsular stretching on improving shoulder external rotation, abduction and internal rotation ROM among patients with AC. Methods Thirty patients will be randomly assigned into two equal groups : Group (A) will receive median nerve mobilization and capsular stretching while Group (B) will receive only capsular stretching (anterior, posterior and anteroinferior capsular stretching). Both groups will receive passive and self-assisted exercises. All patients in both groups will be evaluated pre and post treatment for GH external rotation, abduction and internal rotation ROM.
Patients from both gender (male &female) will be included if they would have second or third stage AC with their age between forty and seventy years
experiencing pain, capsular adhesions, and a reduction of greater than fifty percentage in passive ROM of the GH joint (external rotation, abduction, and internal rotation compared to the sound side
lasting for a minimum of three months. Patients with positive upper limb tension test-1 will be also included in this study
they would have stroke,Parkinson's diseases that interfere with shoulder muscles activity
diabetes
traumatic shoulder conditions
glenohumeral osteoarthritis confirmed by x-ray
Parallel
capsular stretching plus neural mobilization
Other interventionanterior, posterior and inferior capsular stretching and neural mobilization
anterior, inferior and posterior capsular stretching
Other interventionanterior, inferior and posterior glenohumeral capsular stretching
traditional exercises
Other interventionstretching exercises for anterior GH musculture plus auto passive exercises and pendulum exercises
pain intensity
pain was assessed by VAS which has two ends. the left end indicates no pain where the right end indicates maximal pain
central sensitization
central sensitization will be assessed by the the arabic version of central sensitizatuion questionnaire. To understand CSI scores, the following severity categories have been established: subclinical = 0 to 29; mild = 30 to 39; moderate = 40 to 49; severe = 50 to 59; and extreme = 60 to 100
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