The current study's general aim is to compare the effectiveness of Transfer of Energy Capacitive and Resistive (TECAR) therapy combined with stretching versus stretching alone in patients with adhesive capsulitis stage 2,3 on range of motion, pain, and function.
Patients of both genders with primary adhesive capsulitis.
Patients aged between 40-65.
Pain duration of three months or more.
Range of motion loss of greater than 25% in at least 2 planes and passive external rotation loss that is greater than 50% of the uninvolved shoulder or less than 30° of external rotation.
Bilateral adhesive capsulitis,
Systemic diseases such as rheumatoid arthritis,
Malignancies,
Heart diseases
Parallel
Transfer of Energy Capacitive and Resistive (TECAR) Therapy
DeviceTo apply TECAR therapy, the patient will lie supine, with the passive electrode, a flexible rectangular stainless steel plate measuring 150 £ 200 mm, placed under the affected side's scapula. A rigid circular metallic electrode with a 60-mm diameter will be used as the active electrode. Using the resistive mode with the power of 8 to 10 mA, the active electrode will be circularly moved continuously for 10 minutes on the anterior-inferior shoulder capsule while the patient's arm will be held at the end existing range of abduction and external rotation. As well, a conductive cream will be used as a coupling medium between the electrodes and the skin. Based on the manufacturer's recommendation for safe performance, the TECAR intensity will be set as the most effective method, causing no pain based on each patient's feedback.
Stretching exercises
Other interventionWhile the patients were lying on the bed, they would receive cyclic (intermittent) stretching. Cyclic stretching is the application, release, and reapplication of a relatively short-duration stretch force repeatedly but progressively. Twenty seconds of stretching and 10 seconds of rest will be used 10 times in each of the following directions (flexion, scapular plane abduction, external rotation, and internal rotation) and stretch to target rotator cuff interval.
Glenohumeral External Rotation range of motion (ROM) in Adducted shoulder
To measure external rotation range of motion (ROM) with the shoulder adducted, the patient will be positioned in supine with the upper arm positioned at the side and the elbow flexed to 90°. The examiner will passively externally rotate the glenohumeral joint until end range is reached. Range of motion will be measured by placing the axis of the goniometer on the olecranon process. The stationary arm will be aligned with the vertical position. The movable arm will be aligned with the ulnar styloid process.
Glenohumeral External Rotation range of motion (ROM) in Abducted shoulder
External rotation range of motion (ROM) may also be measured with the shoulder abducted to 45° or to 90° in the frontal plane (if the patient has the available abduction ROM). The stationary arm of goniometer will be aligned with the vertical position. The movable arm will be aligned with the ulnar styloid process.
Glenohumeral Internal Rotation range of motion (ROM) in Abducted shoulder
Internal rotation range of motion (ROM) will be measured while the patient is positioned in supine, the shoulder abducted to 90°, and the elbow flexed to 90°. If glenohumeral abduction is less than 90°, a 45° abduction angle can be used. The examiner passively internally rotates the glenohumeral joint until end range is reached, ensuring that there is no scapular compensation. Range of motion will be measured by placing the axis of the goniometer on the olecranon process. The stationary arm will be aligned with the vertical position. The movable arm will be aligned with the ulnar styloid process
Shoulder Flexion range of motion (ROM)
To measure flexion range of motion (ROM), the patient will be positioned in supine with the arm rest at the side. The examiner will passively flex the shoulder until end range is reached (with no compensatory movements from the thorax and the lumbar spine). Range of motion will be measured by placing the axis of the goniometer on the greater tuberosity. The stationary arm will be aligned with the midline of the trunk. The movable arm will be aligned with the lateral epicondyle.
Assessment of shoulder pain
The Arabic version of the shoulder pain and disability index (SPADI) will be used. The 13-item SPADI consists of two primary components, five pain items, and eight disability items. The five pain items will be recorded to determine pain level. The weighting of each domain score for the overall score is equal. The total score for pain is 50. The overall score is between 0 and 100, with 0 denoting no pain or difficulty.
Assessment of shoulder function
The Arabic version of the shoulder pain and disability index (SPADI) will be used. The 13-item SPADI consists of two primary components, five pain items, and eight disability items. The eight disability items will be recorded to determine shoulder function. The weighting of each domain score for the overall score is equal. The total score for the disability scale is 80. A percentage is used to represent the overall SPADI score. The overall score is between 0 and 100 ; 0 for best and 100 for worst. More disability is indicated by a higher score.
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