Adhesive Capsulitis

Objectives： This study aims to compare the efficacy of transcatheter arterial microembolization (TAME) and corticosteroid injection for treatment of frozen shoulder. Background： Frozen shoulder (adhesive capsulitis) is a common condition that leads to significant functional impairment and reduced quality of life. Current treatment options are diverse, including pharmacological therapy, physical rehabilitation, corticosteroid injection, hydrodilatation, and the more recently developed transcatheter arterial microembolization (TAME). Corticosteroid injection, due to its anti-inflammatory effects, has been shown in numerous clinical studies to provide short-term pain relief and improved range of motion; however, its benefits are often limited to several weeks or months, and some patients continue to experience persistent symptoms. In contrast, TAME has emerged as a novel treatment for musculoskeletal disorders by targeting abnormal neovascularization and inflammatory processes in the affected tissues, there by achieving pain reduction. Multiple studies from both international and domestic medical centers have demonstrated its safety and efficacy, though most reports focus on case reports or case series observational outcomes. To date, there is a lack of clinical trials directly comparing the therapeutic outcomes of TAME versus corticosteroid injection in patients with frozen shoulder. Study Design： This study is a single-center, prospective, randomized controlled trial (RCT). Methods： A total of 94 patients diagnosed with frozen shoulder in the freeing stage will be recruited from the Department of Physical Medicine and Rehabilitation at Shin Kong Hospital. Eligible patients will be randomly assigned to either the transcatheter arterial microembolization (TAME) group and the corticosteroid injection (CS) group. The arterial microvascular embolization group will receive one treatment, while the corticosteroid injection group will receive two corticosteroid injections into the shoulder joint and subacromial bursa, with a two-week interval between the two injections. Additionally, all patients in both groups will undergo 4 weeks of physical therapy. Clinical assessments will be conducted at baseline and at 1, 2, 4, and 6 months after initiation of treatment, including Shoulder Pain and Disability Index (SPADI), the Visual Analogue Scale (VAS) for pain, Shoulder Disability Questionnaire (SDQ), active and passive range of motion (ROM), Short Form-36 (SF-36) for quality of life, and patient-reported global efficacy. Patients will be followed for 6 months after completion of treatment, and statistical analyses will be performed to evaluate the therapeutic outcomes. Effect： Efficacy comparison: Both the TAME and corticosteroid injection are expected to effectively improve pain, function, and quality of life. However, the TAME group is anticipated to demonstrate greater pain relief and better recovery of shoulder function compared with the corticosteroid injection group, with longer-lasting therapeutic effects. Safety: Both treatments are considered safe. TAME may lead to temporary local pain, transient radial artery spasm, or low-grade fever, all of which are self-limiting or manageable with supportive care. Corticosteroid injection may be associated with transient hyperglycemia, local injection site pain, or, rarely, infection. No permanent or severe adverse events are expected. Exploration of prognostic factors: By comparing treatment responses between the two groups and incorporating clinical characteristics, imaging findings, and treatment outcomes, this study aims to identify potential prognostic factors that may predict therapeutic response, thereby guiding future clinical decision-making. Intermediate follow-up results: At 1 to 3 months post-treatment, both groups are expected to show improvement in the clinical outcomes, but the TAME group is expected to demonstrate superior effect compared with that of the corticosteroid injection group.

The purpose of this study is to compare the effects of a physiotherapy program on pain levels, shoulder range of motion, functional status, pain catastrophizing, perceived change, sleep quality, and quality of life in postmenopausal women diagnosed with frozen shoulder, with and without Hormone Replacement Therapy (HRT). The findings are expected to contribute to personalized treatment planning for postmenopausal women with frozen shoulder and help fill the gap in current literature.

To compare the effects of spinal mobilization with arm movement and Kaltenborn Mobilization on pain, range of motion, functional reaching, and disability in patients with Adhesive Capsulitis.

Adhesive capsulitis is a common musculoskeletal disorder characterized by shoulder pain, restricted range of motion (ROM), and functional disability, leading to limitations in daily activities and reduced quality of life. Manual therapy techniques, including Gong's Mobilization and Maitland Mobilization, are widely used in physiotherapy management; however, evidence comparing their effectiveness remains limited.

Adhesive Capsulitis causes a progressive tightening of the glenohumeral joint capsule, restricting both active and passive movements and resulting in functional impairments. Joint mobilization is an essential component of physical therapy for managing adhesive capsulitis. Two new techniques are emerging in the treatment of Adhesive capsulitis; one of them is called Gong's Mobilization. This technique emphasizes correcting positional faults by applying controlled, dynamic movements to the glenohumeral joint. The other technique, known as Niel-Asher technique is a five-step trigger point therapy which offers a unique, non-invasive holistic approach to address adhesive capsulitis. This study, will be conducted as a randomized clinical trial at Ghurki Trust Teaching Hospital and Hope Rehabilitation Center, it aims to evaluate the effects of Gong's mobilization with and without Niel-Asher technique on shoulder pain, ROM and disability in Adhesive Capsulitis of patients aged 40-60 years. A non-probability convenience sampling method will recruit 46 participants meeting the inclusion criteria only. Participants will be randomly assigned to Group A (Gong's Mobilization) or Group B (Gong's mobilization and and Niel-Asher technique) with interventions given for four weeks. Pain severity will be measured using the Numeric Pain Rating Scale, Range of Motion will be assessed via goniometer, and disability will be evaluated using the SPADI. Statistical analysis using SPSS will compare outcomes between groups at baseline, at two weeks and post-treatment after 4 weeks.

Frozen shoulder remains a challenging disease to treat as pain and loss of range of motion can persist for many months or even years. This loss of function can have a severe impact on the patient's activities, participation and overall quality of life. The use of ultrasound-guided (USG) suprascapular nerve blocks (SSNB) and/or intra-articular corticoid injections (IACI) has been supported by many studies. However, double blinded randomized clinical trials using a combination of SSNB and IACI are rare. The primary objective of this study is to compare the effectiveness of a glenohumeral IACI combined with a SSNB, compared to a glenohumeral IACI combined with a sham SSNB. Outcome measures of interest are shoulder-related disability reported by the patients, shoulder pain and shoulder stiffness. These outcome parameters will be compared between both treatment arms with an intention-to-treat analysis. As key secondary objectives, the investigators aim to identify which physical examination tests, or combinations of those, are correlated with MRI diagnostic criteria and favor a more positive evolution. Finally, through predictive analysis the investigators will try to establish which patients benefit the most from the combined SSNB + IACI.

Patients aged 18-75 years who present to a tertiary rehabilitation hospital with shoulder pain and restricted range of motion, and who consent to participate, will be included in the study. Eligibility will be determined based on predefined inclusion and exclusion criteria. Eligible patients will be randomly assigned to receive one of several nonsteroidal anti-inflammatory drugs (NSAIDs) with differing chemical properties (e.g., diclofenac, meloxicam, or indomethacin), in combination with a home-based exercise program for shoulder adhesive capsulitis. Patients' sociodemographic data, as well as detailed clinical and examination findings and baseline outcomes, will be recorded. Patients will be informed about their condition, and modifications to activities of daily living will be recommended.Patients' pain phenotypes (nociceptive, neuropathic, nociplastic) will be categorized based on clinical history and questionnaires, and it will be determined which pain types derive greater benefit from NSAIDs. Follow-up assessments will be conducted at the end of the first and second weeks. At the first-week follow-up, pain intensity will be evaluated using the Visual Analog Scale (VAS). If the treatment is deemed effective (defined as a ≥3-point reduction or ≥50% decrease in VAS), the same NSAID will be continued for an additional week; otherwise, it will be switched to an alternative NSAID with a different biochemical profile (group). The outcomes assessments will be performed by a blinded evaluator to minimize bias.

Frozen shoulder (adhesive capsulitis) is characterized by pain and a progressive restriction of both active and passive shoulder range of motion, significantly impairing daily activities and quality of life. This study aims to evaluate the effectiveness of USG-guided shoulder injections, when added to a home-based exercise program, in the conservative management of patients with chronic, painful frozen shoulder. In this prospective randomized study, patients diagnosed with painful frozen shoulder will be included. In addition to a standardized home-based exercise program, patients will receive either USG-guided suprascapular nerve block alone or a combination of suprascapular nerve block and subacromial injection. The effects of these approaches on clinical outcomes will be assessed over a 20-week follow-up period. Primary outcome measures include pain intensity assessed by the Visual Analog Scale (VAS), functional status evaluated by the Shoulder Pain and Disability Index (SPADI), and shoulder range of motion. Secondary outcomes include depression level (Beck Depression Inventory), sleep quality, pain phenotype (nociplastic, neuropathic, or nociceptive), hand grip strength, ultrasonographic findings ( (coracohumeral ligament thickness, subacromial bursa thickness) , and patient satisfaction (subjective impression of improvement). The results of this study are expected to provide evidence on the comparative effectiveness and additional benefits of different shoulder injection approaches when combined with home-based exercise therapy in patients with chronic frozen shoulder.

This randomized controlled trial aims to compare the effects of scapular proprioceptive neuromuscular facilitation (PNF) alone versus PNF combined with latissimus dorsi myofascial release on pain, range of motion, and functional disability in patients with stage II adhesive capsulitis; a condition characterized by capsular stiffness, pain, and restricted shoulder mobility, with outcomes assessed using NPRS, goniometry, and SPADI over a 6-week intervention period.

This is a double-blind interventional superiority study evaluating the efficacy of suprascapular nerve block in addition to conventional therapies for adhesive capsulitis. Adhesive capsulitis is a pathology that results in reduced shoulder mobility due to retraction of the periarticular capsule. It may be primary or secondary to traumatic or neurological events, or associated with diabetes in particular. The usual treatment includes re-education sessions to improve joint amplitude and restore shoulder mobility. In persistent forms, intra-articular injection of cortisone is combined with distension of the capsule with a local anaesthetic under radiographic control. In some countries, subscapular nerve block (reversible anaesthesia) is used to improve pain. The combination of arthrodistension and subscapular nerve block has never been performed to accelerate the healing process. The aim of this study is to compare the performance of these two procedures together against the reference technique alone on time to improvement with the number of patients improved at one month according to the Constant score. This score is used to assess shoulder pain and function, with a significant improvement above eight points.

The randomized controlled trail aims is to evaluate the outcome of Gongs mobilization and PNF in patients with adhesive capsulitis. The significance of this study is to compare Gong's mobilization technique with proprioceptive neuromuscular facilitation (PNF) compare their effects on pain, range of motion, and functional disability. The sample size was calculated with G-power. This study would include total 44 female participants aged 40-60 years will be recruited and randomly assigned to two groups. Group A(Gongs mobilization+ conventional therapy)and Group B(PNF+ Conventional therapy). Intervention will be provided for 4 weeks 3 session per week. Primary outcome measures are pain, ROM and functional disability via NPRS, Goniometer and U-SPADI. Outcomes will be reassessed at baseline, after 2nd week, and after 4th week.

The goal of this clinical trial is to investigate if nunchaku exercise works to treat adhesive capsulitis, or frozen shoulder in middle-aged or older adults. It will also learn about the adherence of this exercise intervention. The main questions it aims to answer are: * Does practicing nunchaku exercises help reduce shoulder pain and improve shoulder movement? * Do people stick with nunchaku exercises better, and spend more time practicing on their own, compared with standard exercises for alleviating frozen-shoulder? Researchers will compare nunchaku exercise to standard exercises for alleviating frozen-shoulder to see if nunchaku exercise works to alleviate frozen shoulder. Participants will: * Join small group exercise classes for 12 weeks, doing either nunchaku based exercises or standard exercises designed to help relieve frozen shoulder. * Have their shoulder pain and movement checked three times: * before training * after 6 weeks of training, * after finishing the 12 week program, and * 12 weeks after the program ends. * Keep a record of their home practice time.

Frozen shoulder (adhesive capsulitis) is a condition characterized by shoulder pain and restricted range of motion, significantly impairing daily living activities. In cases that do not respond to conservative treatment, arthroscopic capsular release is an effective surgical treatment option. The 360° capsular release technique, performed by some surgeons, involves release of the inferior capsule and therefore carries a potential risk of nerve injury due to the anatomical proximity of neurovascular structures such as the axillary nerve. In addition, surgical manipulations performed around the coracoid process may exert mechanical or compressive effects on the musculocutaneous nerve and its sensory continuation, the lateral antebrachial cutaneous nerve, due to their close relationship with the lateral cord of the brachial plexus. The aim of this prospective, single-center observational clinical study is to objectively evaluate the morphological and functional effects of inferior capsular release and coracoid region dissection performed during arthroscopic 360° capsular release surgery on the axillary and musculocutaneous nerves, using electromyography (EMG) and nerve conduction studies (NCS) in patients with frozen shoulder. Patients aged 21-70 years with a diagnosis of frozen shoulder who have not responded to conservative treatments and are scheduled for arthroscopic capsular release will be included in the study. EMG and NCS assessments will be performed at the preoperative baseline, and at 12 weeks postoperatively. For the axillary nerve, the deltoid and teres minor muscles will be evaluated; for the musculocutaneous nerve, the biceps brachii and brachialis muscles will be assessed. Additionally, sensory conduction of the lateral antebrachial cutaneous nerve will be examined. Along with electrophysiological findings, shoulder range of motion (ROM), pain (VAS), muscle strength (MRC), and functional scores will also be recorded. This study is expected to provide objective evidence regarding the effects of arthroscopic capsular release surgery on peripheral nerve function, thereby contributing new data on the safety of the surgical technique and enriching the currently limited literature on electromyographic evaluation in frozen shoulder surgery.

Adhesive capsulitis ("frozen shoulder") causes significant pain and loss of shoulder mobility. Shoulder hydrodistension is an established treatment that can improve movement and reduce symptoms, but the procedure itself may be painful and difficult for some patients to tolerate. This randomized clinical trial will evaluate whether performing a suprascapular nerve block with local anesthetic immediately before hydrodistension can reduce pain during the procedure, improve patient comfort, and potentially enhance clinical outcomes. Participants will be randomly assigned to one of two groups: hydrodistension alone, or suprascapular nerve block followed by hydrodistension. Pain, shoulder mobility, functional ability, psychological measures, and quality of life will be assessed at baseline, 1 month, and 3 months after the procedure. The study aims to determine whether adding a suprascapular nerve block provides better tolerability and improved recovery for patients with adhesive capsulitis.

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.

A prospective, multicentre, randomized controlled study comparing the efficacy of conservative treatment for early adhesive capsulitis

Adhesive capsulitis is a debilitating shoulder condition characterized by pain, restricted range of motion (ROM), and significant functional limitations. Conventional treatment primarily targets the glenohumeral joint, often neglecting the role of regional interdependence, particularly the thoracic spine's influence on shoulder mobility. Emerging evidence suggests that thoracic spine mobility plays a crucial role in optimizing shoulder mechanics, yet its therapeutic application in adhesive capsulitis remains underexplored. This study aims to investigate the additional effects of thoracic spine mobilization combined with glenohumeral joint mobilization, providing a more comprehensive rehabilitation approach to enhance pain relief, ROM, and functional outcomes. A randomized controlled trial (RCT) will be conducted over one year at the Rehabilitation Department of Fauji Foundation Hospital (FFH) after obtaining ethical approval. Participants diagnosed with adhesive capsulitis will be selected through non-probability purposive sampling based on predefined inclusion and exclusion criteria. Subjects will be randomly assigned to either the experimental group receiving thoracic spine mobilization alongside glenohumeral joint mobilization or the control group receiving glenohumeral joint mobilization alone. Randomization will be conducted using the coin toss method and block randomization to ensure balanced subject distribution. Outcome measures include the Numeric Pain Rating Scale (NPRS) for pain assessment, the Shoulder Pain and Disability Index (SPADI) for functional disability evaluation, and a goniometer for ROM measurement. Baseline and post-treatment scores will be statistically analyzed using SPSS to determine intervention effectiveness. By integrating thoracic spine mobilization into standard treatment, this study seeks to refine clinical rehabilitation protocols, improve functional recovery, and enhance patient outcomes. Findings may contribute to evidence-based practice, supporting the inclusion of thoracic spine mobilization in treatment guidelines for adhesive capsulitis.

The goal of the current study is to evaluate the effects of pectoralis minor stretching and strengthening with mobility and stability exercises in patients aged 40-70 years with adhesive capsulitis. The main questions it aims to answer are: Does the combination of pectoralis minor stretching and strengthening with mobility and stability exercises significantly reduce shoulder pain compared to mobility and stability exercises only? Does the combination of pectoralis minor stretching and strengthening with mobility and stability exercises improve scapular dyskinesis (scapular movement patterns) and thoracic expansion more effectively than mobility and stability exercises? Participants will be assigned to either an experimental group receiving pectoralis minor stretching and strengthening exercises with mobility and stability exercises or a control group receiving mobility and stability exercises only, and will complete standardized assessments of shoulder pain, scapular dyskinesis (scapular movement patterns) and thoracic expansion before and after the intervention.

Adhesive capsulitis (frozen shoulder) is a complex condition characterized by inflammation, fibrosis, and restriction of movement in the shoulder capsule, significantly limiting an individual's participation in daily living activities. It is most commonly observed in individuals aged between 40 and 60 years, and its treatment frequently involves approaches such as manual therapy, exercise, corticosteroid injections, and electrotherapy. However, these conventional methods may be limited by factors such as lack of motivation, pain-related avoidance behavior, and poor treatment adherence. Today, immersive virtual reality technologies introduce a new dimension to rehabilitation by gamifying exercise, providing sensory feedback, and enabling graded exposure through mechanisms such as distraction and engagement. They also enhance motivation and compliance with exercise programs. Studies in the literature have reported that virtual reality-based exercise is an effective method for reducing pain levels in patients diagnosed with frozen shoulder. However, only a limited number of studies have specifically examined the effects of immersive virtual reality in patients with adhesive capsulitis. To date, no study has investigated the impact of immersive virtual reality interventions on sleep and cognitive functions in these patients. Furthermore, the combined effect of patient education, home exercise programs, and immersive virtual reality therapy has not yet been explored. For these reasons, the present study aims to investigate the effects of immersive virtual reality-based exercise therapy on pain, functionality, sleep, and cognitive functions in patients with Grade 1-2 adhesive capsulitis.

The aim of this randomized controlled trial is to find the additional effects of Niel-Asher technique along with sleeper stretch and conventional physical therapy on pain, shoulder ranges of motion and functional disability in patients with Adhesive capsulitis

The purpose of this study is to identify individuals 18 or older who have diagnostic presentation of adhesive capsulitis and randomize them into two arms, distinguished by use of physical therapy and steroid injections compared with steroid injections followed by watchful waiting. This prospective study will be used to determine whether there is a significant impact on patient outcome and whether the additional financial burden is justified. There are no experimental interventions for this study. The use of physical therapy, oral and parenteral corticosteroids, and watchful waiting are offered following the standard of care for adhesive capsulitis. Our hypothesis is that patients will not have a significant difference in outcome between the two study arms. One group will undergo regular physical therapy with corticosteroid injections (Arm 1) and the other will have steroid injections during the inflammatory phase only and then be regularly observed (Arm 2). We also hypothesize there will be a significant financial burden associated with the PT arm that is not justified with the possibility of increased symptom reports in that arm.

Our study is unique in that it utilizes a self-designed fascial mobilization protocol and ultrasonographic evaluation for adhesive capsulitis. Therefore, the aim of our study is to investigate the effects of fascial therapy on pain, normal joint range of motion, proprioception, and fascial architecture in patients diagnosed with adhesive capsulitis.

Our study aims to investigate the effects of exercise training on pain, range of motion, functionality and shoulder architecture in patients with adhesive capsulitis.

The goal of this clinical trial is to learn if Perineural Injection Therapy (PIT) works to treat adhesive capsulitis (frozen shoulder) in adults. It will also learn about the safety of PIT. The main questions it aims to answer are: Does PIT reduce shoulder pain and improve shoulder range of motion more effectively than conventional therapy alone? What side effects or medical problems do participants experience when receiving PIT? Researchers will compare PIT to conventional therapy to see if PIT works better to treat adhesive capsulitis. Participants will: Receive either: PIT once weekly for 6 weeks plus physiotherapy and oral analgesics (excluding NSAIDs), or Conventional therapy only (physiotherapy and analgesics including NSAIDs) Attend scheduled follow-up visits at Week 6, 1 month, and 3 months after treatment Perform daily home-based shoulder exercises and record their analgesic use and any side effects in a patient diary

This study aims to compare the effectiveness of two manual therapy techniques-Niel-Asher Technique and Spencer Technique-when combined with conventional physiotherapy in treating patients with frozen shoulder (adhesive capsulitis). Frozen shoulder is a painful condition that limits movement and function of the shoulder joint. The study will include 44 adults aged 35 to 65 years who have been diagnosed with stage II frozen shoulder. Participants will be randomly assigned to one of two groups. Both groups will receive standard physiotherapy, including heat therapy, TENS, and stretching exercises. In addition, one group will receive the Niel-Asher Technique, while the other group will receive the Spencer Technique. Pain, range of motion, and shoulder function will be measured before and after a 4-week treatment period using validated tools such as the Visual Analogue Scale (VAS), a goniometer, and the Shoulder Pain and Disability Index (SPADI). The goal is to determine which manual therapy technique is more effective in improving symptoms and function in patients with frozen shoulder.