Glenohumeral posterior mobilisation in acute capsulitis
Acute adhesive capsulitis is a frequent shoulder pathology, characterised by a spontaneous pain onset and a progressive loss of scapular movement. External rotation seems to be most restricted in these patients. Previous studies have shown beneficial effects of physiotherapy. However, the direct effect of the Kaltenborn glenohumeral posterior mobilisation technique on range of motion (ROM), function and pain perception has not been proven yet. This study compared conventional physiotherapy with the glenohumeral posterior mobilisation technique and revealed significant pain decrease, significant increase of external rotation and an improve in function.
To compare the therapeutic effectiveness of two treatment modalities in patients with an acute adhesive capsulitis, the patients were randomly assigned into two groups.
The first group received the glenohumeral posterior mobilisation technique after a training with an upper extremity cycle ergometer. The mobilisation technique was performed with the patient lying supine in 30º to 40º of abduction and a slight external rotation, depending on the tolerance. After an initial axial distraction type III, the therapist applied a posterior glide of one minute without oscillations, which was repeated 15 times.
The other group received a conventional physiotherapy program based on ultrasound application, self assisted exercises, Codman exercises, Swiss ball exercises and isometric exercises depending on their tolerance. Both groups performed 10 sessions, 2-3 times a week.
The ROM was assessed by utilising a goniometer, pain by using the visual analogue scale (VAS) scale, and function by using the Constant-Murley score.
At the end of the treatment, both groups showed improvements in ROM, pain and function. The patients who had received the glenohumeral posterior mobilisation technique had an improvement of 46 degrees external rotation, compared to 18 degrees in the group receiving conventional physiotherapy. The pain was decreased by 2.7 on the VAS scale after the mobilisation, in comparison to 1.4 in the conventional physiotherapy group. Function was increased by 39 points of the Constant-Murley score in the mobilisation, and 18 points in the conventional physiotherapy group.
The effectiveness of high mobilization techniques is based on distension and elongation of periarticular structures: an axial distraction causes passive elongation of periarticular components. Through this, joint contact zones are minimized and a posterior glide can generate a maximum elongation of the posterior portion of the joint capsule. In addition, a passive glide at the end range of motion increases the rotational movement and decreases the translation of the humeral head in antero-superior direction.
Thus, the glenohumeral posterior mobilization applied after an upper extremity cycle ergometer is an effective short-term technique to improve ROM, pain and function.
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> From: Gutierrez Espinoza et al., Medwave 22 (2016) . All rights reserved to Medwave. Click here for the Pubmed summary.