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A Critical Appraisal of the Research Regarding Physical Therapy as an Intervention for Treating Adhesive Capsulitis

1 May 2006


Overall Clinical Bottom Line: Adhesive capsulitis is a self-limiting condition that may require greater than three years to resolve.1 Due to the economic and emotional suffering that may accompany this lengthy resolution, it is worthwhile for health care providers to find an effective method to expedite the recovery from adhesive capsulitis. Current treatment protocols include benign neglect, supervised physical rehabilitation, nonsteroidal anti-inflammatory medications (NSAIDs), oral corticosteroids, intra-articular injections, distension arthrography, closed manipulation, open surgical release, and arthroscopic capsular release. However, there does not appear to be an agreement regarding the most effective protocol for expediting this condition's natural progression. The articles we have evaluated for this critically appraised topic include: benign neglect, supervised physical rehabilitation, NSAIDs, and/or intra-articular corticosteroid injections.

Based on current research, two main points can be stated with confidence. First, a home exercise program prescribed by a physical therapist incorporating active range of motion (AROM) and passive range of motion (PROM) stretching exercises is more likely to significantly improve glenohumeral motion than no home exercise program prescription (Carette et al. 2003, Ryans et al. 2005, Guler-Uysal et al. 2004, Nicholson 1985). Second, physical therapy combined with a corticosteroid injection was the only treatment to significantly decrease pain scores in patients with adhesive capsulitis after six weeks of treatment (Carette et al., 2003). However, these suggestions should not be interpreted as absolute prescriptions, as all studies had threats to internal validity.


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