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Abstract

Purpose:

The purpose of this study was to determine the effects of thoracic and rib manipulation on pain and restricted shoulder mobility in subjects with frozen shoulder.

Relevance:

The term frozen shoulder was first introduced by Codman in 1934 and described as "a painful condition of insidious onset that was associated with stiffness and difficulty in sleeping on the affected side." The main physical therapy program consists of thermotherapy, shoulder exercise, mobilization techniques, Codman's exercise, and capsular stretches. Recent discussion in the physical therapy community has been targeted toward addressing the thoracic spine for treating the patients with shoulder impairments.

Participants:

A total of 30 subjects (mean age of  55.70 ± 9.49 years) with the diagnosis of frozen shoulder stage II and III were recruited from outpatient department of Physiotherapy of KLES Dr. Prabhakar Kore Hospital and MRC and KLES Ayurved Hospital and Research Centre, Shahpur, Belgaum.

Methods:

The present randomized clinical trial was conducted on 30 subjects. They were randomly allocated into two groups. Group A (

n

= 15) receiving conventional therapy for 6 sessions a week for 2 weeks and Group B (

n

= 15) receiving thoracic and rib manipulation 3 sessions a week for 2 weeks in addition to conventional therapy. The outcome measures taken were visual analogue scale (VAS), shoulder range of motion (ROM) of flexion, abduction, internal rotation and external rotation and Disabilities of Arm Shoulder and Hand (DASH) score. The outcomes were assessed on day 1 pretreatment and day 14 posttreatment. Data was analyzed using SPSS software.

Results:

The intra group mean difference in pre and postvalues for Group A were 4 ± 0.27 cm, 49.7° ±13.3°,49.3° ±13.38°, 21.4° ±7.33°, 23.9° ±7.51°, and 893.3° ±269.66° for VAS, shoulder ROM of flexion, abduction, internal rotation, external rotation and DASH scores respectively. While for Group B intra group mean differences in pre and postvalues were 5.7 ± 0.66 cm, 64.1° ±7.09°, 71.1° ±5.59°, 32.3° ±5.23°, 40.9° ±5.52°, 1073.3° ±229.42° for VAS, shoulder ROM of flexion, abduction, internal rotation, external rotation and DASH scores respectively

.

The intra group comparison showed statistical significance with

P

< 0.001. Whereas results of the between the group comparison showed that Group B showed better improvement than Group A that was statistically significant with

P

< 0.001.

Conclusion:

Based on the results of the present study it can be concluded that thoracic and rib manipulation is effective in relieving pain, improving the shoulder range and reducing disability in patients with Frozen Shoulder.

Clinical Implication:

Thoracic and rib Manipulation can be added in the treatment plan for frozen shoulder for better and speed recovery.

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