CC BY
41
МЕДИЦИНСКИЕ НАУКИ
COMPARING THE EFFECT OF CONVENTIONAL PHYSIOTHERAPY AND RADIAL SHOCKWAVE THERAPY IN PATIENTS WITH CAPSULITIS ADHESIVE ON SHOULDER JOINT
DOI: 10.31618/ESU.2413-9335.2020.2.80.1100 Asst. Madzharova Radostina Petkova, MD1 Asst. Simeonov Emil Borisov, PhD 2
1/ Department of Physical Medicine, rehabilitation, occupational therapy and sport
Medical University Pleven, 5800 Pleven, Bulgaria 2/ Department of Orthopedics and Traumatology Medical University Pleven, 5800 Pleven, Bulgaria
ABSTRACT
Purpose: Capsulitis adhesive is a degenerative disease of soft tissues around the shoulder joint. Characterized by pain and limited movements in the shoulder joint. It has always been considered important because of the impact on the quality-of-life and long period of illness. Therefore, the use of noninvasive and safe techniques that can speed up the healing process of the disease is important.
The aim of the follow-up the effect on pain and range of motion (ROM) after conventional physiotherapy versus radial shockwave therapy (RSWT) in the same patients with Capsulitis adhesive.
Method: 10 patients ware treated for 2 months with a conventional physiotherapy without improvement and followed 6 weeks treatment with RSWT. Visual analogy scale (VAS) used for pain assessment, goniometry for the ROM and Neer test, Upper limb Activity of daily living (ADL) to objectitize the patient state before and after both therapies.
Results: The patient's condition has not improved after conventional therapy. The treatment with RSWT provides a significant reduction of pain, increase ROM in the shoulder joint and improve ADL for the upper limb.
Conclusions: Usage of RSWT alone is much better option compared to the conventional physiotherapy in patients with Capsulitis adhesive.
Key words: Capsulitis adhesive, physiotherapy, radial shockwave therapy
INTRODUCTION
Capsulitis Adhesive is an inflammatory degenerative disease of soft tissues around the shoulder joint. Characterized by pain and limited movements in the shoulder joint. The disease has chronic course and prolonged illness of patients.
Nontraumatic etiologies include degenerative chances, secondary dysfunctions, non traumatic injuries as well as muscle wasting or osteoporotic changes, where these predispose damage due to traumata. Age and excessive repetetive motions also lead to injuries and predispose damage.
Adhesive capsulitis (AC), often referred to as frozen shoulder is characterized by initially painful and later progressively restricted active and passive glenohumeral joint range of motion with spontaneous complete or near complete recovery over varied period of time.
This inflammatory condition that causes fibrosis of the glenohumeral joint capsule is accompanied by gradually progressive stiffness and significant restriction of range of motion (typically external rotation). In clinical practice it can be very challenging to differentiate early stage of AC from other shoulder pathologies (1).
Etiology remains unclear. Primary - onset is idiopathic. Secondary - results from a known cause or surgical event (2). Three subcategories of secondary frozen shoulder include systemic (diabetes mellitus and other metabolic conditions), extrinsic (cardiopulmonary disease, cervical disc, humerus fractures, Parkinson's disease), and intrinsic factors
(rotator cuff pathologies, biceps tendinopathy, calcific tendinopathy, AC joint arthritis) (3).
Adhesive capsulitis is often more prevalent in women, individuals 40-65 years old, and in the diabetic population, with an occurrence rate of approximately 25% in the general population, (3)(4)(5)(6)(7)(8) and 1020% of the diabetic population (6)(7). If an individual has adhesive capsulitis they have a 5-34% chance of having it in the contralateral shoulder at some point. Simultaneous bilateral involvement has been found to occur in approximately 14% of cases (3).
Patients presenting with adhesive capsulitis will often report an insidious onset with a progressive increase in pain, and gradual decrease in active and passive range of motion (3)(5).
Adhesive capsulitis is considered to be a self-limiting disease with sources stating symptom resolution as early as 6 months up to 11 years. The literature reports that adhesive capsulitis progresses through three overlapping clinical phases: (1)(7)(9)(10)
Acute/freezing/painful phase: gradual onset of shoulder pain at rest with sharp pain at extremes of motion, and pain at night with sleep interruption which may last anywhere from 3-9 months.
Adhesive/frozen/stiffening phase: Pain starts to subside, progressive loss of glenohumeral motion in capsular pattern. Pain is apparent only at extremes of movement. This phase may occur at around 4 months and last till about 12 months.
Resolution/thawing phase: Spontaneous, progressive improvement in functional range of motion which can last anywhere from 1 to 3.5 years.
Physical therapy
For patients with early stages of adhesive shoulder capsulitis, physical therapy is the first line of treatment. In general, physical therapy is simultaneously combined with other treatment modalities, as a Cochrane study concludes that there is little overall evidence to support physical therapy alone in the treatment of adhesive capsulitis (11).
Extracorporeal shock wave therapy (ESWT) has recently drawn great attention as a non-surgical treatment(12). This therapy assists revascularization through the application of extracorporeal shock waves to the lesion, and reduces pain and improves function in the shoulder by stimulating or reactivating the healing process of connective tissues, including tendons and bones(13). While it is currently used for musculoskeletal diseases, such as calcific tendinitis and plantar fasciitis(14), few studies have focused on its
This is a severe degree of disfunction of ROM.
Neer test: positive
ADL for upper limb: Score 1- Patient carried out only part of the activity, but has to be greatly supported.
A course of conventional FTR was 2 months and included :
1/HHMn, 50 Hz, 0,2 s 2/10 15 min 15 procedures
2/H®T 0-100 Hz, 10 min and 80-100 Hz 15 min 15 procedures
3/Cryotherapy 15 procedures
4/Active analytical kinesiotherapy 30 min 15 procedures
5/Ultrasound with gel, 0,3 W/sm2, 7 min 15 procedures
After conventional FTR, we start only RSWT for 6 weeks. The classification of the degree of disfunction on shoulder joint was moderate to severe.
Shockwave treatment parameters: In 4 trigger points with beam applicator with 1,8 bar ,600 shocks, 10 Hz. After 3-th procedure treatment parameters was 2,5 bar, 1000 shocks, 10 Hz. Therapy was 1 time per week, for 6 weeks.
RESULTS
Reported results after 2 months conventional FTR:
VAS for 7 patients were 10. VAS for 3 patients were 8.
ROM: 7 patients have not improvement. 3 patients have 10% improvement of extension, flexion, abduction, adduction, external rotation and internal rotation in glenohumeral joint.
Neer test: positive
therapeutic effects on adhesive capsulitis. In addition, the ESWT may have stabilized the tissues by stimulating and reactivating the healing process of the tendons and their surrounding tissues by creating new muscle fibers through facilitating the secretion of angiogenic substances around the affected region and increasing blood flow to the region(15). MATERIALS AND METHODS It concerns 10 patients with primary frozen shoulder according to Lundberg classification. Stage 2 stiffness according to Reeves.(16) The patients have complaints of pain and limited movements in the shoulder joint more than 4 months. In the baseline data: VAS for all patients were 10 ROM : All 10 patients were with 50% reduction of extension, flexion, abduction, adduction, external rotation and internal rotation in glenohumeral joint.
ADL for upper limb: Score 1- Patient carried out only part of the activity, but has to be greatly supported. No reported side effects. There remains a severe degree reduction of ROM on shoulder joint.
Results after 6 weeks of RSWT:
VAS: 3 patients were 8 points, 7 patients were 4 points.
ROM: 3 patients have 10% improvement. 7 patients have 100% improvement of extension, flexion, abduction, adduction, external rotation and internal rotation in glenohumeral joint.
Neer test: negative for 7 patients.
ADL for upper limb: Score 4- Normal for 7 patients. The patient performs the activity effectively with normal strength and speed. Score 2-for 3 patients. No reported side effects. Mild degree reduction of ROM on shoulder joint for 3 patients and normal volume of ROM on shoulder joint for 7 patients.
Long-term results after 3 months follow-up:
VAS: 7 patients were 0 points. 3 patients were 5 points.
ROM: 3 patients have 10% improvement. 7 patients have 100% improvement of extension, flexion, abduction, adduction, external rotation and internal rotation in glenohumeral joint.
Neer test: negative
ADL for upper limb: Score 4- Normal for 7 patients. The patient performs the activity effectively with normal strength and speed. Score 3-for 3 patients.
No reported side effects. Mild degree reduction of ROM on shoulder joint for 3 patients and normal volume of ROM on shoulder joint for 7 patients.
Capsule model of the ROM restriction in the glenohumeral joint.(17) (table.1)
Degree of disfunction reduction
External rotation abduction Internal rotation
mild 20 10 Normal, with pain
moderate 60-70 45 10-15
severe 90-100 70-80 30
VAS data before and after bought treatments. Fig. 1
ROM in percent before and after bought treatment. Fig. 2
Upper limb ADL scale before and after bought treatments. Fig. 3
DISCUSSION
After two months convention FTR 70 % of patient had reduction of pain and 10 % increase ROM in 30 % of patients. Upper limb ADL no improvement.
After RSWT 100% of patients had reduction of pain and 70 % of patients had 100% ROM. Significant improve upper limb ADL.
After 3 moths follow up all patients had additional reduction of pain and improvement of ROM and improvement of upper limb ADL. Usage of RSWT alone is much better option compared to the conventional physiotherapy in patients with Capsulitis adhesive.
CONCLUSIONS
According to the findings of this study. RSWT has positive effects on acceleration of the healing process of frozen shoulder. RSWT is more effective treatment than conventional physiotherapy. Considering the significant side-effects of other therapies such as surgery, patients with frozen shoulder can take advantage of RSWT because of its noninvasive, safe nature, low costs, no need for hospitalization, fewer visits of patient in the hospital, and the lack of significant adverse events during the treatment.
REFERENCES
(1) Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ 2005; 331:1453-6
(2) Walmsley S, Rivett DA, Osmotherly PG. Adhesive capsulitis: Establishing consensus on clinical identifiers for stage 1 using the delphi technique. Phys Ther 2009;89:906-917
(3)_Kelley M, Mcclure P, Leggin B. Frozen shoulder: Evidence and a proposed model guiding rehabilitation. J Orthop Sports Phys Ther 2009;39: 135-148.
(4) Bal A, Eskioglu E, Gulec B, Aydog E, Gurcay E, Cakci A. Effectiveness of corticosteroid injection in adhesive capsulitis. Clinical Rehabilitation 2008; 22:503-512.
(5) Gaspar P, Willis B. Adhesive capsulitis and dynamic splinting: a controlled, cohort study. BMC Musculoskeletal Disorders 2009;10:111.
(6) Boyles RE, Flynn TW, Whitman JM. Manipulation following regional intrascalene
anesthetic block for shoulder adhesive capsulitis: A case series. Man Ther 2005:10;164-171.
(7) Cleland J, Durall CJ. Physical therapy for adhesive capsulitis: Systematic review. Physiotherapy 2002;88:450-457.
(8) Vermeulen HM, Rozing PM, Obermann WR, Cessie S, Vlieland T. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: Randomized clinical trial. Phys Ther 2006;86:355-368.
(9 )_Jewell DV, Riddle DL, Thacker LR.
Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: A retrospective cohort study. Phys Ther 2009;89:419-429
(10)_Kline CM. Adhesive capsulitis: clues and complexities. JAMA Online 2007;2-9.
(11) Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev 2003; 2: CD004258-CD004258.
(12) Lee SB, Kwon DJ, Song YJ, et al. : Shockwave therapy for tennis elbow. J Korean Orthop Assoc, 2004, 39: 142-145
(13) Lee SB, Kwon DJ, Song YJ, et al. : Shockwave therapy for tennis elbow. J Korean Orthop Assoc, 2004, 39: 142-145. [Google Scholar]
(14) Kudo P, Dainty K, Clarfield M, et al. : Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study. J Orthop Res, 2006, 24: 115-123.
(15) Hammer DS, Rupp S, Ensslin S, et al. : Extracorporal shock wave therapy in patients with tennis elbow and painful heel. Arch Orthop Trauma Surg, 2000, 120: 304-307
(16) Classifications and Scores of the shoulder, Peter Habermeyer, Petra Magosch, Sven Lichtenberg, Springer, ISBN 978-3-540-35142-9
(17) Kинезиология и патокинезиология на опорно-двигателния апарат, Николай Попов, НСА ПРЕС, ISBN: 978-964-718-245-5
ORGANIZATIONAL MANAGEMENT CAPABILITY AND EMPLOYEE SATISFACTION _ASSESSMENT AT MATERNITY HOSPITALS IN MONGOLIA_
DOI: 10.31618/ESU.2413-9335.2020.2.80.1097 Batbold Tseleejav1, Odonzul Tsogbadrakh2 Tumurbaatar Luvsansambuu3, Munkh-Erdene Luvsan4
1,2Amgalan Maternal Hospital, 0000-0003-1338-8879 0000-0002-1836-3580
3Capital Health Department 0000-0003-1858-2240
4Public Health School, Mongolian National University of Medical Sciences
0000-0001-7819-1765
ABSTRACT
Background: Management capability index presents the management assessment of any organizations. Therefore, we aimed to compare Mongolian maternity hospitals with the ones that have and have not implemented the quality management system.
