Clinical Research Directory

PNF and Shoulder Function in Adhesive Capsulitis

This study aimed to investigate the effects of Proprioceptive Neuromuscular Facilitation (PNF) on range of motion, pain, and shoulder function in patients with frozen shoulder.

The Effects of Immersive Virtual Reality in Patients With Grade 1-2 Adhesive Capsulitis

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.

Maitland Mobilization With and Without Stroking Release Technique of Rotator Cuff Muscle in Frozen Shoulder

Frozen shoulder has been described as a painful condition associated with stiffness and difficulty in sleeping on the affected side. People with this condition have difficulty in dressing, overhead movements and sleep disturbance. It occurs in 2 - 5% of general adult population, 10 - 15% of the people with diabetes. It mainly affects the individuals of 35 - 65 years of age with female predominance. Frozen shoulder is characterized by fibroproliferative tissue fibrosis whereby fibroblasts, producing predominantly type I and type III collagen, transform into myofibroblasts, which is accompanied by inflammation, resulting in shoulder capsular fibrotic contractures and the associated clinical stiffness. There are two frozen shoulder syndromes, namely primary syndrome and secondary syndrome. In primary or idiopathic syndrome, frozen shoulder that occurs spontaneously or directly without knowing the causative factors. Primary syndrome occurs due to a chronic inflammatory response with fibroblast proliferation which can actually be a response from an abnormal immune system. Secondary syndromes occur due to several triggers such as trauma that can cause shoulder injuries or surgery associated with the onset of other conditions such as diabetes mellitus, autoimmune diseases and cardiovascular disorders. The clinical presentation of frozen shoulder typically progresses through three stages: the freezing stage, where the shoulder becomes painful and progressively stiff over two to nine months; the frozen stage, characterized by significant stiffness and reduced pain over four to twelve months; and the thawing stage, where gradual improvement in shoulder mobility occurs over five to twenty-four months. The condition can be severely debilitating, impacting daily activities and overall quality of life. Adhesive capsulitis treatment primarily consists of pain relief and physical therapy techniques. Anti-inflammatory medication is helpful in pain relief, so that mobility interventions can be initiated. Therapeutic modalities include Transcutaneous Electrical Nerve Stimulation (TENS), Interferential Therapy (IFT), Ultrasound, Short Wave Diathermy (SWD) etc, and the physical therapy exercises such as stretching, Codman exercise can be used. Exercises which may be active, passive or active assisted, play a crucial role in the early rehabilitation of these patients.

Comparative Effects of Niel Asher Technique and Bowen Technique on Pain, Range of Motion and Functional Disability in Patients With Adhesive Capsulitis.

This research synopsis, titled "Comparative Effects of Niel-Asher Technique and Bowen Technique on Pain, Range of Motion, and Functional Disability in Adhesive Capsulitis," aims to compare the effectiveness of two manual therapy techniques in managing adhesive capsulitis (frozen shoulder). Adhesive capsulitis is a painful musculoskeletal condition characterized by progressive stiffness, reduced shoulder range of motion (ROM), and functional limitations that significantly affect daily activities and quality of life. Although several conservative treatment approaches exist, there is still no consensus regarding the most effective intervention. The study will be conducted as a single-blind randomized clinical trial at the Rehabilitation Department of Fauji Foundation Hospital, Rawalpindi, over one year. A total of 54 participants aged 40-60 years with stage II (frozen stage) adhesive capsulitis will be recruited using purposive sampling and randomly allocated into two groups through a coin toss method. Group A will receive the Niel-Asher Technique (NAT) combined with conventional physical therapy, while Group B will receive the Bowen Technique along with the same conventional treatment. Both groups will undergo treatment three times per week for four weeks.

Spencer's Technique Versus Mulligan's Technique for Stage II Frozen Shoulder

Stage II frozen shoulder (adhesive capsulitis) is associated with pain, stiffness, restricted shoulder range of motion, and reduced quality of life. This randomized controlled trial will compare Spencer's Muscle Energy Technique with Mulligan's Mobilization with Movement in adults with Stage II idiopathic frozen shoulder. Seventy-two participants will be randomized to two groups of 36. Both groups will receive their allocated manual therapy together with conventional physiotherapy for four weeks, three sessions per week. Outcomes will be assessed at baseline and after the 4-week intervention using the Numeric Pain Rating Scale, goniometric shoulder range of motion, and the SF-36 questionnaire.

Additional Effects of Thoracic Mobilization Versus Manipulation Along With Standard Physical Therapy in Adhesive Capsulitis

Participants will be divided into two groups, with both receiving conventional physical therapy along with their respective thoracic intervention. One group will receive thoracic manipulation at the identified T1-T7 segment using a controlled High-Velocity, Low-Amplitude thrust in the prone position at the end of full exhalation, while the other group will receive central PosterioAnterior thoracic mobilization in the prone position for 30 repetitions with a 1-minute rest between two sets. The most painful or stiffest segment will be identified using the Passive Accessory Intervertebral Movement (PAIVM) test; if no joint sign is present, mobilization will be performed at T6-T7.

GDS Method for Frozen Shoulder

This randomized exploratory clinical trial evaluated the effectiveness of the GDS Muscle and Joint Chains Method compared with conventional physiotherapy in patients with frozen shoulder (adhesive capsulitis). Thirty participants were randomly assigned to either the GDS intervention group or the conventional physiotherapy control group. Both interventions consisted of eight 50-minute sessions administered twice weekly for four weeks. The primary therapeutic objectives were to improve shoulder range of motion and reduce pain. Shoulder mobility was assessed using goniometry, and pain intensity was evaluated using a Visual Analog Scale. The study hypothesized that the GDS Muscle and Joint Chains Method would produce greater improvements in shoulder mobility and pain than conventional physiotherapy.

Transfer of Energy Capacitive and Resistive Therapy on Shoulder Range of Motion In Idiopathic Adhesive Capsulitis

The current study's general aim is to compare the effectiveness of Transfer of Energy Capacitive and Resistive (TECAR) therapy combined with stretching versus stretching alone in patients with adhesive capsulitis stage 2,3 on range of motion, pain, and function.

Evaluation of the Efficacy of Suprascapular Nerve Block in Adhesive Capsulitis

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 Effectiveness of Using Interactive Devices for Home Exercise in Patients With Frozen Shoulder.

This study is a randomized clinical trial designed to evaluate the effectiveness of using interactive digital devices to guide home exercise for patients with frozen shoulder (adhesive capsulitis). Background: While exercise therapy is a crucial treatment for improving joint mobility and reducing pain in frozen shoulder patients, ensuring proper technique and compliance during home exercises can be difficult. Methodology: The trial plans to enroll 30 participants, randomly assigning them to either an interactive device group or a control group. Both groups will undergo standard hospital rehabilitation twice a week. Intervention: The intervention group will be provided with an iPhone containing interactive rehabilitation software to perform 15 minutes of guided home exercise daily. The control group will receive standard home exercise education. Hypothesis: The study hypothesizes that after a 4-week period, the group utilizing the interactive device for home exercise will demonstrate superior improvements in pain, joint angle, grip strength, and quality of life compared to the control group.

Effects of Gong's Mobilization With and Without Scapular High Lift on Shoulder Range of Motion and Functional Recovery in Adhesive Capsulitis.

This study aims to compare the effectiveness of Gongs Mobilization with and without scapular High-lift in the management of Adhesive Capsulitis, focusing on specific outcomes like pain, functional outcomes, and work productivity.

Comparison of Transcatheter Arterial Microembolization and Corticosteroid Injection and for Treatment of Frozen Shoulder

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.

Effect of Hormone Replacement Therapy on Physiotherapy Outcomes in Postmenopausal Women With Frozen Shoulder

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.

Spinal Mobilization With Arm Movement and Kaltenborn Mobilization in Adhesive Capsulitis

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.

Comparative Effects of Gongs and Maitland Mobilization 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.

Pericapsular vs Intra-Articular Injection in Adhesive Capsulitis

Adhesive capsulitis is a common and disabling shoulder disorder characterized by progressive pain and restricted active and passive range of motion, leading to significant limitations in daily activities and reduced quality of life. Corticosteroid injections are widely used to relieve pain and improve shoulder function; however, the optimal injection site remains a matter of debate. While ultrasound-guided intra-articular injections are considered a standard treatment, ultrasound-guided pericapsular injections have recently emerged as a potential alternative by targeting the inflamed capsular tissues directly. The primary objective of this study is to compare the clinical effectiveness of ultrasound-guided pericapsular corticosteroid injection with ultrasound-guided intra-articular corticosteroid injection in patients diagnosed with adhesive capsulitis. The study aims to determine whether one injection technique provides superior improvements in pain, shoulder range of motion, functional status, and patient-reported outcomes.

Isolated Glenohumeral Corticosteroid Injection Versus Concomitant Capsule Preserving Hydrodilatation

This clinical trial investigates whether concomitant capsule-preserving hydrodilatation (CSHD) is more effective than isolated glenohumeral corticosteroid injection (CS) in treating shoulder adhesive capsulitis. The main questions it aims to answer are * Is CSHD inferior to CS in immediate pain relief as the solution is diluted? * Is CSHD superior to CS in improving the range of motion as the contracted capsule is dilated? Group CS will receive an ultrasound-guided glenohumeral corticosteroid injection only, with a solution of 5 mL. Group CSHD will receive an ultrasound-guided glenohumeral corticosteroid with hydrodilatation, with a solution of 20 mL. Clinical scores and range of motion will be compared between the groups up to six months post-injection.

Comparison of the Effects Suprascapular Nerve Block and Intra-articular Shoulder Injection

Objectives: In this study, we aimed to compare the efficacy of ultrasonography-guided suprascapular nerve block and intra-articular shoulder injection treatment in terms of joint range of motion, pain and functional status in patients with adhesive capsulitis (AC). Patients and Methods: 60 patients AC were included in our study. The patients were randomized into two groups according to the sealed envelope method. In the evaluation of the patients before the injection, age, gender, body mass index (BMI), occupation, education, duration of complaint, symptomatic side and dominant hand information were recorded. In the first group, 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine injection were mixed with the posterior approach method into the shoulder joint under the guidance of ultrasonography (USG). The second group underwent suprascapular nerve block (SSNB) injection with 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine under USG guidance. Shoulder range of motion (ROM), visual analog scale (VAS) scores and Shoulder Pain and Disability Index (SPADI) scores were compared before the injection, on the tenth day after the injection and at the third month after the injection. Conclusion: As a result of our study, although it was observed that both methods provided improvement in the treatment process, the significant improvement in the SSNB group indicates that it is a more reliable treatment method in AC treatment.

AI-Assisted Ultrasound Therapy for Adhesive Capsulitis

This study aims to integrate artificial intelligence with ultrasound imaging to investigate the dynamic biomechanical characteristics of adhesive capsulitis and to compare the therapeutic effectiveness of three ultrasound-guided hydrodilatation techniques: rotator interval injection, dual-target injection, and posterior glenohumeral injection. In the observational phase, healthy participants and patients with adhesive capsulitis will undergo static and dynamic ultrasound evaluations to quantify subacromial motion and the minimal vertical acromiohumeral distance (mvAHD) during shoulder abduction. A Faster R-CNN model will automatically identify the acromion and greater tuberosity to extract motion trajectories and frequency-based features. In the randomized clinical trial phase, patients will be assigned to one of the three hydrodilatation techniques to compare improvements in pain, function, and range of motion at 6 and 12 weeks. All participants will subsequently enter a one-year follow-up to document recurrence, defined as the need for repeat intervention. Clinical characteristics, static sonographic parameters, dynamic motion metrics, and short-term treatment responses will be incorporated into machine-learning models to predict long-term outcomes, including recurrence risk. Eligible patients who decline randomization may consent to join a parallel observational cohort. They will receive standard-of-care treatment (conservative or interventional) based on their preference, and undergo the exact same baseline, Week 6, and Week 12 clinical and ultrasound assessments as the randomized trial participants. The ultimate goal is to establish an AI-assisted predictive framework that enables individualized risk stratification, early identification of poor responders, and optimization of injection strategies. This model is expected to improve clinical decision-making, enhance treatment precision, and contribute to higher-quality patient care.

Effects of Gong's Mobilization With and Without Nielasher Technique on in Adhesive Capsulitis

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 Treatment With Intra-Articular Corticosteroid Injection and Suprascapular Nerve Block

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.

Cyriax Capsular Stretching Technique and Mulligan Mobilization in Adhesive Capsulitis

This study aims to evaluate the comparative effectiveness of Mulligan's mobilization versus the Cyriax capsular stretching technique for individuals suffering from adhesive capsulitis. Specifically, the research focuses on determining which approach is more successful in alleviating pain, improving shoulder range of motion (ROM), and reducing functional disability.

Effect of HVLA vs MET on Shoulder Mobility and Pain in Adhesive Cpsulitis

This study compared the effects of High-Velocity Low-Amplitude (HVLA) thrust and Post-Isometric Relaxation Muscle Energy Technique (PIR-MET) on pain and shoulder mobility in patients with adhesive capsulitis. Sixty-six participants received either HVLA or PIR-MET with conventional physiotherapy for four weeks. Both treatments improved pain and range of motion, but PIR-MET showed significantly greater improvement, making it a more effective approach for managing frozen shoulder symptoms.

Hyaluronic Acid Injection Combined With Rehabilitation for Frozen Shoulder

This randomized controlled trial evaluates the clinical efficacy of ultrasound-guided intra-articular hyaluronic acid injection combined with rehabilitation in patients with adhesive capsulitis (frozen shoulder). Participants were randomly assigned to either an injection plus rehabilitation group or a rehabilitation-only group. The injection group received ultrasound-guided intra-articular hyaluronic acid once weekly for three weeks, along with a standardized rehabilitation program for six weeks. The control group received the same rehabilitation program without injection. Clinical outcomes were assessed at multiple time points, including baseline, 4, 6, 8, and 12 weeks. The primary outcome was the change in the Shoulder Pain and Disability Index (SPADI) total score. Secondary outcomes included SPADI pain and disability subscales, as well as shoulder range of motion. The trial was registered retrospectively at ClinicalTrials.gov (NCT07570095) after study completion due to administrative oversight. The study was conducted in accordance with the protocol approved by the Tri-Service General Hospital Institutional Review Board (approval no. C202205160) prior to enrollment. The IRB-approved protocol specified the eligibility criteria and outcome measures reported in this record; discrepancies in the initial registry entry have been corrected in this amendment.