title: End-range mobilization techniques in adhesive capsulitis of the shoulder joint: A multiple-subject case report.
abstract: OBJECTIVE
  The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis.
  
  
  METHODS
  Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment.
  
  
  RESULTS
  After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90-145) to 147 degrees (SD=18, range=115-175), and mean lateral rotation increased from 13 degrees (SD=13, range=0-40) to 31 degrees (SD=11, range=15-50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70-125) to 159 degrees (SD=24, range 110-180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95-145) to 154 degrees (SD=19, range=120-180), and mean lateral rotation increased from 21 degrees (SD=11, range=10-45) to 41 degrees (SD=8, range=35-55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6-15) to 15 cc (SD=3, range=10-20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up.
  
  
  CONCLUSIONS
  There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted.
authors.affiliation: Department of Physical Therapy, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. h.m.vermeulen@lumc.nl
authors.forename: H M
authors.initials: HM
authors.lastname: Vermeulen
authors.forename: W R
authors.initials: WR
authors.lastname: Obermann
authors.forename: B J
authors.initials: BJ
authors.lastname: Burger
authors.forename: G J
authors.initials: GJ
authors.lastname: Kok
authors.forename: P M
authors.initials: PM
authors.lastname: Rozing
authors.forename: C H
authors.initials: CH
authors.lastname: van Den Ende
mesh_terms: D000328:Adult; D000368:Aged; D002062:Bursitis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000379:methods*; D016059:Range of Motion, Articular; D012785:Shoulder Joint; D016896:Treatment Outcome