title: High-intensity stretch treatment for severe postoperative adhesive capsulitis of the shoulder.
abstract: BACKGROUND
  Some patients with postoperative adhesive capsulitis reach a plateau in their recovery with a standard protocol of physical therapy (PT), which puts them at risk for further surgical intervention.
  
  
  OBJECTIVE
  We aimed to evaluate therapy for postoperative adhesive capsulitis of the shoulder in 2 groups of patients: (1) those who used a high-intensity stretch (HIS) device after reaching a plateau in their recovery with a standard protocol of traditional PT (PT+HIS) and (2) those who showed no plateau in their recovery with a standard protocol of traditional PT alone (PT only).
  
  
  METHODS
  We retrospectively reviewed the records for 60 patients (51 males; mean age 46.7±12.6years) with postoperative adhesive capsulitis who received treatment between March 2007 and May 2010. Forward elevation and combined internal/external rotation at the initial postoperative visit and final visit were measured. The measurements from group 2 patients were used as an observational benchmark.
  
  
  RESULTS
  The PT+HIS (n=42) and PT-only (n=18) patients did not differ in total follow-up time. Initial elevation was worse for PT+HIS than PT-only patients (22.1° lower, P=0.02), but the final elevation was equivalent. Initial rotation was worse for PT+HIS than PT-only patients (16.6° lower, P=0.04), but the final rotation was higher for PT+HIS patients (10.6° higher, P=0.04). Gains in elevation and rotation were greater for the PT+HIS than PT-only patients (P=0.04 and P=0.01).
  
  
  CONCLUSIONS
  Patients with postoperative adhesive capsulitis of the shoulder who are unable to reach their PT treatment goals with a standard protocol of PT may benefit from the addition of HIS to their treatment regimen. HIS could be a valuable adjunct to PT for treating postoperative adhesive capsulitis in appropriate patients.
authors.affiliation: Center for Athletic Medicine, Chicago, IL, USA.
authors.forename: Preston M
authors.initials: PM
authors.lastname: Wolin
authors.affiliation: Center for Athletic Medicine, Chicago, IL, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Ingraffia-Welp
authors.affiliation: Tenet Florida Physician Services, Boca Raton, FL, USA.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Moreyra
authors.affiliation: Emory University, Atlanta, GA, USA. Electronic address: whutton@emory.edu.
authors.forename: William C
authors.initials: WC
authors.lastname: Hutton
mesh_terms: D000328:Adult; D002062:Bursitis / Q000209:etiology / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000534:rehabilitation*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Adhesive capsulitis; High intensity stretching; Physical therapy; Shoulder; Stretching