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Chronic inflammation of the shoulder joint

The thesis of physiotherapy student Nika Kovač aimed to determine the impact of targeted radiofrequency therapy on the range of motion and pain intensity in patients with adhesive capsulitis.

Adhesive capsulitis is a condition in which chronic inflammation of the shoulder joint capsule leads to a reduced range of motion and severe pain. This condition can last weeks, months, or even years, preventing the patient from performing normal daily activities. "First of all, we use conservative treatment, but if there is no improvement, the operative release of the joint capsule is necessary," says the graduate.
Treatment can be carried out conservatively with physiotherapy, oral or intra-articular corticosteroids, acupuncture, non-steroidal anti-rheumatic drugs, and hydrodilatation, or operatively, where orthopedists most often arthroscopically release the joint capsule and manipulate it.
Conservative therapy
Non-steroidal anti-inflammatory drugs and physiotherapy are often prescribed for pain relief. "The goal of therapies is to prevent further loss of range of motion and eventually increase range of motion in the affected shoulder. Passive mobilization and capsular stretching are the two most commonly used techniques," the student describes, adding that the combination of physiotherapy and corticosteroid injections provides more significant improvement than physiotherapy alone.
Hydrodilation (arthroscopic distension) is a non-operative treatment that involves injecting a local anesthetic into the shoulder capsule under high pressure to tighten and stretch the joint capsule.
In the first phase of the physiotherapy protocol for the treatment of adhesive capsulitis, the use of TENS, low-energy laser, Kinesio taping (lymphatic technique), pendulum exercises, cryotherapy, thermotherapy, continuous passive stretching of the upper limb, use of a pulley, actively assisted exercises, hydrotherapy, stretching, isometric exercises, and traction according to Kaltenborn 1st and 2nd level.
Operative therapy
Surgical options for adhesive capsulitis include manipulation under anesthesia and arthroscopic release of the capsule. Manipulation is a technique performed under general anesthesia in which the humerus is manipulated to break adhesions. Moderate evidence suggests that manipulation relieves pain and may improve range of motion when followed by early physiotherapy.
By assessing the pain according to the VAS and measuring the range of motion of the shoulder joint with a goniometer, she got the results of the immediate effect of the therapy. "The average pain score decreased with all three therapies. The largest measured difference was 3 points, the smallest was 0, and nobody's pain worsened. Regarding the range of motion, we found that, on average, the motion in all directions increased after each therapy. The largest measured difference was as much as 20°, the smallest was 0°, and there was no deterioration in mobility. "Despite some improved measurements and predictions, we had to reject three out of four hypotheses, as not all patients improved," she concludes.