Neural Mobilization and Capsular Stretching in Adhesive Capsulitis

Effectiveness of Combined Neural Mobilization Techniques and Capsular Stretching Exercises in Patients With Adhesive Capsulitis.

Restriction of glenohumeral (GH) mobility in patients with adhesive capsulitis (AC) was known owing to capsular adhesion. There is a little evidence about the involvement of neural restriction in limiting range of motion (ROM) of the GH joint in patients with AC. Objectives: The purpose of this study is to investigate the combined effect of median nerve mobilization and capsular stretching on improving shoulder external rotation, abduction and internal rotation ROM among patients with AC. Methods Thirty patients will be randomly assigned into two equal groups : Group (A) will receive median nerve mobilization and capsular stretching while Group (B) will receive only capsular stretching (anterior, posterior and anteroinferior capsular stretching). Both groups will receive passive and self-assisted exercises. All patients in both groups will be evaluated pre and post treatment for GH external rotation, abduction and internal rotation ROM.

Inclusion Criteria:

• Patients from both gender (male &female) will be included if they would have second or third stage AC with their age between forty and seventy years
• experiencing pain, capsular adhesions, and a reduction of greater than fifty percentage in passive ROM of the GH joint (external rotation, abduction, and internal rotation compared to the sound side
• lasting for a minimum of three months. Patients with positive upper limb tension test-1 will be also included in this study

Exclusion Criteria:

• they would have stroke,Parkinson's diseases that interfere with shoulder muscles activity
• diabetes
• traumatic shoulder conditions
• glenohumeral osteoarthritis confirmed by x-ray
• previous surgery, and manipulation of the affected GH joint under general anesthesia
• Patients with passive elbow extension ROM