Adhesive Capsulitis of Shoulder Emphasising on Restorative and Compensatory Management: A Case Study

Adhesive capsulitis more commonly periarthritis of shoulder is a common condition characteristic by pain, stiffness and restricted range of motion leading to difficulty in household activities, overhead reach and complexity in daily activities. This condition affects around two million mostly women between the ages of 40 and 60. Some experts say changing levels of hormones may be to blame for this connection between adhesive capsulitis and menopause. This is a case study of Mrs. R a 55-year-old female presenting complain of left-sided shoulder pain and restricted movement. These symptoms started gradually but over time they began to affect her general quality of life and morale. Pain increased, particularly at night leaving her extremely tired during the daytime and she Case Study Waghale et al.; JPRI, 33(38A): 49-54, 2021; Article no.JPRI.71011 50 started to experience problems especially when dressing. After conducting a thorough examination, which included assessment of active and passive range of movements (rom), x rays and diagnostic special tests we reached a diagnosis of adhesive capsulitis of left shoulder The conservative management remains the mainstay treatment of adhesive capsulitis With using soft tissue mobilization treatment techniques in combination with a home exercise programmed with active assisted exercise. Here in this case study, we are emphasizing on the restorative and compensatory management decreasing the hours of OPD visits and promoting home program


INTRODUCTION
The clinical condition known as adhesive capsulitis also can be termed as idiopathic frozen shoulder this entity progresses through a sequence of stages mainly painful stage, freezing stage, frozen stage and thawing stage.
1) Painful stage stage 1 -in this stage patient experience slight pain increasing in the night with limited external rationalist for 3 months. 2) Stage 2 freezing stage-intense pain at movement as well as at rest. This stage is characterized by limitation in all direction of the movement. Last for 3 to 9 months 3) Stage 3 frozen stage-In this condition the pain is limited during rest and increase in certain amount during activity with limited glenohumeral mobility. The atrophy of muscle is usually noted at deltoid, biceps and rotator cuff. This stage lasts for 9 to 15 months. 4) Stage 4 thawing stage-motion of glenohumeral joint may increase a little with no increase in pain this stage lasts for 15 to 24 months [1].
Various non-operative treatment approaches have been evaluated in the literature [2][3][4][5][6][7]. These include corticosteroid injections, oral medications, electro therapy modalities, stretching exercises, joint mobilization, and muscle energy techniques (met). The objective of this review case study is to systematically apply the efficacy of physiotherapy interventions with home program guidelines in the treatment of patients with adhesive capsulitis. This case study deals with management of adhesive capsulitis of a 55 years old female presenting complain of left shoulder pain with restricted range of motion with difficulty in performing activities of daily living especially the overhead activities [8].

CASE PRESENTATION
Mrs. R is a 55-year-old women house wife in occupation with right hand dominance started experiencing pain in the left shoulder while doing house hold activities especially overhead activities from 4 months. The orthopedic doctors ruled out repetitive micro trauma as per patient history as a possible option and diagnosed her with periarthritis of left shoulder. Radiological examination and diagnostic special test helped in establish the diagnosis. Mrs.R was prescribed corticosteroids to reduce inflammation and swelling. The orthopedic doctor recommended physiotherapy treatment for restorative function. The patient attended natural menopause 6 years ago and is having hypothyroidism from 6 years and hypertension from past 1 year.

Tenderness
Grade 2 tenderness on anterior-lateral side of shoulder over the acromion and lateral border of scapula.

RESISTED ISOMETRICS
Weak and Painfull for Shoulder Abduction Flexion and Internal Rotation and External Rotation. Weak and Painfree for Shoulder Adductors.

Follow-Up and Outcomes
After the session of 2 months for Mrs. R with strict home exercise protocol of active assisted exercise of 2 sets with 10 repetition on duration of 8 weeks daily with mobilization with movement and glides presented to be effective in decreasing the pain with 3 on vas of the patient and restoration of range of motion of abduction to 110, external rotation 55, flexion 130 of left shoulder when measure with goniometer.

DISCUSSION
Adhesive capsulitis is a condition which progressively cause thickening of glenohumeral joint capsule the effectiveness of various nonoperative methods which we established as conservative treatment for the patient. Has been demonstrated to improve the pain, range of motion (rom) and functional status of patients with adhesive capsulitis. Therapeutic home exercises program and mobilization are strongly recommended for reducing pain, improving range of motion (rom) and function in patients with stages 2 and 3 of frozen shoulder. Electrotherapy can help in providing short-term pain relief [9].
The patient in this case report, was on stage 2 of adhesive capsulitis. Peripheral joint mobilization and home exercise program was the main stay of rehabilitation.
Patient visited community rehabilitation center with complain of left shoulder pain and restricted range at left shoulder joint. Due to inadequate transport facility could not able to visit the opd daily after the 10 days continuous program so the patient was suggested for home exercises for continue 3 weeks daily with 2 set of 10 repetitions and 3 days in a week visit in the opd [10][11][12][13][14].

CONCLUSSION
Compensatory management and home program with duration of 8 weeks 2 sets of 10 repetition daily was effective session program. The patient was satisfied with the treatment due to decrease in pain, increased range of motion and efficiency in doing work with home exercise and compensatory management.

ETHICAL APPROVAL
Ethical clearance taken from institutional ethics committee CONSENT As per international standard or university standard, patient's written consent has been collected and preserved by the author(s).