Clinical Research Directory

Electrophysiologic Changes After Extended 360° Capsular Release

Frozen shoulder (adhesive capsulitis) is a condition characterized by shoulder pain and restricted range of motion, significantly impairing daily living activities. In cases that do not respond to conservative treatment, arthroscopic capsular release is an effective surgical treatment option. The 360° capsular release technique, performed by some surgeons, involves release of the inferior capsule and therefore carries a potential risk of nerve injury due to the anatomical proximity of neurovascular structures such as the axillary nerve. In addition, surgical manipulations performed around the coracoid process may exert mechanical or compressive effects on the musculocutaneous nerve and its sensory continuation, the lateral antebrachial cutaneous nerve, due to their close relationship with the lateral cord of the brachial plexus. The aim of this prospective, single-center observational clinical study is to objectively evaluate the morphological and functional effects of inferior capsular release and coracoid region dissection performed during arthroscopic 360° capsular release surgery on the axillary and musculocutaneous nerves, using electromyography (EMG) and nerve conduction studies (NCS) in patients with frozen shoulder. Patients aged 21-70 years with a diagnosis of frozen shoulder who have not responded to conservative treatments and are scheduled for arthroscopic capsular release will be included in the study. EMG and NCS assessments will be performed at the preoperative baseline, and at 12 weeks postoperatively. For the axillary nerve, the deltoid and teres minor muscles will be evaluated; for the musculocutaneous nerve, the biceps brachii and brachialis muscles will be assessed. Additionally, sensory conduction of the lateral antebrachial cutaneous nerve will be examined. Along with electrophysiological findings, shoulder range of motion (ROM), pain (VAS), muscle strength (MRC), and functional scores will also be recorded. This study is expected to provide objective evidence regarding the effects of arthroscopic capsular release surgery on peripheral nerve function, thereby contributing new data on the safety of the surgical technique and enriching the currently limited literature on electromyographic evaluation in frozen shoulder surgery.

USG-Guided Shoulder Injections in Frozen Shoulder

Frozen shoulder (adhesive capsulitis) is characterized by pain and a progressive restriction of both active and passive shoulder range of motion, significantly impairing daily activities and quality of life. This study aims to evaluate the effectiveness of USG-guided shoulder injections, when added to a home-based exercise program, in the conservative management of patients with chronic, painful frozen shoulder. In this prospective randomized study, patients diagnosed with painful frozen shoulder will be included. In addition to a standardized home-based exercise program, patients will receive either USG-guided suprascapular nerve block alone or a combination of suprascapular nerve block and subacromial injection. The effects of these approaches on clinical outcomes will be assessed over a 20-week follow-up period. Primary outcome measures include pain intensity assessed by the Visual Analog Scale (VAS), functional status evaluated by the Shoulder Pain and Disability Index (SPADI), and shoulder range of motion. Secondary outcomes include depression level (Beck Depression Inventory), sleep quality, pain phenotype (nociplastic, neuropathic, or nociceptive), hand grip strength, ultrasonographic findings ( (coracohumeral ligament thickness, subacromial bursa thickness) , and patient satisfaction (subjective impression of improvement). The results of this study are expected to provide evidence on the comparative effectiveness and additional benefits of different shoulder injection approaches when combined with home-based exercise therapy in patients with chronic frozen shoulder.

Efficacy of Chemically Distinct Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Pain Phenotypes in Adhesive Capsulitis

Patients aged 18-75 years who present to a tertiary rehabilitation hospital with shoulder pain and restricted range of motion, and who consent to participate, will be included in the study. Eligibility will be determined based on predefined inclusion and exclusion criteria. Eligible patients will be randomly assigned to receive one of several nonsteroidal anti-inflammatory drugs (NSAIDs) with differing chemical properties (e.g., diclofenac, meloxicam, or indomethacin), in combination with a home-based exercise program for shoulder adhesive capsulitis. Patients' sociodemographic data, as well as detailed clinical and examination findings and baseline outcomes, will be recorded. Patients will be informed about their condition, and modifications to activities of daily living will be recommended.Patients' pain phenotypes (nociceptive, neuropathic, nociplastic) will be categorized based on clinical history and questionnaires, and it will be determined which pain types derive greater benefit from NSAIDs. Follow-up assessments will be conducted at the end of the first and second weeks. At the first-week follow-up, pain intensity will be evaluated using the Visual Analog Scale (VAS). If the treatment is deemed effective (defined as a ≥3-point reduction or ≥50% decrease in VAS), the same NSAID will be continued for an additional week; otherwise, it will be switched to an alternative NSAID with a different biochemical profile (group). The outcomes assessments will be performed by a blinded evaluator to minimize bias.

Effects of Nunchaku Exercise for Improving Frozen Shoulder

The goal of this clinical trial is to investigate if nunchaku exercise works to treat adhesive capsulitis, or frozen shoulder in middle-aged or older adults. It will also learn about the adherence of this exercise intervention. The main questions it aims to answer are: * Does practicing nunchaku exercises help reduce shoulder pain and improve shoulder movement? * Do people stick with nunchaku exercises better, and spend more time practicing on their own, compared with standard exercises for alleviating frozen-shoulder? Researchers will compare nunchaku exercise to standard exercises for alleviating frozen-shoulder to see if nunchaku exercise works to alleviate frozen shoulder. Participants will: * Join small group exercise classes for 12 weeks, doing either nunchaku based exercises or standard exercises designed to help relieve frozen shoulder. * Have their shoulder pain and movement checked three times: * before training * after 6 weeks of training, * after finishing the 12 week program, and * 12 weeks after the program ends. * Keep a record of their home practice time.

Evaluation of the Efficacy of Suprascapular Nerve Block in Adhesive Capsulitis

This is a double-blind interventional superiority study evaluating the efficacy of suprascapular nerve block in addition to conventional therapies for adhesive capsulitis. Adhesive capsulitis is a pathology that results in reduced shoulder mobility due to retraction of the periarticular capsule. It may be primary or secondary to traumatic or neurological events, or associated with diabetes in particular. The usual treatment includes re-education sessions to improve joint amplitude and restore shoulder mobility. In persistent forms, intra-articular injection of cortisone is combined with distension of the capsule with a local anaesthetic under radiographic control. In some countries, subscapular nerve block (reversible anaesthesia) is used to improve pain. The combination of arthrodistension and subscapular nerve block has never been performed to accelerate the healing process. The aim of this study is to compare the performance of these two procedures together against the reference technique alone on time to improvement with the number of patients improved at one month according to the Constant score. This score is used to assess shoulder pain and function, with a significant improvement above eight points.

Operative vs Non Operative Management of Adhesive Capsulitis: A Comparative Review

Adhesive capsulitis is a common disabling shoulder condition characterized by pain and progressive restriction of shoulder motion. This study aims to compare recent non-operative vs operative treatment modalities for adhesive capsulitis based on previously published literature to identify current trends and outcomes.

Suprascapular Nerve Block to Improve Tolerance and Outcomes of Shoulder Hydrodistension in Adhesive Capsulitis

Adhesive capsulitis ("frozen shoulder") causes significant pain and loss of shoulder mobility. Shoulder hydrodistension is an established treatment that can improve movement and reduce symptoms, but the procedure itself may be painful and difficult for some patients to tolerate. This randomized clinical trial will evaluate whether performing a suprascapular nerve block with local anesthetic immediately before hydrodistension can reduce pain during the procedure, improve patient comfort, and potentially enhance clinical outcomes. Participants will be randomly assigned to one of two groups: hydrodistension alone, or suprascapular nerve block followed by hydrodistension. Pain, shoulder mobility, functional ability, psychological measures, and quality of life will be assessed at baseline, 1 month, and 3 months after the procedure. The study aims to determine whether adding a suprascapular nerve block provides better tolerability and improved recovery for patients with adhesive capsulitis.

Additional Effects of Thoracic Spine Mobilization Combined With Glenohumeral Joint Mobilization on Pain, Range of Motion, and Functional Disability in Adhesive Capsulitis

Adhesive capsulitis is a debilitating shoulder condition characterized by pain, restricted range of motion (ROM), and significant functional limitations. Conventional treatment primarily targets the glenohumeral joint, often neglecting the role of regional interdependence, particularly the thoracic spine's influence on shoulder mobility. Emerging evidence suggests that thoracic spine mobility plays a crucial role in optimizing shoulder mechanics, yet its therapeutic application in adhesive capsulitis remains underexplored. This study aims to investigate the additional effects of thoracic spine mobilization combined with glenohumeral joint mobilization, providing a more comprehensive rehabilitation approach to enhance pain relief, ROM, and functional outcomes. A randomized controlled trial (RCT) will be conducted over one year at the Rehabilitation Department of Fauji Foundation Hospital (FFH) after obtaining ethical approval. Participants diagnosed with adhesive capsulitis will be selected through non-probability purposive sampling based on predefined inclusion and exclusion criteria. Subjects will be randomly assigned to either the experimental group receiving thoracic spine mobilization alongside glenohumeral joint mobilization or the control group receiving glenohumeral joint mobilization alone. Randomization will be conducted using the coin toss method and block randomization to ensure balanced subject distribution. Outcome measures include the Numeric Pain Rating Scale (NPRS) for pain assessment, the Shoulder Pain and Disability Index (SPADI) for functional disability evaluation, and a goniometer for ROM measurement. Baseline and post-treatment scores will be statistically analyzed using SPSS to determine intervention effectiveness. By integrating thoracic spine mobilization into standard treatment, this study seeks to refine clinical rehabilitation protocols, improve functional recovery, and enhance patient outcomes. Findings may contribute to evidence-based practice, supporting the inclusion of thoracic spine mobilization in treatment guidelines for adhesive capsulitis.

Effects of Gong's Mobilization With and Without Scapular High Lift on Shoulder Range of Motion and Functional Recovery in Adhesive Capsulitis.

This study aims to compare the effectiveness of Gongs Mobilization with and without scapular High-lift in the management of Adhesive Capsulitis, focusing on specific outcomes like pain, functional outcomes, and work productivity.

Neural Mobilization and Capsular Stretching in 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.

Conservative Treatment of Early Adhesive Capsulitis

A prospective, multicentre, randomized controlled study comparing the efficacy of conservative treatment for early adhesive capsulitis

Mulligan Mobilization vs Shockwave Therapy in Adhesive Capsulitis

To investigate and compare the effects of Mulligan mobilization versus shock wave therapy in patients with adhesive capsulitis on Pain intensity level, Range of motion, Functional disability level, Ultrasonographic changes (soft tissue thickness) and Hand grip strength.

Phase 3 Study of the Efficacy and Safety of MR Arthrography Using the NEMO-103 Injection in Patients With Known or Suspected Shoulder Joint Diseases

The goal of this Phase 3 clinical trial is to evaluate whether MR arthrography enhanced with NEMO-103 injection (NEMO-103 Inj.) provides superior diagnostic imaging quality compared to unenhanced MRI in patients with known or suspected shoulder joint disorders, such as rotator cuff tendon tears, labral tears, and articular cartilage injuries. ⦁ The primary objective is to determine whether NEMO-103 Inj.-enhanced MR arthrography offers improved imaging quality in terms of joint distension, contrast resolution, and image sharpness compared to standard unenhanced MRI. Participation Details: * Each participant will undergo two MRI scans: one unenhanced and one enhanced with NEMO-103 Inj. * NEMO-103 Inj. will be administered once, during the second study visit. * Participants will attend a total of three site visits.

Effects of Pectoralis Minor Exercises on Shoulder Pain, Scapular Dyskinesis and Thoracic Expansion in Adhesive Capsulitis Patients

The goal of the current study is to evaluate the effects of pectoralis minor stretching and strengthening with mobility and stability exercises in patients aged 40-70 years with adhesive capsulitis. The main questions it aims to answer are: Does the combination of pectoralis minor stretching and strengthening with mobility and stability exercises significantly reduce shoulder pain compared to mobility and stability exercises only? Does the combination of pectoralis minor stretching and strengthening with mobility and stability exercises improve scapular dyskinesis (scapular movement patterns) and thoracic expansion more effectively than mobility and stability exercises? Participants will be assigned to either an experimental group receiving pectoralis minor stretching and strengthening exercises with mobility and stability exercises or a control group receiving mobility and stability exercises only, and will complete standardized assessments of shoulder pain, scapular dyskinesis (scapular movement patterns) and thoracic expansion before and after the intervention.

The Effects of Immersive Virtual Reality in Patients With Grade 1-2 Adhesive Capsulitis

Adhesive capsulitis (frozen shoulder) is a complex condition characterized by inflammation, fibrosis, and restriction of movement in the shoulder capsule, significantly limiting an individual's participation in daily living activities. It is most commonly observed in individuals aged between 40 and 60 years, and its treatment frequently involves approaches such as manual therapy, exercise, corticosteroid injections, and electrotherapy. However, these conventional methods may be limited by factors such as lack of motivation, pain-related avoidance behavior, and poor treatment adherence. Today, immersive virtual reality technologies introduce a new dimension to rehabilitation by gamifying exercise, providing sensory feedback, and enabling graded exposure through mechanisms such as distraction and engagement. They also enhance motivation and compliance with exercise programs. Studies in the literature have reported that virtual reality-based exercise is an effective method for reducing pain levels in patients diagnosed with frozen shoulder. However, only a limited number of studies have specifically examined the effects of immersive virtual reality in patients with adhesive capsulitis. To date, no study has investigated the impact of immersive virtual reality interventions on sleep and cognitive functions in these patients. Furthermore, the combined effect of patient education, home exercise programs, and immersive virtual reality therapy has not yet been explored. For these reasons, the present study aims to investigate the effects of immersive virtual reality-based exercise therapy on pain, functionality, sleep, and cognitive functions in patients with Grade 1-2 adhesive capsulitis.

Additional Effects of Niel-asher Technique on Patients With Adhesive Capsulitis

The aim of this randomized controlled trial is to find the additional effects of Niel-Asher technique along with sleeper stretch and conventional physical therapy on pain, shoulder ranges of motion and functional disability in patients with Adhesive capsulitis

Adhesive Capsulitis: Prospective Analysis of Efficacy and Financial Impact for Use of Physical Therapy in Treatment

The purpose of this study is to identify individuals 18 or older who have diagnostic presentation of adhesive capsulitis and randomize them into two arms, distinguished by use of physical therapy and steroid injections compared with steroid injections followed by watchful waiting. This prospective study will be used to determine whether there is a significant impact on patient outcome and whether the additional financial burden is justified. There are no experimental interventions for this study. The use of physical therapy, oral and parenteral corticosteroids, and watchful waiting are offered following the standard of care for adhesive capsulitis. Our hypothesis is that patients will not have a significant difference in outcome between the two study arms. One group will undergo regular physical therapy with corticosteroid injections (Arm 1) and the other will have steroid injections during the inflammatory phase only and then be regularly observed (Arm 2). We also hypothesize there will be a significant financial burden associated with the PT arm that is not justified with the possibility of increased symptom reports in that arm.

The Effect of Fascial Treatment in Patients With Adhesive Capsulitis

Our study is unique in that it utilizes a self-designed fascial mobilization protocol and ultrasonographic evaluation for adhesive capsulitis. Therefore, the aim of our study is to investigate the effects of fascial therapy on pain, normal joint range of motion, proprioception, and fascial architecture in patients diagnosed with adhesive capsulitis.

Effects of Exercise on Adhesive Capsulitis

Our study aims to investigate the effects of exercise training on pain, range of motion, functionality and shoulder architecture in patients with adhesive capsulitis.

The Impact of Perineural Injection Therapy for Adhesive Capsulitis.

The goal of this clinical trial is to learn if Perineural Injection Therapy (PIT) works to treat adhesive capsulitis (frozen shoulder) in adults. It will also learn about the safety of PIT. The main questions it aims to answer are: Does PIT reduce shoulder pain and improve shoulder range of motion more effectively than conventional therapy alone? What side effects or medical problems do participants experience when receiving PIT? Researchers will compare PIT to conventional therapy to see if PIT works better to treat adhesive capsulitis. Participants will: Receive either: PIT once weekly for 6 weeks plus physiotherapy and oral analgesics (excluding NSAIDs), or Conventional therapy only (physiotherapy and analgesics including NSAIDs) Attend scheduled follow-up visits at Week 6, 1 month, and 3 months after treatment Perform daily home-based shoulder exercises and record their analgesic use and any side effects in a patient diary

Comparison of Niel-Asher and Spencer Techniques in Frozen Shoulder Patients

This study aims to compare the effectiveness of two manual therapy techniques-Niel-Asher Technique and Spencer Technique-when combined with conventional physiotherapy in treating patients with frozen shoulder (adhesive capsulitis). Frozen shoulder is a painful condition that limits movement and function of the shoulder joint. The study will include 44 adults aged 35 to 65 years who have been diagnosed with stage II frozen shoulder. Participants will be randomly assigned to one of two groups. Both groups will receive standard physiotherapy, including heat therapy, TENS, and stretching exercises. In addition, one group will receive the Niel-Asher Technique, while the other group will receive the Spencer Technique. Pain, range of motion, and shoulder function will be measured before and after a 4-week treatment period using validated tools such as the Visual Analogue Scale (VAS), a goniometer, and the Shoulder Pain and Disability Index (SPADI). The goal is to determine which manual therapy technique is more effective in improving symptoms and function in patients with frozen shoulder.

Bowen Technique Versus Dynamic Soft Tissue Mobilization on Pain, Range of Motion and Functional Disability in Patients With Adhesive Capsulitis

A randomized controlled trial included 72 patients diagnosed with adhesive capsulitis will conduct in University of Lahore Teaching Hospital. The study will complete within 9 months after the approval of synopsis. Patients who fulfilled the inclusion criteria will identified by individual physiotherapist and will enrolled for particular study. Informed written consent will be taken by the patients and will randomly allocated into two groups. The total numbers of sessions will 12 (3 sessions per week). The study will single blinded. The assessor will unaware of the treatment given to both groups. Control group received routine physical therapy with dynamic soft tissue mobilization technique. thermotherapy, trans-cutaneous electrical nerve stimulation, shoulder isometrics and stretching that includes 12 sessions and three times per week. Experimental group received routine physical therapy along with Bowen technique. This includes thermotherapy, trans-cutaneous electrical nerve stimulation, shoulder isometrics and stretching that includes 12 sessions and three times per week

Effect of Gongs Mobilization With Neuromuscular Electrical Stimulation vs Conservative Exercises Among AC

This study evaluates the effectiveness of Gong's mobilization combined with neuromuscular electrical stimulation versus conservative exercises in improving range of motion, pain relief, and functional outcomes in patients with adhesive capsulitis.

Effect of Mulligan Mobilization With or Without Niel Asher Technique in Patients With Adhesive Capsulitis

Adhesive capsulitis is a prevalent condition characterized by pain and stiffness in shoulder joint and surrounding muscles shows decrease range and strength in patients with adhesive capsulitis. This study aims to determine the effect of mulligan mobilization with or without Niel Asher technique on pain, range of motion and disability in patients with adhesive capsulitis. This study will be a randomized controlled trial and will be conducted in Ibne-siena Hospital Multan and Multicare physiotherapy clinic. Non-probability convenience sampling will be used to collect the data. Sample size of subjects with age group between 40 to 60 years will be taken. Data will be collected from the patients having present complaint of adhesive capsulitis. Outcome measures used will be Numeric pain rating scale (NPRS) for shoulder pain and SPADI for shoulder disability and Universal Goniometer (GU) for Range of motion. An informed consent will be taken. Subjects will be selected on the basis of inclusion and exclusion criteria. Subjects will be divided into two groups by random number generator table. Both the Groups will receive heating pad, TENS. Group A will receive Mulligan Mobilizations and Neil Asher technique, and Group B will receive Mulligan mobilization and Conventional Treatment. Outcome measures will be measured at baseline and after 4 weeks. Data analysis will be done by SPSS version 26.