Vermeulen H M, Obermann W R, Burger B J, Kok G J, Rozing P M, van Den Ende C H
Department of Physical Therapy, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
Phys Ther. 2000 Dec;80(12):1204-13.
The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis.
Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment.
After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90-145) to 147 degrees (SD=18, range=115-175), and mean lateral rotation increased from 13 degrees (SD=13, range=0-40) to 31 degrees (SD=11, range=15-50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70-125) to 159 degrees (SD=24, range 110-180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95-145) to 154 degrees (SD=19, range=120-180), and mean lateral rotation increased from 21 degrees (SD=11, range=10-45) to 41 degrees (SD=8, range=35-55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6-15) to 15 cc (SD=3, range=10-20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up.
There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted.
本病例报告旨在描述终末范围松动技术在粘连性肩关节囊炎患者管理中的应用。
4名男性和3名女性（平均年龄 = 50.2岁，标准差 = 6.0，范围 = 41 - 65岁）患有盂肱关节粘连性肩关节囊炎（平均病程 = 8.4个月，标准差 = 3.3，范围 = 3 - 12个月），接受终末范围松动技术治疗，每周两次，共3个月。在治疗前、治疗3个月后以及9个月随访时，由同一名观察者测量疼痛、关节活动度和功能指标。此外，在治疗初始和3个月后进行关节造影评估关节容量（即关节可容纳的液体量），并在X线平片上测量盂肱关节外展的活动范围。
治疗3个月后，主动活动范围增加。平均外展从91度（标准差 = 16，范围 = 70 - 120度）增加到151度（标准差 = 22，范围 = 110 - 170度），矢状面平均屈曲从113度（标准差 = 17，范围 = 90 - 145度）增加到147度（标准差 = 18，范围 = 115 - 175度），平均外旋从13度（标准差 = 13，范围 = 0 - 40度）增加到31度（标准差 = 11，范围 = 15 - 50度）。被动活动范围也增加：平均外展从96度（标准差 = 18，范围 = 70 - 125度）增加到159度（标准差 = 24，范围110 - 180度），矢状面平均屈曲从120度（标准差 = 16，范围 = 95 - 145度）增加到154度（标准差 = 19，范围 = 120 - 180度），平均外旋从21度（标准差 = 11，范围 = 10 - 45度）增加到41度（标准差 = 8，范围 = 35 - 55度）。盂肱关节囊的平均容量（其容纳液体的能力）从10立方厘米（标准差 = 3，范围 = 6 - 15立方厘米）增加到15立方厘米（标准差 = 3，范围 = 10 - 20立方厘米）。4名患者将其肩部功能改善评为优秀，2名患者评为良好，1名患者评为中等。所有患者在9个月随访时保持了关节活动度的改善。
强化松动技术在粘连性肩关节囊炎的治疗中似乎有作用。有必要进行关于终末范围松动技术治疗粘连性肩关节囊炎有效性的对照研究。
