Wong Christopher Kevin, Strang Bryanna L, Schram Galen A, Mercer Elizabeth A, Kesting Rebecca S, Deo Kabi S
Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA.
Program in Physical Therapy, Columbia University, New York, NY, USA.
J Man Manip Ther. 2018 May;26(2):109-118. doi: 10.1080/10669817.2018.1432524. Epub 2018 Mar 26.
Although the shoulder is known to move together with the scapula and other upper quarter joints, the current frozen shoulder clinical practice guidelines describe only physical therapy study treatments directed to the shoulder. None received a strong recommendation, highlighting the need for alternate interventions. This retrospective case series describes a pragmatic regional interdependence approach to frozen shoulder with impairment and functional outcomes, noting whether final ROM approached normal.
Five consecutive patients referred with frozen shoulder diagnoses attended 11-21 sessions over 5-10 weeks with one physical therapist. Treatment addressed inter-related regions (shoulder, shoulder girdle, scapulothoracic/humerothoracic, and spine) following a pragmatic approach using impairment-based interventions (joint/soft tissue mobilization, muscle stretching/strengthening) as well as patient education, modalities and warm up that addressed individual presentations.
All patients improved on all outcomes. Mean shoulder ROM at discharge, the impairment outcome, demonstrated large effect size increases: flexion (117 ± 10-179 ± 12, = 5.9), abduction (74 ± 8-175 ± 9, = 9.3), external rotation (23 ± 7-89 ± 2, = 12.0). The Disability of Arm Shoulder Hand functional outcome score upon follow up demonstrated a large effect size improvement ( = 1.5) from 40.0 ± 19.4-6.2 ± 3.7. Final ROM approached normal.
This case series utilized a regional interdependence approach to frozen shoulder that included manual therapy interventions directed to consistent upper quarter body segments. Shoulder ROM was returned to near normal with functional improvements evident months after discharge. A pragmatic regional interdependence approach addressing multiple joints related to shoulder function may benefit other people with frozen shoulder.
尽管已知肩部会与肩胛骨及其他上肢关节协同运动，但当前的肩周炎临床实践指南仅描述了针对肩部的物理治疗研究性治疗方法。这些方法均未获得强烈推荐，这凸显了替代干预措施的必要性。本回顾性病例系列描述了一种针对肩周炎的实用区域相互依存方法及其损伤和功能结局，记录最终的关节活动度（ROM）是否接近正常。
五名连续被诊断为肩周炎的患者在5至10周内与一名物理治疗师进行了11至21次治疗。治疗采用实用方法，针对相互关联的区域（肩部、肩胛带、肩胛胸壁/肱骨胸壁以及脊柱），使用基于损伤的干预措施（关节/软组织松动术、肌肉拉伸/强化训练），以及针对个体表现的患者教育、物理治疗方式和热身训练。
所有患者在各项结局指标上均有改善。出院时的平均肩部ROM（损伤结局指标）显示出效应量大幅增加：前屈（117±10 - 179±12，效应量 = 5.9），外展（74±8 - 175±9，效应量 = 9.3），外旋（23±7 - 89±2，效应量 = 12.0）。随访时的手臂、肩部和手部功能障碍功能结局评分显示出效应量大幅改善（效应量 = 1.5），从40.0±19.4降至6.2±3.7。最终的ROM接近正常。
本病例系列采用了针对肩周炎的区域相互依存方法，其中包括针对上肢特定身体节段的手法治疗干预措施。肩部ROM恢复至接近正常水平，且出院数月后功能改善明显。一种针对与肩部功能相关的多个关节的实用区域相互依存方法可能会使其他肩周炎患者受益。
4级。
