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Background
Adhesive capsulitis (AC) is a musculoskeletal disorder characterised by painful limitation of upper limb activities that is associated with a combination of pain and limitation of passive movements [1]. The joint capsule of the shoulder becomes inflamed and gradual limitation of shoulder range of motion occurs; the condition is often explained as a stiff shoulder [2]. Aetiology is unknown but cardiovascular disease, cervical spine conditions, diabetes, sudden trauma, stroke, Parkinson’s disease, coronary artery bypass grafting (CABG) and humeral fractures are often associated with AC [3]. Moreover, some intrinsic factors such as injuries to the rotator cuff muscles, long head of the biceps tendon, joint inflammation and calcification of the biceps tendon and other tendons may contribute to AC [4].
AC is believed to be a self-limiting condition lasting 2 to 3 years; some studies have reported that up to 40% of patients have persistent symptoms and stiffness even after 3 years because pain and inflammation are self-remitting but the muscle atrophy and joint pathology are consistent if not treated [5]. It is difficult to find an actual population prevalence of AC; the incidence is evident between 3 and 5% of the normal population in a given year [6, 7]. AC greatly affects between 40 and 60 years of aged people, with females being higher than males [6]. About 20 to 30% of people having AC in one shoulder develop symptoms in the opposite shoulder after a certain period [7].
The biomechanical abnormalities of the scapulohumeral rhythm and muscle control of the prime movers of the shoulder especially the deltoid and rotator cuff play vital role in developing AC associated musculoskeletal issues [8]. Moreover, the painful movement contributes to kinesiophobia that gradually hinders the flexibility of the muscles of shoulder and causes disruption to the scapula-humeral synergistic relationship [9]. The medical treatment for AC involves the use of nonsteroidal anti-inflammatory medications, short-term oral corticosteroids, intra-articular corticosteroid injections, physiotherapy, acupuncture and hydro-dilatation [10]. The role of physiotherapy is to facilitate the arthrokinematic motion of glenohumeral joint, acromio-clavicular joint and improve the osteokinematics of these joints including scapula-thoracic articulation [11]. The gradual mobility and motion facilitate a range of motion (ROM), mimic the inflammatory mediators and break down the scars of the joint capsule [12]. The convex-concave...