The Study of Different Treatment Programs for Patients With Frozen Shoulder
The Study of Different Treatment Programs for Patients With Frozen Shoulder
The purpose of this study is to investigate and compare different treatment programs for
 frozen shoulder by evaluating changes in pain scale and shoulder range of motion(ROM) before
 and after treatment.

 The investigators define frozen shoulder as shoulder pain with ROM limitation,shoulder
 arthrography demonstration of at least two of the following criteria:(1)reduced joint volume
 under 10ml; (2)irregular capsular margin;(3)diminished or absent axillary recess.

 Afer define diagnosis of frozen shoulder ,patients are randomly assigned to different
 Subgroups for different treatment programs.Each subgroup consists of ten patients.

 Each treatment program performed for 6 consecutive courses with each course consists of 6
 days.Total 36 treatment days.

 The treatment programs and grouping as follow:

 Group 1:Physical modalities + therapeutic exercise Group 2:Physical modalities + therapeutic
 exercise+ intra-articular injection of steroid Gouup 3:Therapeutic exercise Before
 treatment,after each consecutive course (6days) of treatment,and at the end of treatment
 program, the investigators evaluate the range of motion and muscle strength of shoulder
 flexion,external rotation,abduction and internal rotation. Severity of shoulder pain also
 evaluated by pain scale before and after treatment program.

 The ROM before and after treatment program is compared by paired t-test.The ROM change before
 and after treatment in different groups compared by analysis of variance(ANOVA). The ROM
 change after consecutive treatment courses(6 days) are compared by multivariate ANOVA.Pain
 scale before and after treatment is compared by paired t-test.
(A) Diagnosis: Patients with shoulder pain onset within 6 months are included in our study to
 evaluate shoulder range of motion (ROM) in flexion, external rotation,abduction and internal
 rotation by goniometer(9).Restriction in ROM is noted.Cases with possible diagnosis of frozen
 shoulder is arranged to receive shoulder arthrography(10,11,12)which is performed by the
 administration of contrast media(2ml) into joint space,followed by injection of air.Injection
 is discontinued when resistance is felt.The joint space capacity is defined as the total
 volume of contrast media and air that could be injected without resistance.All procedures are
 conducted by the same well experienced radiologist to keep measurement reproducible.The
 arthrographic findings should met at least two of the following criteria for final diagnosis
 of frozen shoulder:(1)joint space capacity less than 10ml;(2)irregularity of capsular margin;
 (3)diminished or absent axillary recess.Once frozen shoulder is confirmed,the patient is
 randomly arranged to receive a specific treatment program.

 (B) Treatment program:

 The treatment program and grouping arranged as follow:

 Group 1:Physical modalities + therapeutic exercise Group 2:Physical modalities + therapeutic
 exercise+ intra-articular injection of steroid Gouup 3:Therapeutic exercise

 (C) Sample size estimation: We assume α=0.05,power=1-α=0.95,from previous
 literature(10),change of ROM in flexion, abduction, external rotation, internal rotation
 before and after treatment was estimated as 40,40,40,20 degrees respectively,,standard
 deviation was 10,15,10,10 degrees respectively.Therefore,standard effective size was
 4,2.6,4,2 respectively.From applied linear statistical models(13)fourth edition,1996,if
 α=0.05 sample size estimated as 5,7,5,10 Respectively.Therefore,sample size in each group is
 estimated as 10.
Inclusion Criteria:

 -  Patients with shoulder pain and range of motion limitaiton

 Exclusion Criteria:

 -  Rotator tear