Chung, Hoe-Jeong
(Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine)
,
Kim, Doo-Sup
(Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine)
,
Yoon, Yeo-Seung
(Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine)
,
Lee, Dong-Woo
(Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine)
,
Hong, Kyung-Jin
(Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine)
Background: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. Methods: Thirty patients diagnosed with...
Background: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. Methods: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg+lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. Results: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of $2.4{\pm}2.1$ points, which was lower, with statistical significance, than the VAS score of group 2, which was $4.4{\pm}3.1$ points (p<0.001). Conclusions: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.
Background: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. Methods: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg+lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. Results: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of $2.4{\pm}2.1$ points, which was lower, with statistical significance, than the VAS score of group 2, which was $4.4{\pm}3.1$ points (p<0.001). Conclusions: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.
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제안 방법
All patients were evaluated before the rehabilitation program was started and follow-ups were done every 4 weeks after it began. The subjects’ passive ROMs were measured and a survey on their pain and clinical score was administered during the final follow-up.
Pain was graded using a visual analog scale (VAS) of 0 to 10 with 10 being severe pain and 0 being no pain. For evaluation of the clinical score, Constant score was used and was measured before the program and at the final follow up. Forward elevation, external rotation on neutral state, and internal rotation at abduction were measured in 10 degrees, summed up, and then divided by the ROM of the normal side to determine the ratio.
Anatomic shoulder CPM machine (Centura; Kinetec, Tournes, France) was used in the rehabilitation process; the gonionmeter for measuring ROM. Research was conducted on 30 patients who signed the informed consent form for this research and were divided into 2 groups of 15 people each through random sampling. Group 1 underwent rehabilitation using CPM, and group 2 received conservative treatment.
The principle of group 2 was self-treatment after undergoing passive–stretching education in the physical therapy department. The program started with forward elevation exercise, external rotation, and exercise using a pulley. Internal rotation and adduction were added depending on the improvement of the ROM.
The subjects’ passive ROMs were measured and a survey on their pain and clinical score was administered during the final follow-up.
Similar to how CPM has become a basic procedure in knee joint situations, we believe that CPM can play a major role in rehabilitation of the shoulder joint through more research on the effectiveness of CPM on various shoulder diseases. Therefore, this prospective research was conducted on subjects with frozen shoulder who were divided into two groups, with one group undergoing rehabilitation with CPM and the other group without it to evaluate the clinical results and effectiveness of CPM.
Such a short follow-up period can conceal the true impact of CPM as the healing process of idiopathic frozen shoulder is believed to be over two years. This study lengthened the time of treatment to six months and monthly follow-up to six months, attempting to clarify any significant differences in clinical results between treatment using CPM and conventional rehabilitation treatment.
대상 데이터
The research was conducted from March 2012 to February 2013, after being approved by the Yonsei University Wonju College of Medicine’s Institutional Review Board. The subjects were 30 patients diagnosed with idiopathic frozen shoulder. Inclusion criteria were treatment with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg+lidocaine 4 ml) injection and follow-up by a step by step systematic shoulder ROM exercise.
데이터처리
Forward elevation, external rotation on neutral state, and internal rotation at abduction were measured in 10 degrees, summed up, and then divided by the ROM of the normal side to determine the ratio. The statistical review performed for this research was the independent t-test using the IBM SPSS ver. 20.0 (IBM Co., Armonk, NY, USA) statistics program.
성능/효과
However, the VAS score showed great improvement in the CPM group compared to the control group starting from week 4 and a statistically significant result was recorded at the last follow-up. This result agrees with a research study conducted by Dundar et al.
In this study, performance of CPM showed the greatest improvement in the first four weeks of treatment in all evaluation values. In addition, constant improvements in not only ROM but also in clinical outcomes were observed during 24 weeks of treatment and follow-up. However, no statistically significant differences in all values and evaluation criteria, except the VAS score, were observed between the two groups.
In this study, performance of CPM showed the greatest improvement in the first four weeks of treatment in all evaluation values. In addition, constant improvements in not only ROM but also in clinical outcomes were observed during 24 weeks of treatment and follow-up.
후속연구
However, CPM treatment allows the patient have the main role in his or her own rehabilitation, resulting in satisfaction with their rehabilitation process even in situations where there is a lack of qualified professionals. In addition, study using CPM in treatment of idiopathic frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.
참고문헌 (11)
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