Immediate Effects of Angular Joint Mobilization (a New Concept of Joint Mobilization) on Pain, Range of Motion, and Disability in a Patient with Shoulder Adhesive Capsulitis: A Case Report

Patient: Female, 53 Final Diagnosis: Adhesive capsulitis Symptoms: Pain • limited range of motion Medication: None Clinical Procedure: Manual therapy (joint mobilization) Specialty: Physical Therapy OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Adhesive capsulitis is a common disabling condition, with reviews reporting up to 5.3% of the population being affected, the burden placed upon individuals and healthcare services may therefore be considered substantial. For recovering the normal extensibility of the capsule in individuals with adhesive capsulitis of the shoulder, passive stretching of the capsule through end-range mobilization has been suggested. Recently, the concept of joint mobilization into angular joint mobilization (AJM), which is rotational joint mobilization with joint axis shift, was proposed. This case report aimed to investigate the immediate effect of AJM on pain, range of motion (ROM), and disability in a patient with shoulder adhesive capsulitis. CASE REPORT: The patient was a 53-year-old woman who was diagnosed with left shoulder adhesive capsulitis. Her left shoulder gradually stiffened, affecting functional activity. The patient attended 12 joint mobilization sessions over a period of six weeks (two times per week). The intervention consisted of rotary oscillations of the left shoulder, which were applied with overpressure and stops before the end of the pathological limit. After intervention, the patient reported 3/100 pain intensity on the visual analogue scale (VAS) (before versus after: 58 versus 3). Active ROM improved by 51° in flexion, 76.4° in abduction, 38.7° in external rotation, and 51.4° in active internal rotation. Passive ROM improved by 49° in flexion, 74.6° in abduction, 39.4° in external rotation, 51.4° in internal rotation. The total shoulder, pain and disability index (SPADI) score improved by 53.9%. CONCLUSIONS: The patient reacted positively to AJM, resulting in improved shoulder pain, ROM, and disability, and the results suggest that AJM allow consideration in the management of individuals with adhesive capsulitis.