From the Guidelines
Continuous passive motion (CPM) is not recommended as a primary treatment for frozen shoulder (adhesive capsulitis) due to its limited effectiveness compared to other interventions. The provided evidence does not support the use of CPM in the management of frozen shoulder, and instead, suggests a comprehensive physical therapy program focusing on gentle stretching exercises, joint mobilization techniques, and progressive range of motion activities as a more beneficial approach 1.
Key Considerations
- The pathophysiology of frozen shoulder involves capsular inflammation and fibrosis, which requires gradual stretching and mobilization rather than the repetitive motion that CPM provides.
- A structured rehabilitation program, including pain management with NSAIDs like ibuprofen 400-800mg three times daily or naproxen 500mg twice daily, heat application before exercises, and progressive range of motion activities, is typically recommended for patients with frozen shoulder.
- In more severe cases, corticosteroid injections into the glenohumeral joint or hydrodilatation procedures may be necessary.
- Recovery from frozen shoulder typically progresses through freezing, frozen, and thawing phases, with most patients seeing improvement within 12-18 months even without intervention, though appropriate therapy can accelerate this process and improve outcomes.
Alternative Interventions
- Gentle stretching exercises and joint mobilization techniques to improve range of motion and reduce stiffness.
- Progressive range of motion activities to promote gradual improvement in shoulder mobility.
- Pain management strategies, including NSAIDs and heat application, to reduce discomfort and facilitate exercise.
- Corticosteroid injections or hydrodilatation procedures for more severe cases.
The evidence from 1 focuses on occupational therapy consensus recommendations for functional neurological disorder, which is not directly relevant to the management of frozen shoulder. Therefore, it is not considered in this recommendation. The most effective approach for managing frozen shoulder is a comprehensive physical therapy program that prioritizes gradual stretching, mobilization, and progressive range of motion activities.
From the Research
Role of Continuous Passive Motion (CPM) in Adhesive Capsulitis
- Continuous Passive Motion (CPM) is a method used to prevent joint stiffness and overcome it in patients with adhesive capsulitis (frozen shoulder) 2.
- A study comparing CPM with conventional physiotherapy treatment (CPT) found that CPM provides good pain control in patients with adhesive capsulitis 2.
- The study showed that patients who received CPM treatments had better pain reduction and shoulder pain index scores compared to those who received CPT 2.
- CPM treatment is typically used in combination with other treatments such as physical therapy, nonsteroidal anti-inflammatories, and injection therapies 2, 3.
Comparison with Other Treatments
- While CPM has been shown to be effective in pain reduction, other treatments such as glenohumeral intra-articular corticosteroid injections have also been found to be beneficial in the management of adhesive capsulitis 4.
- Physical therapy, including exercises and manual techniques, is also an important part of the treatment plan for adhesive capsulitis 4, 5, 6.
- The choice of treatment may depend on the stage of the condition, with analgesics and joint injections often used in the first stage and physiotherapy in combination with manual therapy used in the second and third stages 5.
Clinical Evidence
- The evidence for the use of CPM in adhesive capsulitis is based on a randomized, comparative prospective clinical trial that compared CPM with CPT 2.
- The study found that both CPM and CPT resulted in significant improvements in pain and range of motion, but CPM was more effective in pain reduction 2.
- Other studies have also highlighted the importance of physical therapy and other conservative treatments in the management of adhesive capsulitis 4, 5, 6, 3.