Mulligan Mobilization vs Shockwave Therapy in Adhesive Capsulitis

Mulligan Mobilization Versus Extracorporeal Shockwave Therapy on Ultrasonographic Changes in Patients With Adhesive Capsulitis

To investigate and compare the effects of Mulligan mobilization versus shock wave therapy in patients with adhesive capsulitis on Pain intensity level, Range of motion, Functional disability level, Ultrasonographic changes (soft tissue thickness) and Hand grip strength.

Study Overview

• Status: Active, not recruiting
• Conditions: Adhesive Capsulitis
• Intervention / Treatment: Other: Mulligan mobilization; Other: Conventional treatment; Device: Shockwave

Detailed Description

sixty patients of both genders according to sample size calculation, referred from orthopedist, diagnosed adhesive capsulitis patients. they screened according to inclusion and exclusion criteria. Their age between 40 and 60 years was randomly allocated to three treatment groups.

• Group A (study group) (n=20) will receive mulligan technique and conventional treatment.
• Group B (study group) (n=20) will receive extracorporeal shockwave therapy and conventional treatment.
• Group C (control group) (n=20) will receive conventional treatment only.

Inclusion criteria: patients that will be included in the study will be referred from orthopedic physician with:

1. Patients referred from orthopedist and diagnosed as frozen shoulder
2. The age of the participant will be from 40-60 (Agarwal S., et al.2016).
3. Body mass index from 25- 30 kg/m2.
4. having a painful stiff shoulder for at least 3 months
5. having limited ROM of a shoulder joint (ROM losses of 25% or greater compared with the noninvolved shoulder in at least 2 of the following shoulder motions: glenohumeral flexion, abduction and lateral rotation.
6. ability to complete Disabilities of the Arm, Shoulder and Hand questionnaires (DASH).

Exclusion criteria:

1. history of surgery on the particular shoulder
2. Rheumatoid arthritis
3. painful stiff shoulder after a severe trauma
4. fracture of the shoulder complex
5. rotator cuff rupture
6. tendon calcification.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Giza, Egypt, 12612
    • Faculty of Physical Therapy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Patients referred from orthopedist and diagnosed as frozen shoulder The age of the participant will be from 40-60 (Agarwal S., et al.2016). Body mass index from 25- 30 kg/m2. having a painful stiff shoulder for at least 3 months having limited ROM of a shoulder joint (ROM losses of 25% or greater compared with the noninvolved shoulder in at least 2 of the following shoulder motions: glenohumeral flexion, abduction and lateral rotation.

ability to complete Disabilities of the Arm, Shoulder and Hand questionnaires (DASH).

Exclusion Criteria:

history of surgery on the particular shoulder Rheumatoid arthritis painful stiff shoulder after a severe trauma fracture of the shoulder complex rotator cuff rupture tendon calcification.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: - Group A (study group); received mulligan technique and conventional treatment	Other: Mulligan mobilization; Mobilization with movement (MWM) is the concurrent application of sustained accessory mobilization applied by a therapist and an active physiological movement to end range applied by the patient. Passive end-of-range overpressure, or stretching, is then delivered without pain as a barrier; Other Names: Mobilization with movement; Other: Conventional treatment; Conventional treatment will be axillary ultrasound and laser ,low loading stretching exercise and home program exercises
Experimental: Group B (study group); received extracorporeal shockwave therapy and conventional treatment.	Other: Conventional treatment; Conventional treatment will be axillary ultrasound and laser ,low loading stretching exercise and home program exercises; Device: Shockwave; From sitting with shoulder abducted at 45 degree and elbow flexed and the forearm rested on flat surface, The patients in the intervention group B received shock wave therapy once a week for 4 weeks. The focus probe sets were used and, in each session, patients received ESWT from anterior and posterior directions (on the average 1200 shocks between 0.1 and 0.3 mJ/mm2) up to the maximum threshold of pain tolerance in the shoulder
Experimental: Group C (control group); received conventional treatment only.	Other: Conventional treatment; Conventional treatment will be axillary ultrasound and laser ,low loading stretching exercise and home program exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity level.	measured by Visual analog scale	4 weeks
Range of motion.	measured by digital goniometer	4 weeks
Functional disability level.	Determined by Disabilities of the arm, shoulder and hand questionnaire (DASH)	4 weeks
Soft tissue thickness (Capsule thickness)	measured by musculoskeletal ultrasonography	4 weeks
Hand grip strength	Measured by hand dynamometer	4 weeks

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Principal Investigator: Mohamed R Gaber, Asst. lect., Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2025
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): February 1, 2026

Study Registration Dates

• First Submitted: December 16, 2025
• First Submitted That Met QC Criteria: December 16, 2025
• First Posted (Actual): December 30, 2025

Study Record Updates

• Last Update Posted (Actual): December 30, 2025
• Last Update Submitted That Met QC Criteria: December 16, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Adhesive capsulitis; Mulligan mobilization; EXTRACORPOREAL SHOCKWAVE THERAPY; ULTRASONOGRAPHIC CHANGES
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Joint Diseases; Bursitis; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Physiological Phenomena; Movement
• Other Study ID Numbers: 012/005863

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No