Background: Frozen shoulder or idiopathic adhesive capsulitis is an enigma of musculo-skeletal medicine. It is a difficult condition to treat and its etiology is still unknown. Aim: The aim of this study is to investigate whether acupuncture has a role in the management of frozen shoulder. Objectives: An in-depth literature review was conducted on all aspects related to the current concepts and treatments for frozen shoulder. Although there were discussions on associated conditions and possible causes of frozen shoulder, there is currently no consensus on its management. Acupuncture has been used successfully as a treatment for frozen shoulder by many eastern practitioners. Unfortunately, their claims could not be substantiated due to a lack of properly conducted clinical trials. An acupuncture treatment protocol for the management of frozen shoulder was designed based on both Traditional Chinese Medicine (TCM) and Anatomical principles. This protocol was then tested with a clinical trial. Methods: A pilot study, using a prospective case series of 20 patients suffering with the “adhesive phase” of frozen shoulder, was conducted to test the effectiveness of the acupuncture treatment protocol. This study included specific selection and exclusion criteria; an objective assessment of the range of movement and subjective assessments on the quality of life and pain. All data were collated and analysed with SPSS version 12. The pretreatment and post-treatment data were tested using both parametric paired sample t test and non-parametric Wilcoxon signed-rank test. Results: The patients’ profile confirmed the affected age group and gender distribution to be similar to those in the literature search. Unfortunately, due to the small sample size, there were no significant associated conditions demonstrated. There were twice as many cases of primary frozen shoulder than secondary frozen shoulder in this study. These analyses suggested that there were significant changes in all three areas of assessment – range of shoulder movement, quality of life and visual analogue pain scale (p&lt0.001). At completion of treatment, the result revealed that the acupuncture treatment protocol was successful in 60%, and moderately successful in 15%, of the 20 cases tested. This outcome was compared with the study by Omari and Bunker which showed only 12% success with conservative western medical treatments, suggesting that acupuncture may be better than conservative western medical treatments. Conclusion: Acupuncture treatment is less costly and has minimal side effects. It should be part of the non-procedural modalities offered to patients suffering with frozen shoulder. For patients who have failed western conservative managements, a trial of acupuncture treatment should be considered prior to embarking on the more invasive interventions..

Bakgrund: Frusen skuldra (FS) är ett smärttillstånd som drabbar 2-5% av befolkningen och som påverkar skulderfunktionen. I dagsläget finns det ingen konsensus kring den bästa behandlingsformen vid FS, dock anses proprioceptiv neuromuskulär facilitering (PNF) ge minskad smärta och ökad rörlighet (ROM) samt skulderfunktion.   Syfte: Att kartlägga evidensen av PNF som behandling vid FS. Det var även att granska kvaliteten i inkluderade studier och att studera effekten av PNF på skulderfunktion och ROM. Metod: En systematisk litteraturstudie. Sökningen utfördes i databaserna PubMed, Cochrane, Web of Science samt Google scholar. Artiklarna kvalitetsgranskades med PEDro scale och tillförlitligheten graderades med GRADEstud.  Resultatsammanfattning: Åtta artiklar inkluderades i studien med totalt 360 deltagare. Enligt PEDro scale varierade kvaliteten i studierna mellan tre till åtta poäng. Evidensgraderingen enligt GRADEstud visade mycket låg (+) evidens gällande skulderfunktion och låg (++) evidens gällande ROM. Graderingen baserades på fyra studier av hög kvalitet vid skulderfunktion respektive ROM. Studiernas resultat var motstridiga gällande huruvida PNF ger en signifikant positiv effekt på skulderfunktion och ROM vid FS. Konklusion: Det finns mycket låg (+) evidens för att PNF skulle ha en effekt på skulderfunktionen och en låg (++) evidens för att PNF har en effekt på ROM. För att förtydliga evidensen och användningen av PNF behövs fler studier av hög kvalitet och med liknande tillvägagångssätt. / Background: Frozen shoulder (FS) is a painful condition affecting 2-5% of the population and it affects the shoulder function. Currently there’s no consensus to which treatment is most effective in FS. However, proprioceptive neuromuscular facilitation (PNF) is assumed to bring pain relief and increase range of motion (ROM) and shoulder function.  Objective: To review the evidence regarding the effect of PNF as treatment in patients with FS. It’s also to examine the quality of included studies and to study the effect of PNF on shoulder function and ROM.  Method: A systematic review. The search was conducted in the databases of PubMed, Cochrane, Web of Science and Google scholar. The quality was assessed according to PEDro scale and the reliability with GRADEstud.  Results: Eight studies were included with a total of 360 participants. The quality of the studies ranged between three to eight points according to PEDro scale. According to GRADEstud PNF received very low (+) evidence for shoulder function and low (++) evidence for ROM. The grading was based on four, high quality studies for both shoulder function and ROM. The included studies were conflicting regarding whether PNF had a significant, positive effect on shoulder function and ROM in FS.   Conclusion: There’s very low (+) evidence that PNF would have an effect on shoulder function and low (++) evidence that PNF has an effect on ROM. In order to clarify the evidence there’s a need for future well-conducted studies with a similar approach.

Theoretical part of the thesis is a scientific research of latest articles about frozen shoulder syndrome with accent to immunohistochemical level. At the same time, based on scientific literature it aims to clarify and statistically prove multifactorial causes of this syndrome especially in women going through hormonal changes. Psychosocial factors are also taken into account in this study and examined by unique questionnaire that was made expressly for this thesis. The questionnaire originates from internationally accepted clinimetrics such as VAS, SPADI, DASH score and most importantly SF-36. The theoretical research part also consists of "Therapy" chapter which describes latest trending treatment method for this condition. Experimental part, which consists of few case reports, focuses on a group of female patients who underwent range of motion measurement including functional testing of the affected limb. Next step followed was consecutive twelve minutes exercise on bicycle. They were controlled not to cross over anaerobic threshold. Level of exercise was controlled by predicted heart rate and estimation of the threshold by basic calculation and also by subjective Borg's scale of effort determined by the patient. After the bicycle exercise the range of motion was measured again and compared to the...