Physiotherapeutic treatment and clinical evaluation of shoulder disorders

Following the general introduction regarding the epidemiology, aetiology, assessment and treatment of the frozen shoulder in Chapter 1 this thesis is divided into two parts: Part I describes the results of the physiotherapeutic treatment of the frozen shoulder by means of mobilization techniques; Part II describes the clinical evaluation of the frozen shoulder and other shoulder disorders by various measurement instruments. Part I Physiotherapeutic treatment of the frozen shoulder. Chapter 2 shows a multiple-subject case study in 7 patients with a unilateral frozen shoulder treated with end-range mobilization techniques. Chapter 3 presents the results of a randomized controlled trial, comparing two treatment strategies with mobilization techniques in 100 patients with a unilateral frozen shoulder. In this trial we performed a cost-utility analysis comparing both mobilization techniques with respect to societal costs and quality-adjusted life years. Next a burden-of-illness study is presented estimating the impact of the frozen shoulder on costs and health. The results of this economic evaluation are presented in Chapter 4. Part II Clinical evaluation of the frozen shoulder and other shoulder disorders. Chapter 5 describes a new method of measuring shoulder positions by means of a three-dimensional electromagnetic tracking system. In a group of 15 healthy volunteers, two observers performed repeated measurements to examine the inter-trial, inter-day, inter-observer and intersubject reliability. In Chapter 6 the clinical application of the three-dimensional electromagnetic tracking device was tested on 10 patients with a unilateral frozen shoulder. The three-dimensional movement patterns of affected and non-affected shoulders were compared before and after 3 months treatment by means of end-range mobilization techniques. The translation, adaptation and validation of the Shoulder Rating Questionnaire into the Dutch language is discussed in Chapter 7 while the responsiveness of the Shoulder Function Assessment scale in 35 patients with rheumatoid arthritis suffering from shoulder complaints is presented in Chapter 8. Chapter 9 describes a comparison between two portable dynamometers in the assessment of shoulder and elbow strength in order to determine the practical applicability and the measurement properties of both devices. Finally, in Chapter 10, the findings and conclusions of the preceding chapters are summarized and indications for further research are discussed.