***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Clinical observations have suggested a relationship between shoulder range of movement ( ROM ) and lateral epicondylalgia . This study reports the effect of a single intervention of a mobilization with movement ( MWM ) applied to the elbow , on shoulder rotation ROM in subjects with lateral epicondylalgia . Twenty-three subjects with lateral epicondylalgia were included . In a one-group pretest-post-test design , ROM of shoulder internal and external rotation were measured by goniometer before and after the application of the MWM , of both the unaffected and the affected limbs . Significant differences in pre-intervention external rotation ROM were found between unaffected and affected shoulders of subjects with lateral epicondylalgia , but no significant difference remained post-intervention . It may be concluded that restriction of shoulder rotation ROM is present in patients with lateral epicondylalgia , probably due to a facilitated level of shoulder rotator muscle tone . Shoulder internal and external rotation ROM increases significantly following MWM to the elbow , in subjects with unilateral lateral epicondylalgia . Surprisingly , these ROM increases are also apparent on the ' unaffected ' limb . These findings suggest that the MWM causes a neurophysiologically mediated decrease in resting muscle tone BACKGROUND AND PURPOSE In many physical therapy programs for subjects with adhesive capsulitis of the shoulder , mobilization techniques are an important part of the intervention . The purpose of this study was to compare the effectiveness of high- grade mobilization techniques ( HGMT ) with that of low- grade mobilization techniques ( LGMT ) in subjects with adhesive capsulitis of the shoulder . SUBJECTS One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a > or = 50 % decrease in passive joint mobility relative to the nonaffected side were enrolled in this study . METHODS Subjects r and omly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint , and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone . The duration of treatment was a maximum of 12 weeks ( 24 sessions ) in both groups . Subjects were assessed at baseline and at 3 , 6 , and 12 months by a masked assessor . Primary outcome measures included active and passive range of motion and shoulder disability ( Shoulder Rating Question naire [ SRQ ] and Shoulder Disability Question naire [ SDQ ] ) . An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year , respectively . RESULTS Overall , subjects in both groups improved over 12 months . Statistically significant greater change scores were found in the HGMT group for passive abduction ( at the time points 3 and 12 months ) , and for active and passive external rotation ( at 12 months ) . A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation , SRQ , and SDQ with greater change scores in the HGMT group . DISCUSSION AND CONCLUSION In subjects with adhesive capsulitis of the shoulder , HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs , with the overall differences between the 2 interventions being small PRINCIPLE A r and omised , comparative prospect i ve clinical trial was planned to compare the early response to different rehabilitation methods for adhesive capsulitis taking into consideration the clinical efficacy and the cost effectiveness of the methods . METHODS Forty patients with adhesive capsulitis were r and omised into two treatment groups . The first group ( CYR ) received the Cyriax approach of deep friction massage and mobilisation exercises three times weekly . The second group ( PT ) had daily physical therapy including hot pack and short wave diathermy application . Both groups concluded their treatments with stretching exercises and were also instructed to a daily home exercise program . The primary end point of the study was to reach 80 % of the normal passive range of motion ( ROM ) of the shoulder in all planes within a period of two weeks . Secondary end points were the overall ROM and pain response ( spontaneous pain , night pain and pain with motion ) to each treatment . RESULTS 19 patients in the CYR group ( 95 % ) and 13 patients in the PT group ( 65 % ) reached sufficient ROM at the end of the second week ( p < 0.05 ) . The improvement in shoulder flexion , inner and outer rotation values and the decrease in pain with motion were significantly better in the CYR group after the first week of treatment . CONCLUSION The Cyriax method of rehabilitation provides a faster and better response than the conventional physical therapy methods in the early phase of treatment in adhesive capsulitis . The method is non-invasive , effective and requires fewer hospital visits for a sufficient early response Seventy-seven patients with idiopathic frozen shoulder syndrome were included in a prospect i ve study to compare the effect of intensive physical rehabilitation treatment , including passive stretching and manual mobilization ( stretching group ) versus supportive therapy and exercises within the pain limits ( supervised neglect group ) . There were no significant differences in age , sex , time elapsed since onset , and disease severity at inclusion . All patients were followed up for 24 months after the start of treatment . In the patients treated with supervised neglect , 89 % had normal or near-normal painless shoulder function ( Constant score > or = 80 ) at the end of the observation period . This end result was reached by 64 % within 12 months . In contrast , of the group receiving intensive physical therapy treatment , only 63 % reached a Constant score of 80 or higher after 24 months . Both the level of the Constant score at the end of the study and the moment a Constant score of 80 or higher was reached confirm that supervised neglect yields better outcomes than intensive physical therapy and passive stretching in patients with frozen shoulder Treatment strategies targeting abnormal shoulder kinematics may prevent pathology or if the pathology develops , shorten its duration . We examined the effectiveness of the end-range mobilization/scapular mobilization treatment approach ( EMSMTA ) in a subgroup of subjects with frozen shoulder syndrome ( FSS ) . Based on the kinematics criteria from a prediction method , 34 subjects with FSS were recruited . Eleven subjects were assigned to the control group , and 23 subjects who met the criteria were r and omly assigned to the criteria -control group  with a st and ardized physical therapy program or to the EMSMTA group . Subjects attended treatment sessions twice a week for 8 weeks . Range of motion ( ROM ) , disability score , and shoulder complex kinematics were obtained at the beginning , 4 weeks , and 8 weeks . Subjects in the EMSMTA group experienced greater improvement in outcomes compared with the criteria -control group at 4 weeks ( mean difference=0.2 of normalized h and -behind-back reach ) and 8 weeks ( mean difference=22.4 degrees humeral external rotation , 0.31 of normalized h and -behind-back reach , 7.5 disability , 5 degrees tipping and 0.32 rhythm ratio ) . Similar improvements were found between the EMSMTA group and control group . The EMSMTA was more effective than a st and ardized physical therapy program in a subgroup of subjects who fit the criteria from a prediction method OBJECTIVE To evaluate Mulligan 's technique for relieving pain and improving functional capacity of the shoulder in patients with adhesive capsulitis in the stiffness phase . DESIGN R and omized controlled study . METHODS A total of 40 subjects were r and omly allocated into 2 groups : ( i ) group 1 ( n = 20 ) were treated with hot pack , transcutaneous electrical nerve stimulation , and passive stretching exercises ; ( ii ) group 2 ( n = 20 ) were treated with hot pack , transcutaneous electrical nerve stimulation and Mulligan 's technique . Mulligan 's technique combines the sustained application of a manual " gliding " force to a joint , with the aim of repositioning bone positional faults while enabling concurrent physiological ( osteo-kinematic ) motion of the joint . All cases were evaluated using visual analogue scales for pain , passive and active range of motion , Constant score , Shoulder Disability Question naire , and patient and therapist satisfaction at baseline , after completion of treatment sessions and at the end of 3 months of follow-up . RESULTS Marked improvement was noted in both groups after completion of treatment sessions and at the third month of follow-up compared with baseline . The improvements in outcome measures , namely pain , range of motion , shoulder scores , and patient and physiotherapist satisfaction , were significantly greater in subjects in group 2 , who were treated with Mulligan 's technique . CONCLUSION Mulligan 's technique and passive stretching exercises are both effective in reducing pain , and restoring range of motion and function . However , compared with stretching exercises , Mulligan 's technique led to better improvements in terms of pain , range of motion , shoulder scores , and patient and physiotherapist satisfaction Background Adhesive Capsulitis ( AC ) affects patient of all ages , and stretching protocol s are commonly prescribed for this condition . Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis . The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC . Methods This controlled , cohort study , was conducted at four physical therapy , sports medicine clinics in Texas and California . Sixty-two patients diagnosed with Stage II Adhesive Capsulitis were grouped by intervention . The intervention categories were as follows : Group I ( Control ) ; Group II ( Physical Therapy exclusively with st and ardized protocol s ) ; Group III ; ( Shoulder Dynasplint system exclusively ) ; Group IV ( Combined treatment with Shoulder Dynasplint and st and ardized Physical Therapy ) . The duration of this study was 90 days for all groups , and the main outcome measures were change in active , external rotation . Results Significant difference was found for all treatment groups ( p < 0.001 ) following a one-way ANOVA . The greatest change with the smallest st and ard deviation was for the combined treatment group IV , ( mean change of 29 ° ) . Conclusion The difference for the combined treatment group was attributed to patients ' receiving the best PT combined with structured " home therapy " that contributed an additional 90 hours of end-range stretching . This adjunct should be included in the st and ard of care for adhesive Capsulitis . Trial Registration Trial Number : OBJECTIVE To determine whether an active physiotherapy program  following arthrographic joint distension for adhesive capsulitis provides additional benefits . METHODS We performed a r and omized , placebo-controlled , participant and single assessor blinded trial . A total of 156 participants with pain and stiffness in predominantly 1 shoulder for > or=3 months and restriction of passive motion > 30 degrees in > or=2 planes of movement entered the study , and 144 completed the study . Following joint distension , participants were r and omly assigned to either manual therapy and directed exercise or placebo ( sham ultrasound ) , both administered twice weekly for 2 weeks then once weekly for 4 weeks . Pain , function , active shoulder movements , participant-perceived success , and quality of life were assessed at baseline , 6 , 12 , and 26 weeks . Costs were also collected . RESULTS Both groups improved over time with no significant differences in improvement between groups for pain , function , or quality of life at any time point . Significant differences favored the physiotherapy group for all active shoulder movements ( e.g. , pooled difference in mean change between groups across all time points for total shoulder abduction was 10.6 degrees , 95 % confidence interval [ 95 % CI ] 3.1 , 18.1 ) and participant-perceived success ( pooled relative risk 1.4 , 95 % CI 1.1 , 1.65 ; number needed to treat = 5 ) . Net cost of physiotherapy was $ 136.8 Australian ( 95 % CI -177.5 , 223.1 ) over the 6 months . CONCLUSION Physiotherapy following joint distension provided no additional benefits in terms of pain , function , or quality of life but result ed in sustained greater active range of shoulder movement and participant-perceived improvement up to 6 months OBJECTIVE To determine the efficacy of positioning the affected shoulder in flexion and external rotation to prevent contracture shortly after stroke . DESIGN Prospect i ve , parallel-group , r and omized controlled trial . SETTING Four metropolitan mixed rehabilitation units . PARTICIPANTS A volunteer sample of 36 subjects ( minus 5 dropouts ) , whose mean age was 68 years and had had their first stroke within the past 20 days . INTERVENTIONS The experimental group received two 30-minute sessions a day , 5 days a week , for 4 weeks , during which the affected upper limb was placed in maximum comfortable external rotation and 90 degrees of flexion . Both the experimental and control groups received up to 10 minutes of shoulder exercises and st and ard upper-limb care . MAIN OUTCOME MEASURES Contracture was measured as the maximum passive shoulder external rotation and flexion of the affected side as compared with the intact side . Measures were taken at 2 and 6 weeks after stroke by an assessor blinded to group allocation . RESULTS The 30-minute program of positioning the shoulder in maximum external rotation significantly reduced the development of contractures in the experimental group , compared with the control group ( P = .03 ) . The 30-minute program of positioning the shoulder in 90 degrees of flexion did not prevent contractures in the experimental group as compared with the control group ( P = .88 ) . CONCLUSIONS At least 30 minutes a day of positioning the affected shoulder in external rotation should be started as soon as possible for stroke patients who have little activity in the upper arm Painful stiffening of the shoulder , ‘ frozen shoulder ’ is a common cause of shoulder pain and disability . Continuous passive motion ( CPM ) is an established method of preventing joint stiffness and of overcoming it . A r 
    Output:
    
Spine mobilizations combined with glenohumeral stretching and both angular and translational mobilization ( n=1 ) had a superior effect on active ROM compared with sham ultrasound .
CONCLUSIONS Overall , mobilization techniques have beneficial effects in patients with primary AC of the shoulder .