制动对关节韧带形态学及超微结构的影响

制动对关节韧带的影响是明显的。制动后关节韧带与周围组织粘连较紧．胶原纤维排列紊乱,韧带骨止点出现骨吸收现象．纤维骨附着处破坏。关节韧带中小直径胶原原纤维的比例减少,大直径原纤维的比例增加。成纤维细胞形状改变,梭形成纤维细胞多见,细胞内肌动蛋白染色加深。     

制动与关节功能障碍(一)

制动对韧带的结构特性和材料特性产生明显影响,制动后韧带横截面积变小,刚度降低,强度下降,能量吸收减小,应变加大,弹性模量减少,止点变脆弱,出现骨吸收现象,不同直径原纤维的比例发生改变,大直径原纤维的比例增高。成纤维细胞的形状改变,梭形细胞多见,细胞内肌动蛋白染色加深。制动后,氨基己糖多糖和水分减少,DNA浓度降低,胶原的交联和转化都有改变,表现为胶原的交联增加,而胶原的转化却表现出时间依赖性,较短时间(<9周)制动,胶原的合成和降解都增加,胶原含量基本保持不变,较长时间制动,胶原的降解大于合成,韧带的总胶原含量减少,出现萎缩。制动对韧带的影响是明显的,合理使用制动,制动后正确制订康复计划,对提高康复疗效,尽早恢复病人肢体功能有重要的意义。     

膝关节制动对髌韧带形态结构影响的实验研究

目的 探讨膝关节制动对髌带形态结构的影响。方法 将兔膝关节伸直位制动６周，然后观察髌韧带结构形态的变化，结果 制动组髌韧带的截面面积较正常组显著增加（Ｐ〈０．０１），光镜观察发现制动线髌韧带胶原纤维的排列交正正常组紊乱，电镜观察发现制动组髌韧带胶原原纤维的排列杂乱无章，且与正常组相比，制动组小型纤维所占的比例显著增加，而大型纤维的比例明显下降，结论 膝关节制动使得髌韧带所受的应力下降，为适应这种改     

聚对苯二甲酸乙二醇酯材料LARS韧带重建兔前交叉韧带后早期组织学及超微结构变化

背景:LARS韧带山法国JPLaboureau 1985年设计并应用于临.中短期临床应用报道证实该人工合成韧带疗效满意,但目前该韧带材料移植后组织学转归的研究较少.目的:应用聚对苯二甲酸乙二醇酯材料LARS韧带重建兔前交叉韧带,对移植后移植物组织学及超微结构进行观察.设计、时间及地点:随机对照动物实验,于2007-01/12在苏州大学附属第二医院实验中心及相关实验室完成.材料:聚对苯二甲酸乙二醇酯材料LARS韧带为手术中剩余的LARS韧带残端共3条(上海科隆有限公司提供);健康成年新西兰皇白兔12只.方法:采用系统抽样法将兔分为两组,白体前交叉覆盖残端组(L-LARS)共9膝,右膝前交叉韧带完伞切断后,应用体外编织的聚对苯二甲酸乙二醇酯材料LARS韧带重建,并应用前交叉韧带残端覆盖LARS韧带;单纯LARS韧带组(LARS)共3膝,前交叉韧带完全切除后单纯应用体外编织的聚对苯二甲酸乙:醇酯材料LARS韧带重建前交叉韧带.主要观察指标:术后1.3,6个月切取关节内、骨道内移植物及关节内滑膜组织行苏木精-伊红染色及Masson染色观察,并应用透射电子显微镜观察移植物术后6个月的超微结构.结果:术后1个月,L-LARS组关节内LARS韧带纤维束被纤维结缔组织包裹,而LARS组手术后6个月仍不能被纤维结缔组织包裹.术后3个月,L-LARS组关节内LARS韧带纤维束包裹的纤维结缔组织为不成熟的胶原纤维组织,L-LARS组和LARS组骨道内或LARS韧带纤维束之间,均存在中等程度的异物反应或炎症反应,以LARS组明显.术后6个月,L-LARS组关节内LARS韧带纤维束之间仍为不成熟的胶原纤维组织;L-LARS组及LARS组骨道内或LARS韧带纤维束之问,异物反应或炎症反应逐渐减轻:L-LARS组及LARS组骨道内均存在骨长入,新生编织骨起始丁骨道壁,向人工材料的深层长入;术后6个月,电子显微镜见L-LARS组人工纤维束间胶原纤维直径50～100nm,关节内人工纤维束问的成纤维细胞及骨道内人工纤维束间的成骨细胞体积和细胞核增大,粗而内质网扩张.结论:聚对苯二甲酸乙二醇酯材料LARS韧带生物相容性较好;关节内游离部分用自体组织覆盖后,有助于人工韧带材料"生物化";移植后骨道内是否存在有效骨长入仍需进一步观察.     

早期关节活动对前交叉韧带重建后腱骨愈合的影响

背景:异体移植物可作为前交叉韧带重建翻修以及膝关节复合损伤修复的选择。目的:通过建立异体韧带移植重建前交叉韧带的动物模型,观察早期活动对异体植入物止点腱骨愈合的组织形态以及关节活动功能恢复的影响。方法:健康成年新西兰兔9只,随机取3只兔双侧跟腱作为供体,取6只兔切断一侧膝关节前交叉韧带,固定重建前交叉韧带。动物随机数字表法均分运动组和制动组,6周后观察关节活动功能、腱骨愈合大体观察以及组织学观察。结果与结论:术侧肢体活动情况基本正常,所有动物前交叉韧带上下止点愈合情况均良好。前交叉韧带周围滑膜均可见明显增生。活动组可见较多Sharpey纤维,腱骨间接连接形成,而制动组未见明显Sharpey纤维。说明术后6周异体重建物止点已有腱骨愈合,早期活动对重建物的腱骨愈合并无明显不良影响,可能还更有利。     

聚对苯二甲酸乙二醇酯材料LARS韧带重建免前交叉韧带后早期组织学及超微结构变化

背景：LARS韧带由法国JP Laboureau 1985年设计并应用于临床。中短期临床应用报道证实该人工合成韧带疗效满意，但目前该韧带材料移植后组织学转归的研究较少。目的：应用聚对苯二甲酸乙二醇酯材料LARS韧带重建兔前交叉韧带，对移植后移植物组织学及超微结构进行观察。设计、时间及地点：随机对照动物实验，于2007—01／12在苏州大学附属第二医院实验中心及相关实验室完成。材料：聚对苯二甲酸乙二醇酯材料LARS韧带为手术中剩余的LARS韧带残端共3条（上海科隆有限公司提供）；健康成年新西兰白兔12只。方法：采用系统抽样法将兔分为两组，自体前交叉覆盖残端组（L-LARS）共9膝，右膝前交叉韧带完全切断后，应用体外编织的聚对苯二甲酸乙二醇酯材料LARS韧带重建，并应用前交叉韧带残端覆盖LARS韧带；单纯LARS韧带组（LARS）共3膝，前交叉韧带完全切除后单纯应用体外编织的聚对苯二甲酸乙二醇酯材料LARS韧带重建前交叉韧带。主要观察指标：术后1，3，6个月切取关节内、骨道内移植物及关节内滑膜组织行苏木精-伊红染色及Masson染色观察，并应用透射电子显微镜观察移植物术后6个月的超微结构。结果：术后1个月，L-LARS组关节内LARS韧带纤维束被纤维结缔组织包裹，而LARS组手术后6个月仍不能被纤维结缔组织包裹。术后3个月，L-LARS组关节内LARS韧带纤维束包裹的纤维结缔组织为不成熟的胶原纤维组织，L-LARS组和LARS组骨道内或LARS韧带纤维束之间，均存在中等程度的异物反应或炎症反应，以LARS组明显。术后6个月，L-LARS组关节内LARS韧带纤维束之间仍为不成熟的胶原纤维组织；L-LARS组及LARS组骨道内或LARS韧带纤维束之间，异物反应或炎症反应逐渐减轻；L-LARS组及LARS组骨道内均存在骨长入，新生编织骨起始于骨道壁，向人工材料的深层长入；术后6个月，电子显微镜见L-LARS组人工纤维束间胶原纤维直径50～100nm，关节内人工纤维束间的成纤维细胞及骨道内人工纤维束间的成骨细胞体积和细胞核增大，粗面内质网扩张。结论：聚对苯二甲酸乙二醇酯材料LARS韧带生物相容性较好：关节内游离部分用自体组织覆盖后，有助于人工韧带材料“生物化”；移植后骨道内是否存在有效骨长入仍需进一步观察。     

早期关节活动对前交叉韧带重建后腱骨愈合的影响

背景：异体移植物可作为前交叉韧带重建翻修以及膝关节复合损伤修复的选择。目的：通过建立异体韧带移植重建前交叉韧带的动物模型,观察早期活动对异体植入物止点腱骨愈合的组织形态以及关节活动功能恢复的影响。方法：健康成年新西兰兔9只,随机取3只兔双侧跟腱作为供体,取6只兔切断一侧膝关节前交叉韧带,固定重建前交叉韧带。动物随机数字表法均分运动组和制动组,6周后观察关节活动功能、腱骨愈合大体观察以及组织学观察。结果与结论：术侧肢体活动情况基本正常,所有动物前交叉韧带上下止点愈合情况均良好。前交叉韧带周围滑膜均可见明显增生。活动组可见较多Sharpey纤维,腱骨间接连接形成,而制动组未见明裎Sharpey纤维。说明术后6周异体重建物止点已有腱骨愈合,早期活动对重建物的腱骨愈合并无明显不良影响,可能还更有利。     

运动促进制动后兔膝关节组织恢复的作用

通过观察制动后兔膝关节软骨和关节囊组织超微结构及内侧副韧带力学特性的改变,探讨了制动引起关节组织形态学改变和韧带力学特性改变的机理,以及制动后的主动活动和谈动运动对上述组织病理改变恢复的作用.结果表明,制动可导致关节软骨、关节囊组织退行性改变和关节韧带抗张强度的下降,这种改变随制动时间延长而增加。制动后的关节主动活动有助于关节软骨和关节囊组织形态学和韧带抗张强度的恢复。早期被动运动对关节组织病理改变的恢复及关节韧带抗张强度的恢复有一定促进作用。     

关节制动对韧带的影响

长期以来,制动一直是骨关节损伤的主要治疗手段。然而制动,尤其是长时制动会导致骨关节及其周围软组织的损害。较详细地介绍了关节制动对韧带及其骨附着处等的影响,并对其临床意义进行了分析。     

关节滑液对兔前交叉韧带重建后腱骨愈合生物力学和组织学的影响

背景:目前前交叉韧带重建后关节滑液对移植物强度以及腱骨愈合的影响尚无定论。目的:观察兔前交叉韧带重建后腱骨愈合过程中,关节滑液对移植肌腱生物力学及组织学的影响。方法:取新西兰大白兔下肢半腱肌腱,以同侧肢体半腱肌腱重建前交叉韧带模拟关节滑液影响模型,并同时取对侧肢体半腱肌行股骨髁上"U"形肌腱埋植避免关节滑液的影响。重建4周,取股骨-韧带-胫骨复合体,行生物力学测定和组织学观察。结果与结论:重建后4周,生物力学测定时发现"U"字形埋植肌腱断裂时平均载荷明显大于前交叉韧带重建后处于关节内的肌腱(P<0.01)。组织学观察发现,骨隧道内坏死的腱组织已被纤维组织、新生骨组织替代,腱骨交界面形成Sharpey纤维连接和纤维软骨,优于关节内肌腱;"U"字形埋植肌腱腱骨交界面成骨细胞数目明显多于前交叉韧带重建肌腱(P<0.01)。结果证实"U"字形埋植肌腱的生物力学及腱骨愈合均优于处于关节内肌腱,提示关节滑液对前交叉韧带重建后韧带的强度以及腱骨愈合有不利影响。     

Dihydroergotamine and mobilization after major orthopedic surgery

The effects of dihydroergotamine (DHE) on the degree of mobilization and response to orthostatic stress after total hip arthroplasty were studied. In the mobilization study, 78 patients received DHE, 0.5 mg im, twice a day from the day of surgery until full mobilization was achieved. Eighty-four patients who received placebo served as controls. There was no significant difference in the time until the first day of mobilization or the degree of mobilization. In the orthostatic test condition, subgroups of 61 patients receiving placebo and 55 patients receiving DHE were subjected to orthostatic testing. There were no differences in cardiovascular response to bed rest or in orthostatic stress. We conclude that DHE does not stabilize the cardiovascular reaction to orthostatic stress, nor does it enhance mobilization in patients after total hip arthroplasty.     

Early mobilization of acute stroke patients

Objective. To examine the early mobilization of acute stroke patients. Design. Postal survey. Setting. Thirteen health boards in Scotland. Participants. Ninety‐nine health professionals of whom 39 were doctors, 39 nurses and 21 physiotherapists. Results. There was a lack of understanding and agreement across the three professions in terms of what was meant by ‘early mobilization’. Further, the duration, frequency, intensity, risk/benefits and activities associated with early mobilization are undescribed despite clinical guidelines urging its use. Multi‐disciplinary decision making regarding early mobilization was not self‐evident. Conclusions. (i) An evidence‐base for early mobilization is required along with agreement on what physiological monitoring should be undertaken while early mobilization is on going; (ii) Health professionals need a greater awareness of the evidence linking stroke complications with patient immobilization and in particular in relation to pressure sores, painful shoulder and falls; (iii) The clinical decision to mobilize an acute stroke patient early should be made explicitly within a multi‐disciplinary acute stroke team; (iv) There is an absolute need for further research into early mobilization in terms of intensity, duration, frequency, risks and benefits in relations to types of stroke of early mobilization. Relevance to clinical practice. Early mobilization in acute stroke care is recommended in a range of European, American and UK policy guidelines as a strategy to minimize or prevent complications. However the evidence‐base to support early mobilization in acute stroke is missing. Health professionals require a research‐based approach in order to deliver safe and effective early mobilization to acute stroke patients.     

恶性血液系统疾病自体外周血造血干细胞动员的临床分析

目的:分析恶性血液系统疾病患者外周血造血干细胞动员与采集过程中的影响因素。方法:对50例血液系统恶性疾病患者在东南大学附属中大医院血液科进行外周血造血干细胞动员。对患者年龄、性别、动员方案、疾病状态、采集机器等因素进行分析,评估以上因素对干细胞动员结果的影响,并分析了采集前白细胞、血红蛋白、血小板的数量与采集的CD34^+细胞计数的相关性。结果:动员方案对CD34^+细胞采集数及CD34^+细胞采集成功率的影响有显著性影响,而性别、年龄、确诊到动员间隔时间、既往化疗方案、骨髓受累与否等对干细胞采集数量影响并不显著。采集前外周血白细胞数量及血红蛋白数量与采集的CD34^+细胞数呈正相关。采集前外周血中白细胞计数及单个核细胞计数与采集成功密切相关。结论:化疗联合细胞因子的动员方案采集造血干细胞优于单用细胞因子的动员方案。通过采集前白细胞计数及单个核细胞计数确定合适的采集时机,可以提高采集的成功率。     

Effects of kinesthetic mobilization in comparison with standard mobilization on respiratory function after coronary artery bypass and other relevant factors

Presently no relevant nursing data exist in Germany on the effect of mobilization according to kinaesthetic principles on the physiological system, on locomotion and the sensory system. The effect of two different versions of mobilization was measured in a unicentric, open, randomized study with two parallel groups from December 1999 to October 2000 in the intermediate ICU for patients after heart surgery at Ulm University Hospital. The aim was, to show superiority of kinaesthetic mobilization, compared to empirically developed standard mobilization on patients after aortal coronary bypass surgery, with reference to respiratory function. The two protocols of mobilization were carefully coordinated with precise plans of action and timing. A total of 104 subjects were randomized to the two groups. In the kinaesthetic mobilization group (n = 52) median age was 67.5 years, ten (19.2%) were female and 42 (80.8%) were male. In the standard mobilization group (n = 52) median age was 69 years, eight (15.4%) were female and 44 (84.6%) were male. The main outcome variable was the respiratory minute volume 30 minutes after the second mobilization minus the respiratory minute volume prior to the second mobilization. The median change in respiratory minute volume was 0.4 ltr/min. (-5.1 to 3) in the group with kinaesthetic mobilization and median 0.3 ltr/min (-6.0 to +9.1) in the standard mobilization group. Superiority of kinaesthetic mobilization compared to standard mobilization could not be proven (p = 0.38). Also in the secondary outcome variables the kinaesthetic mobilization showed no superiority over standard mobilization. The respiratory minute volume data within points of measure show that subjects in the kinaesthetic group have less extreme results (> 12 ltr.). In the area < 5 ltr. there is a similar tendency. This may point out that regulation between movement of body, respiration and circulatory system occurs more continuous in kinaesthetic mobilization than the standard mobilization. A similar tendency was seen in the secondary outcomes variables. Subjectively nurses noted that kinaesthetic mobilization was less strenuous than standard mobilization, even though subjects in the kinaesthetic group showed more mobility restriction (37%) than in the standard group (15%). From before to after the first mobilization the percentage of subjects needing less pain medication was higher in the kinaesthetic group (35%), compared to the standard group (19%). There were no serious adverse events in either group. The concept of kinaesthetic mobilization showed no negative effect on subjects compared to empirically developed standard mobilization. There was no diagnosis of pneumonia and none of instabile sternum on any of the subjects in this study. Also, there was no negative effect on the sternum due to the light support arms gave to sitting up and rotating movements in the area of thorax and pelvis on subjects in the kinaesthetic group. The subjects early trust in their own varied movement and the possible effects of kinaesthetic mobilization in later phases of recuperation was not explored in this study.     

自体干细胞移植治疗糖尿病足的干细胞动员和采集

背景：在自体干细胞移植治疗下肢缺血性疾病的干细胞动员期间,国内外大多数研究组均常规应用5～10μg/（kg？d）的粒细胞集落刺激因子动员,5d后采集干细胞进行移植,这是否为最佳的动员时间和采集时机未见相关报道。目的：分析探讨自体干细胞移植最佳动员方案及采集时机,提高该方法的安全性。方法：对备行干细胞移植的18例糖尿病足患者分别采用粒细胞集落刺激因子5,10μg/（kg？d）进行造血干细胞动员,分析粒细胞集落刺激因子动员天数、剂量与外周血白细胞、单个核细胞、CD34＋细胞数的关系,并检测干细胞动员前后、采集前后患者凝血指标、血小板计数的变化,观察患者动员及采集过程的不良反应。结果与结论：随着动员天数的增加,白细胞和单个核细胞、CD34＋细胞数也随之增加,干细胞获得的效率与粒细胞集落刺激因子的剂量、动员时间有关,外周血中CD34＋总数与单个核细胞总数呈正相关。患者的凝血指标在动员和采集前后无显著变化。血小板计数在动员前后无变化,但在采集后有显著下降;18例患者中仅有1例在粒细胞集落刺激因子动员中发生轻度骨头酸痛,1例出现发热,其他患者均无不良反应发生。提示,糖尿病足患者干细胞采集的最佳时机不能单凭动员天数和外周血白细胞数决定,而是由外周血单个核细胞数和CD34＋的数量来决定。且干细胞动员和采集对患者的不良反应小,安全性高。     

地塞米松对G-CSF动员供体外周血干细胞及其移植受体造血功能恢复的影响

本研究旨在观察不同动员方法对健康供者外周血造血干细胞的动员效果、采集过程中的不良反应及移植后受者造血功能恢复的影响.2008年1月-2013年5月期间本院43例异基因造血干细胞移植供者分为单纯动员和联合动员两组.单纯动员组采用粒细胞集落刺激因子5-10 μg/（kg·d）皮下注射,动员4-6天开始采集;联合动员组在单纯动员基础上于采集前2-4h给予静脉滴注地塞米松10 mg.观察不同组采集的MNC、CD34＋细胞数及其与采集前外周血MNC数的关系,观察采集过程中的不良反应和回输不同组供者造血干细胞后受者造血重建情况.结果表明：两组供者采集造血干细胞数均满足移植需要,单纯动员组采集的MNC及CD34＋细胞数均高于联合动员组.两组采集物中MNC与采集前外周血MNC计数均呈正相关;联合动员组采集后血红蛋白及血小板下降幅度较单纯动员组明显.单纯动员组采集过程中不良反应轻微,可以耐受及逆转,联合动员组未出现不良反应.在两组患者预处理方案无统计学差异的情况下,联合动员组相应的受者造血重建时间较单纯动员组明显缩短.结论：在G-CSF动员供体外周血干细胞时加用地塞米松,可以减少外周血造血干细胞采集的不良反应,可采集到足够的造血干细胞数,采集前外周血中MNC计数仍可以作为评估采集物中MNC高低的一项参考指标,特别是联合地塞米松动员干细胞对于受者造血重建有积极意义.     

Effects of early mobilization on pulmonary parameters and complications post coronary artery bypass graft surgery

This study compared the effects of a four-phase and a three-phase early mobilization protocol on respiratory parameters and complications in patients following coronary artery bypass graft surgery. This is a three-arm, parallel-group, randomized controlled clinical trial with 120 candidates for coronary artery bypass graft surgery. Participants were randomly allocated to three groups: four-phase early mobilization protocol, three-phase early mobilization protocol, and control. Arterial blood gases, oxygen saturation, and incidence of pulmonary complications were compared among the groups. Mean arterial blood gases and oxygen saturation improved significantly over time in both four-phase early mobilization protocol and three-phase early mobilization protocol groups compared to control (p < 0.05). There were observed trends for greater improvements in the study outcomes with three-phase early mobilization protocol than four-phase early mobilization protocol; however, did not reach statistically significant levels. The incidence of pulmonary complications was significantly in both intervention groups compared to control (odds ratio: 0.48, 95 % CI 0.007–0.537; p < 0.001). Both four-phase early mobilization and the three-phase early mobilization protocols improved respiratory parameters and reduced pulmonary complications. Statistically insignificant trends were found trends in the three-phase early mobilization protocol, focusing on chest physiotherapy and breathing exercises.     

脉冲调整技术和关节松动术治疗肩峰下撞击综合征的临床疗效对比

目的:比较脉冲调整技术和关节松动术对肩峰下撞击综合征患者的临床疗效。方法:将38例肩峰下撞击综合征患者随机分为脉冲组(脉冲调整技术)和松动组(关节松动术)各19例。脉冲组进行脉冲调整技术治疗、常规理疗和运动训练,松动组进行关节松动术、常规理疗和运动训练。两组患者均进行12周治疗,并于治疗前和治疗第1周、第4周、第12周随访时采用VAS评分和CMS量表进行评估。结果:治疗后第1周、第4周、第12周脉冲组VAS分数分别为2.4±1.3、1.2±1.0、0.9±0.9,CMS总分分别为76.5±11.0、84.3±8.8、89.0±7.1;松动组VAS分数分别为3.5±1.3、2.1±1.3、1.4±1.2,CMS总分分别为69.4±13.1、82.9±6.7、88.5±6.8。两组VAS分数和CMS总分组内对比差异均有显著性意义(P0.01);治疗1周后,脉冲组VAS分数低于松动组,差异有显著性意义(P=0.008),脉冲组CMS评分中的疼痛得分、ADL得分均高于松动组,差异均有显著性意义(P=0.008,P=0.009);治疗4周后,脉冲组VAS分数低于松动组,差异有显著性意义(P=0.034),CMS评分中的疼痛得分高于松动组,差异有显著性意义(P=0.048)。结论:在常规理疗和运动训练基础上无论联合应用脉冲调整技术还是关节松动术,均能有效改善肩峰下撞击综合征患者肩部的疼痛和功能障碍。而脉冲调整技术与关节松动术相比,能在治疗早期更快地减轻疼痛并改善患者日常生活活动能力。     

The Effectiveness of Intensive Mobilization Techniques Combined with Capsular Distension for Adhesive Capsulitis of the Shoulder

[Purpose] The aim of this study was to determine the synergistic effect of intensive mobilization techniques combined with capsular distension for patients with adhesive capsulitis (AC). [Subjects] The subjects were 53 patients with AC (mean age, 56.0 ± 7.6 years). [Methods] Patients were randomized to one of four treatment groups: intensive mobilization after one steroid injection with capsular distension (IMSID); intensive mobilization (IM); one steroid injection with capsular distension (SID); and general physical therapy only (GPT). The IMSID, IM, and SID groups also received general physical therapy for 20 minutes. All treatments were performed twice per week for 4 weeks. Patients were assessed using the Shoulder Pain and Disability Index (SPADI), Constant-Murley Shoulder Function Assessment Score (CS), Active Range of Motion (AROM), and Verbal Numeric Score (VNS). [Results] There were significant post-intervention differences in all the measured values in each of the groups, except for external rotation ROM in the SID group. The IMSID group showed the greatest differences among the groups. There were significant differences among the means of all the groups. [Conclusion] The most effective treatment for AC was the combination of the intensive mobilization and steroid injection with capsular distension, which helped to control inflammation, extend joint space, and recover ROM.Key words: Adhesive capsulitis, Intensive mobilization, Capsular distension