To the editor,
We appreciate the interest by Kraal and colleagues regarding our study, and offer our responses to his major queries.
Kraal et al. were curious as to why we did not define the amount of restriction on the frozen shoulder, nor report the direction of the limitation. The restriction in range or direction was not a limiting factor for this treatment technique. Patients with any restriction either in range or direction were included if they were diagnosed with having a frozen shoulder by the orthopaedic surgeon. Regarding our radiographs, we used conventional x-ray. We do not use ultrasound radiography, as per our hospital setup.
Orthopaedic surgeons diagnosed the patients in our study. Therefore, we did not have any role regarding diagnosis. Patients in the study with diabetes mellitus were equally distributed among the study groups – 13 patients in the study group and 14 patients in the experimental group.
Kraal and colleagues considered our treatment intervention rather short, and believed that the affected arm would need to be elevated between 160° and 180°. They noted that this would be fairly difficult in a painful, contracted frozen shoulder. However, our treatment intervention positioned the patient according to the available ROM in the shoulder joint. If the patient has a range less than 100°, we positioned him or her behind the line of pulley. The position of the patient would advance forward as the ROM improved.
As it is a novel instrument developed from our idea with clinical practice, adequate evidence is not yet available in the literature regarding the efficacy of sustained stretching of the inferior capsule of the frozen shoulder. We agree with Kraal and colleagues, and concluded in our study, that the equipment and procedure should be done with caution.
Footnotes
(RE: Paul A, Rajkumar JS, Pete S, Lambert L. Effectiveness of sustained stretching of the inferior capsule in the management of a frozen shoulder. Clin Orthop Rel Res. 2014;472:2262–2268.)
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