Roopa Rao, Suraj Kanase
Adhesive capsulitis (AC), also known as frozen shoulder (FS), is a common debilitating condition characterized by progressive pain, severe restriction of the shoulder range of motion (ROM), and functional disability. While conventional physical therapy remains the cornerstone of conservative management, the additional benefit of interventions specifically targeting the scapulothoracic joint has not been systematically evaluated. We conducted this systematic review and meta-analysis to determine whether physical therapy targeting the scapulothoracic joint provides a measurable additive benefit over conventional therapy in patients with AC, with emphasis on pain, shoulder ROM, disability, and scapular kinematics. We systematically searched PubMed, Scopus, CINAHL, EBSCO, ProQuest, and Cochrane CENTRAL databases without any year restrictions. Following a thorough, systematic screening by two independent reviewers, nine randomized controlled trials (RCTs) involving 466 participants met our inclusion criteria. A random-effects model was used to conduct meta-analysis. The GRADE framework was used to assess the certainty of evidence. The pooled analysis showed no statistically significant between-group difference in pain (SMD = -0.28; 95% CI -1.11 to 0.54). However, scapulothoracic interventions significantly improved shoulder flexion ROM (SMD = 0.57; 95% CI 0.16 to 0.98; p < 0.05) and functional disability as measured by the Shoulder Pain and Disability Index (SPADI) (SMD = -0.87; 95% CI -1.55 to -0.19; p = 0.012), with a GRADE certainty rated high for the SPADI finding. Effects on abduction and external rotation ROM were positive but could not reach statistical significance. Sensitivity analyses restricted to low-risk-of-bias and studies with some concerns confirmed the robustness of the flexion result and revealed a significant abduction effect (SMD = 0.68; p = 0.029) that was obscured in the primary analysis. These findings support the inclusion of scapulothoracic interventions into physical therapy programs for AC. Future high-quality RCTs with larger samples and standardized protocols are needed to consolidate these results.