Aspectos morfológicos e clínicos do manguito rotador em indivíduos com ombro congelado - Avaliação e tratamento

Abstract

Frozen shoulder (FS) significantly impacts daily life, leading to pain, disability, anxiety, and sleep disturbances. Diagnosis and treatment focus in FS is mainly delivered to the joint capsule; however, little information is available about the contribution of the rotator cuff in this clinical condition. This thesis integrates a cross-sectional study, a randomized clinical trial and a qualitative study. Study 1: Objective: To assess the pennation angle (PA) and Muscle Thickness (MT) of the supraspinatus, infraspinatus, and teres minor muscles in individuals with FS and compare with healthy controls and to compare the PA and MT of these rotator cuff muscles in individuals with FS under muscle contraction and resting conditions. Methods: a cross-sectional study was conducted. Results: 92 participants were divided into a control group and a FS group. There were no differences in the PA and MT in any of the muscles at rest and under contraction when comparing individuals with FS and healthy controls. All muscles showed increased PA and MT under contraction when compared to rest in individuals with FS. Conclusion: PA and MT of the supraspinatus, infraspinatus, and teres minor muscles did not differ between individuals with FS and healthy controls. PA and MT were higher during contraction than at rest. Study 2: Objective: To compare the effects of adding eccentric exercises to a standardized programme that includes manual therapy, stretching, education, and exercise on shoulder function pain intensity, range of motion, quality of life, fear-avoidance beliefs, pain catastrophizing, satisfaction with the treatment, PA, and MT of the supraspinatus, infraspinatus, and teres minor muscles in individuals with primary FS. Methods: This is a two-arm parallel, single-blinded superiority-controlled clinical trial where 40 individuals were randomized. Results and Conclusion: There was no significant interaction in the shoulder function, pain intensity, range of motion, quality of life, fear-avoidance beliefs, pain catastrophizing, satisfaction with the treatment, PA, and MT of the supraspinatus, infraspinatus, and teres minor muscles. Significant time effects (p < 0.001) were observed across most outcomes. The addition of eccentric exercises was not superior to a standardized programme comprising manual therapy, stretching, education, and exercise in individuals with primary FS. Study 3: Objective: To explore the experiences, beliefs, and perceptions of individuals with primary FS after a physical therapy program. Methods: A qualitative study using thematic analysis was conducted in individuals with primary FS after a physical therapy program. Results and Conclusion: Ten participants were included. Three main themes were generated: (1) “My life before starting the treatment”, (2) “Experiencing the treatment”, and (3) “How I am after the treatment”. This study provided information about the experiences, beliefs, and perceptions of individuals with primary FS after a physical therapy program. Overall, participants focused on the FS condition and its consequences, as well as on treatments received and their clinical impact. These findings may help improve the management of FS, guide therapists in their clinical practice, and enhance patient-therapist interactions.