Myofascial Trigger Points in Adhesive Capsulitis: A Systematic Review

Introduction: Adhesive Capsulitis (AC) causes musculoskeletal disorder of shoulder which is a common reason for loss of function and disability in patients. Several interventions have been used for treatment of AC but very few of them have taken into consideration "Myofascial Origin" as a probable cause of pain. Aim: To review the current literature related to prevalence, diagnosis, and treatment of "Myofascial Trigger Points (MTrPs) in AC". To compare the prevalence of MTrPs in Diabetic and Non -Diabetic patients. Materials and Methods: Google Scholar, Pubmed, Cochrane library, Central register for clinical trial were searched for published randomised controlled trials, systematic or literature reviews, case study, pilot study and book references in English language from inception till December 2018. Out of total 1833 results identified, 7 relevant studies with a total of 190 patients were finally selected for the review. Four studies were analysed for methodological quality using Pedro tool for randomised controlled trial and National Institutes of Health tool for observational study and case reports. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (PRISMA). Results: Among all the articles, three of them discussed about the prevalence of MTrPs in AC. These studies showed the greater prevalence of MTrPs in subscapularis muscle which may be the cause for pain and restricted shoulder movements. There was no study on diagnosis of MTrPs in AC. The studies (four in number) which showed the efficacy of treatment of MTrPs included techniques like Myofascial release technique+deep stroking (Niel Asher Technique), Ischaemic Compression of MTrPs, Dry Needling, Infiltration of Subscapularis TrPs with Subscapularis nerve block. Conclusion: MTrPs acts as an important contributing factor for causing pain, movement restriction and disability in the patients. Interventional studies have found significant improvement in shoulder pain and function but the exact method and the muscles which received the treatment were not mentioned. This review suggests that, there is need for good quality studies related to the prevalence, diagnosis and treatment of MTrPs in AC subjects with Diabetes Mellitus as well as without Diabetes Mellitus.