Evaluation of the results of transdermal diffusional patch application in patients with adhesive capsulitis (frozen shoulder) in terms of physiopathological pain and functional status

Aim: The aim of the study was to evaluate the results of the application of CE certified diffusional patch used in disc herniation in patients with adhesive capsulitis (frozen shoulder) in terms of physiopathological pain and functional status. Method: It was conducted as a prospective observational study. Patients between the ages of 18 and 65 who were admitted to the Orthopedics outpatient clinic of Ankara City Hospital and diagnosed with adhesive capsulitis, which is the inclusion criterion, were randomly divided into two groups as placebo and diffusional patch groups. A written consent form was obtained from all patients. Demographic data of the patients participating in the study such as age, gender, height, weight, systemic diseases, smoking and medications were recorded. Transdermal Diffusional Patch was applied to 28 patients and placebo was performed in 28 patients. In patients who underwent Diffusional Patch, it was recommended to fix the patches with a hypoallergenic patch and rest in bed for 24 hours. In the meantime, they did not receive any medical treatment for 24 hours. At the end of 24 hours, the patients removed this patch fixed to their shoulder areas and physical examinations were performed the next day and 10 days - 1 month later. At the end of 1 month, other treatment was started in patients whose pain did not decrease. Pain severity of the patients was evaluated with VAS, and functional status was evaluated with Constant Shoulder Score. The same assessments were repeated after treatment (after 48 hours) and after 4 weeks for long- term effects. Medical treatment and/or physical therapy program was started for patients whose pain did not decrease or who did not improve clinically and functionally (those with less than 50% reduction in pain severity with VAS, 20% or less improvement in functional index scores) regardless of the patient groups. Results: The mean age, male-female distribution, comorbidities, median shoulder pain and duration of shoulder movement limitation were statistically similar between the control and experimental groups (p>0.05). There was no statistically significant change in VAS levels in the control group according to Bonferroni correction according to follow-up times (p=0.042). In the experimental group, there was a statistically significant change (p<0.001), the situation that caused the difference; According to the 0th day, respectively; VAS levels decreased on the 10th and 30th days (p=0.010 and p<0.001). In addition, the VAS level at the 30th day was statistically significantly lower than the 10th day (p=0.010). According to the control and experimental groups, there are frequency distributions of the cases in terms of VAS. The rate of partial response and complete response in terms of VAS on the 10th day compared to the 0th day was higher in the experimental group than in the control group, the rate of those who did not recover in terms of VAS on the 30th day compared to the 0th day was statistically significantly higher in the control group than in the experimental group (p<0.001), and the rate of those who did not recover in terms of VAS on the 30th day compared to the 10th day was statistically significantly higher in the control group than in the experimental group (p<0.001). In the comparison of Bonferroni correction between the two groups in terms of baseline and constant shoulder scores according to the follow-up times, there was a statistically significant change in the Constant shoulder scores in the control group (p=0.017), and the situation that caused the difference; According to the 0th day, Constant shoulder scores were increased on the 10th and 30th days (p=0.018 and p=0.017). There was no statistically significant difference between the 10th and 30th days (p>0.999). There was a statistically significant change in the experimental group (p<0.001), the situation that caused the difference; According to the 0th day; Constant shoulder scores on days 10 and 30 were increased (p<0.001 and p<0.001). In addition, Constant shoulder scores on the 30th day were statistically significantly higher than on the 10th day (p=0.002). In the changes in the Constant shoulder score in the control and experimental groups according to the follow-up times, the Constant shoulder scores were flat in the control group on the 10th day compared to the 0th day, on the 30th day according to the 0th day and on the 30th day according to the 10th day, while there were significant increases in the experimental group and the differences between the groups were found to be statistically significant (p<0.001). After all; Considering the findings of our study, it can be stated that the application of diffusional patch in patients diagnosed with adhesive capsulitis (frozen shoulder) has a positive effect on relieving physiopathological pain and functional status. Keywords: Adhesive capsulitis, transdermal diffusional pacth, physiopathological pain, functional status