Frozen shoulder, medically known as adhesive capsulitis, is a common condition characterized by significant pain and stiffness in the shoulder joint. This stiffness can severely limit a person’s ability to move their arm and perform daily activities. For individuals experiencing severe and persistent limitations after other treatments have not been successful, joint manipulation may be considered. This intervention aims to restore mobility and alleviate discomfort.
Understanding Frozen Shoulder
Frozen shoulder involves the thickening and tightening of the capsule surrounding the shoulder joint, a network of ligaments enclosing the ball-and-socket joint. This inflammation and scarring lead to adhesions, restricting the glenohumeral joint’s normal movement. Individuals typically experience a gradual onset of pain and progressive loss of range of motion, making even simple tasks challenging.
The condition generally progresses through three distinct phases. The “freezing” stage is marked by increasing pain and a gradual reduction in shoulder movement, often lasting six weeks to nine months. This pain can worsen at night and with movement.
The “frozen” stage sees pain begin to subside, but stiffness remains pronounced, limiting the shoulder’s range of motion. This phase can persist for four to twelve months, with movement severely restricted. The “thawing” stage involves a slow, gradual return of shoulder movement, taking five months to two years, with some individuals experiencing residual stiffness.
Joint Manipulation for Frozen Shoulder
Joint manipulation, often called manipulation under anesthesia (MUA), is a non-surgical procedure designed to forcibly break up adhesions and scar tissue within the shoulder joint capsule. Its goal is to restore a greater range of motion. This procedure is considered when conservative treatments, such as physical therapy, anti-inflammatory medications, and steroid injections, have failed to improve shoulder mobility over several months.
Patients suitable for MUA usually have severe, persistent stiffness and limited range of motion that has not responded to other interventions. They often have dense adhesions preventing effective stretching through physical therapy alone. An orthopedic surgeon, with expertise in musculoskeletal conditions, performs the procedure.
The decision to proceed with MUA follows a thorough evaluation, including imaging studies like MRI scans to assess capsular thickening and rule out other pathologies. It is a targeted approach for individuals whose shoulder mobility is severely compromised by fibrotic changes. The aim is to achieve immediate improvement in range of motion, laying the groundwork for subsequent rehabilitation.
The Manipulation Procedure
Joint manipulation for frozen shoulder is carried out under general anesthesia, ensuring the patient is unconscious and muscles are relaxed. This allows the surgeon to move the arm through its full range of motion without pain or muscle resistance. The absence of muscle guarding enables the surgeon to apply controlled force.
During the procedure, the surgeon performs a series of precise, forceful movements to the shoulder. These movements stretch and tear the dense adhesions and scar tissue restricting mobility. The surgeon meticulously moves the arm in various directions, including abduction (lifting away from the body), forward flexion (lifting forward), and external and internal rotation.
Sounds of adhesions breaking may be audible as the fibrotic tissue gives way, signifying the release of the restricted capsule. This controlled tearing immediately increases the available range of motion. The procedure is brief, often lasting 15 to 30 minutes, depending on the severity of adhesions and stiffness.
Recovery and Post-Procedure Care
Immediately following joint manipulation, patients awaken with significantly improved shoulder range of motion. Intensive physical therapy must begin promptly to maintain newly gained mobility and prevent adhesion reformation. Patients often start therapy within hours, performing exercises to stretch the shoulder.
Common experiences include soreness, swelling, and bruising around the shoulder joint, normal responses to forceful manipulation. Pain management, including oral pain relievers and ice application, helps control discomfort. Discomfort varies but generally subsides within a few days to a week.
While joint manipulation is generally safe, potential, though rare, risks exist. These can include a fracture of the humerus (upper arm bone) or scapula (shoulder blade), or nerve damage. These complications are infrequent, with fracture rates estimated below 1% and nerve injury even lower. Many patients see significant improvements in strength and functional use over several weeks to months, often requiring continued physical therapy for three to six months.