Shoulder manipulation, often performed under anesthesia (MUA), is a procedure to improve range of motion in a stiff shoulder joint. This technique treats conditions like frozen shoulder (adhesive capsulitis), where connective tissues become inflamed, tight, and scarred, limiting movement and causing pain. During the manipulation, a healthcare provider forcefully moves the shoulder through its full range of motion to break up adhesions and scar tissue within the joint capsule. This intervention is considered when non-surgical treatments, such as physical therapy and pain medications, have not yielded sufficient improvement.
Immediate Post-Procedure Experience
Upon waking from general anesthesia, patients typically experience grogginess and disorientation. The shoulder will likely be sore, though immediate pain might be reduced if a nerve block was administered. A nerve block can numb the arm and shoulder for several hours, providing initial pain relief. This temporary numbness or weakness usually wears off within 8 to 12 hours.
A sling is commonly applied immediately after the procedure. It offers comfort and protection, but healthcare providers advise against prolonged immobilization. The goal is to begin movement as soon as possible to maintain the newly gained range of motion.
Pain Management and Early Recovery
Effective pain management is important for recovery. Healthcare providers often prescribe a combination of medications, including opioids for severe pain and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Over-the-counter pain relievers like acetaminophen can also be used.
Applying ice packs to the shoulder can reduce swelling and discomfort. Use ice for up to 15 minutes at a time, several times a day. Proper resting positions, such as sleeping in a recliner or with a pillow behind the elbow, also contribute to comfort. Patients should expect fluctuations in pain levels, and adherence to the prescribed pain medication schedule is advised to facilitate early movement and physical therapy.
Rehabilitation and Restoring Function
Rehabilitation is crucial after shoulder manipulation, with physical therapy often beginning within hours or days. The primary goal is to maintain the increased range of motion and prevent the shoulder from stiffening again. Early exercises focus on passive range of motion (PROM), where the therapist or the patient’s other arm moves the affected arm without using shoulder muscles. Pendulum exercises and shoulder pulleys are common passive movements.
As pain subsides and motion improves, rehabilitation progresses to active-assisted range of motion (AAROM) exercises, then to active range of motion (AROM) exercises. Strengthening exercises for the rotator cuff and scapular stabilizers are gradually introduced, starting with light resistance and progressing over several weeks. Consistency with supervised physical therapy and a home exercise program is important for successful long-term outcomes. Full range of motion is often a goal by 4 to 6 weeks, with continued strengthening and a gradual return to daily activities and work over several months.
Potential Concerns and When to Seek Medical Advice
While shoulder manipulation is generally effective, be aware of potential complications requiring prompt medical attention. Red flags include:
Worsening or uncontrolled pain not responding to prescribed medication.
Signs of infection, such as fever, increased redness, warmth, or pus at any incision site (if arthroscopy was also performed).
Significant swelling around the shoulder joint or persistent numbness and tingling in the arm or hand.
A sudden loss of the range of motion gained during the manipulation.
If any of these symptoms occur, contact the surgeon or medical team without delay for timely assessment and appropriate management.