Frozen Shoulder Manipulation - Snap, Crackle, Pop

Of all the treatment options available for a stiff arm, a frozen shoulder manipulation is the one that is feared the most by patients with this condition. As a clinician I'm often asked if this will cure the symptoms, to which I quickly reply "It depends". The consensus among most medical professionals is that aside from surgery, a manipulation should be one of the last courses of action.

To begin with, even though it is a closed procedure (non-surgical), a manipulation under anesthesia is traumatic to the shoulder's joint capsule and soft tissue structures in and around the shoulder complex. In theory the clinician is trying to break loose adhesions that have formed around the capsule, thereby freeing up motion in the shoulder. What happens in some cases though is actual tearing of the capsule itself. Motion is restored, but as the body begins to repair the area it lays down more scar tissue which can potentially cause more loss of motion and pain. This means the patient must undergo additional physical therapy to prevent further loss of motion.

When considering to undergo this type of treatment the patient must also account for other factors which prevent a manipulation from the the best course of action. For instance, if the patient has a history of osteoporosis, there is an increased risk of sustaining a fracture as the arm is carried through various ranges of motion. Also, because of the sudden high velocity stretching, there is a small risk of developing a brachial plexus injury, which is basically an injury to the nerves that pass through the shoulder. Even rotator cuff tears have been documented after a procedure such as this. A skilled orthopedic physician specializing in disorders of the upper extremity can determine a patient's risk for the above.

After the procedure is performed physical therapy must be initiated immediately, as soon as day one after the manipulation in order to maintain any motion that was restored. Ideally the patient should attend PT daily for the first week to control swelling and prevent further loss of motion.

As one can see, a frozen shoulder manipulation is a serious consideration and should be done only after conservative measures fail. Adhesive capsulitis treatment requires persistence, patience, and dedication to achieve full and productive range of motion and function.