Frozen Shoulder Manipulation

An Effective Treatment for Adhesive Capsulitis

Shoulder Manipulation

Physical Therapy Specialists uses this advanced treatment for adhesive capsulitis patients to increase functional outcomes and decrease duration of rehabilitation. The patient is given a local anesthesia vs. general used commonly on other manipulation procedures. The manipulation procedure is therefore painless and allows for chronic adhesions to be broken free to increase mobility and, in most cases, decrease pain. The results are immediate although further rehab will be necessary to gain full movement and increase strength.

Anesthetic Manipulation

Many people suffer from adhesive capsulitis or "frozen shoulder". The condition and traditional rehabilitation may be very painful and time consuming. To decrease time to return to full function, this form of manipulation was developed by Dr. Paul Roubal, PhD, DPT, OCS and Dr. Jeff Placzek, MD, PT, OCS (now a partner at Michigan Hand and Wrist). This is used when conventional treatment fails to improve range of motion and function. It allows for acceleration of therapy, often with a reduction in pain. The procedure requires one day off of work. Patients will have to follow through with an aggressive home stretching program and will be seen daily by their physical therapist. After this first week, they will continue three times a week as needed. Generally, the time following the manipulation requires one month to maintain range of motion and gain strength.

What is Adhesive Capsulitis?

Adhesive Capsulitis or "Frozen Shoulder" is a condition that can occur spontaneously or following inflammation/injury. It is characterized by a loss of mobility in the shoulder which is usually accompanied by significant pain. This condition severely inhibits the normal function of the upper extremity. It can last for years and often leaves the patient with permanent loss of movement if not treated properly. The severe pain is from an inflammatory reaction of the capsule which is the soft tissue which surrounds the joint. Once this inflammation is present, the body develops scar tissue which causes adhesions to thicken the capsule and restrict movement.

How is Adhesive Capsulitis Treated?

Traditional therapy can be successful for some patients and involves the use of treatment modalities to reduce inflammation as well as mobilization/stretching and exercise. Many patients may not make significant gains with this slow paced treatment or may not be able to progress well with their exercise due to pain. Anesthetic manipulation is a method of releasing these adhesions under a local anesthetic without surgery. Patients undergo a local nerve block which anesthetizes the arm and keeps the muscles around the shoulder from resisting movement or "guarding". The manipulation technique involves a gliding mobilization which reduces the risk of damage to the important rotator cuff muscles. Other manipulation techniques involve long lever arms and can sometimes damage the rotator cuff.

Once the procedure is completed, the patients arm regains feeling and motor control within a few hours. Once this occurs, stretching must begin to maintain the range that has been gained. Usually, this increased mobility is quite dramatic. The patient and their therapist work together to return the shoulder to its normal level of function.

The following are actual before and after pictures of one patient with a successful manipulation. The patient has just received the nerve block and has no control of his right arm. The therapist is holding the patients arm to the absolute maximum the patient's shoulder will allow. These are the "cardinal" planes or available range of motion measured in degrees.


Pre and Post Manipulation

Post manipulation pictures taken only 10 minutes after pre manipulation pictures

Flexion

Pre-Manipulation
flexion

Post-Manipulation
flexion

Abduction

Pre-Manipulation
flexion

Post-Manipulation
flexion

Internal Rotation

Pre-Manipulation
flexion

Post-Manipulation
flexion

External Rotation

Pre-Manipulation
flexion

Post-Manipulation
flexion