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Adhesive Capsulitis—Closed Manipulation

(Frozen Shoulder—Closed Manipulation)

Definition

Adhesive capsulitis is a tightening in the shoulder joint. It decreases the range of motion in the shoulder and causes pain. The shoulder does not have full range of motion even when a therapist tries to move the shoulder. This condition is also known as frozen shoulder . It is caused by tightening of the soft tissue and formation of scar tissue.
During closed manipulation, the doctor moves the arm at the shoulder joint. This is done to break up adhesions and loosen the stiff joint. The goal of the procedure is to improve range-of-motion by breaking up scar tissue.
Frozen Shoulder
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Reasons for Procedure

Your doctor may recommend closed manipulation if other methods of relief have failed. This procedure can relieve pain and stiffness for some patients. In others, there is still some pain and swelling in the shoulder joint. If the closed manipulation is not successful, you may need arthroscopic surgery .

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a shoulder manipulation, your doctor will review a list of possible complications, which may include:
  • Pain
  • Nerve injury
  • Damage to soft tissue
  • Instability or stiffness in joint
  • Fracture
  • Reaction to anesthesia used
Some factors that may increase the risk of complications include:
  • Recent or chronic illness
  • Certain medicines—especially those that increase bleeding (eg, aspirin )
  • Smoking or alcohol use
  • Previous shoulder surgery (may cause damage)
Some factors that may increase the risk of complications include:
  • Recent or chronic illness
  • Certain medicines—especially those that increase bleeding (eg, aspirin )
  • Smoking or alcohol use
  • Previous shoulder surgery (may cause damage)

What to Expect

Prior to Procedure

Your doctor may do the following:
  • Physical exam
  • Blood and urine tests
  • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
Leading up to the procedure:
  • Arrange for a ride to and from the hospital. Also arrange for help at home after the procedure.
  • The night before, eat a light meal. Do not eat or drink anything after midnight. If you have diabetes, you may need to adjust your medicines. Ask your doctor about this.

Anesthesia

Your doctor may choose either:
  • General anesthesia —You will be asleep during the surgery.
  • Local anesthesia (less common)—The shoulder area will be numbed.

Description of the Procedure

The doctor will twist and move your shoulder upward and outward. The actions will break up scar tissue to improve range of motion.

Immediately After Procedure

If you had general anesthesia, the nurses will monitor you in the recovery room.

How Long Will It Take?

45-60 minutes

How Much Will It Hurt?

You will feel no pain during the procedure. You will have soreness after the procedure. The doctor will give you pain medicine.

Average Hospital Stay

Once you recover from the anesthesia, you will be able to go home.

Post-procedure Care

You will have pain and swelling for 1-2 weeks after the surgery. Your doctor may instruct you to:
  • Ice the swollen area for the first 24-48 hours. Do this for periods of 20-30 minutes.
  • Sleep sitting up or in a recliner. Place a pillow behind your elbow.
  • Periodically open and close your hand and move your elbow.
  • Begin intense physical therapy.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Cough, trouble breathing, or chest pain
  • Severe nausea or vomiting
  • Pain becomes worse or swelling increases
  • Tingling or numbness that will not go away, especially in arms and hands
In case of an emergency, call for medical help right away.

RESOURCES

American Academy of Orthopaedic Surgeons http://www.aaos.org/

American Orthopaedic Society for Sports Medicine http://www.aossm.org/

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org/

Canadian Orthopaedic Foundation http://www.canorth.org/

References

Adhesive capsulitis. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20030315/1323ph.html . Accessed November 18, 2008.

Adhesive capsulitis. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed December 3, 2008.

Adhesive capsulitis (frozen shoulder). Palo Alto Medical Foundation website. Available at: http://www.pamf.org/sports/king/adhesive%5Fcaps.html . Accessed December 3, 2008.

Adhesive capsulitis: physical therapy. EBSCO Publishing Nursing Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/nrc-about . Updated June 2007. Accessed November 18, 2008.

Arthroscopy. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2008. Accessed December 3, 2008.

Carson-DeWitt R. Frozen shoulder. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2008. Accessed December 3, 2008.

Examination under anesthesia. University of Washington Orthopaedics and Sports Medicine website. Available at: http://www.orthop.washington.edu/uw/examination/tabID%5F%5F3376/ItemID%5F%5F207/PageID%5F%5F425/Articles/Default.aspx . Accessed November 21, 2008.

Frozen shoulder. EBSCO Publishing Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated March 2008. Accessed November 19, 2008.

Geier C, orthopedic surgeon. Surgery times. E-mail communication. December 9, 2008.

Iannotti JP, Williams GR. Disorders of the Shoulder : Diagnosis and Management Philadelphia, PA: Lippincott Williams & Wilkins; 2007: 556.

Kellicker P. General anesthesia. EBSCO Publishing Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 2008. Accessed December 3, 2008.

Outpatient surgery. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/florida/weston/hospital/outpatient%5Fsurgery.aspx . Accessed November 21, 2008.

Role of massage in scar therapy. EBSCO Publishing Consumer Health Complete website. Available at: http://www.ebscohost.com/thisMarket.php?marketID=14 . Updated March 2002. Accessed November 18, 2008.

Rouzier P. Frozen shoulder (adhesive capsulitis). EBSCO Publishing Consumer Health Complete website. Available at: http://www.ebscohost.com/thisMarket.php?marketID=14 . Published July 2006. Accessed November 18, 2008.

Solomon D, director of Sports Medicine and Shoulder Service at Naval Medical Center, San Diego, CA. Surgery times. E-mail communication. December 5, 2008.

Warner JP. Frozen shoulder: diagnosis and management. J Am Acad Orthop Surg . 1997;5:130-140.

What treatments work best for shoulder pain? Best Health website. Available at: http://besthealth.bmj.com/btuk/conditions/1000096758.html . Updated September 2008. Accessed December 3, 2008.

Wolf BR, spokesperson for American Orthopaedic Society for Sports Medicine. Surgery times. Oral communication. December 5, 2008.

Your shoulder surgery. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00066 . Updated August 2007. Accessed November 20, 2008.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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