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Adhesive Capsulitis—Closed Manipulation(Frozen Shoulder—Closed Manipulation)

Pronounced: ad-HEE-siv cap-soo-LIGHT-iss

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

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
  • Previous shoulder surgery

Prior shoulder surgery may also increase the risk of complications.

What to Expect
Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Blood and urine tests
  • X-ray—to look for any damage to the shoulder bones
  • MRI scan—to look for damage to the shoulder structures

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.

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

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

You will have pain and swelling for 1-2 weeks after the surgery. Your doctor may instruct you to begin physical therapy.

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 DynaMed website. Available at: http://www.ebscohost.com/dynamed. 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_caps.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.

Examination under anesthesia. University of Washington Orthopaedics and Sports Medicine website. Available at: http://www.orthop.washington.edu/uw/examination/tabID__3376/ItemID__207/PageID__425/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.

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

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

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.



Last reviewed December 2012 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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