Health Library

Adhesive Capsulitis—Closed Manipulation

(Frozen Shoulder—Closed Manipulation)

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

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

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

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)

What to Expect

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.

Your doctor may choose either:

General anesthesia —You will be asleep during the surgery.
Local anesthesia (less common)—The shoulder area will be numbed.

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

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

45-60 minutes

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

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

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.

American Academy of Orthopaedic Surgeons

http://www.aaos.org/

American Orthopaedic Society for Sports Medicine

http://www.aossm.org/

Canadian Orthopaedic Association

http://www.coa-aco.org/

Canadian Orthopaedic Foundation

http://www.canorth.org/

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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.