by Cresse M

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. 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 people. 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

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Pain
  • Nerve injury
  • Damage to soft tissue
  • Instability or stiffness in joint
  • Fracture
  • Reaction to anesthesia used
Factors that may increase your risk of complications:

What to Expect

Prior to Procedure

Your doctor may do the following:
Leading up to the procedure:
  • Arrange for a ride to and from the hospital, and 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, you will be taken to a recovery room and monitored.

How Long Will It Take?

45-60 minutes

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

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

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
  • 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
If you think you have an emergency, call for medical help right away.

RESOURCES

Ortho Info— American Academy of Orthopaedic Surgeons
http://www.orthoinfo.org
Sports Med—American Orthopaedic Society for Sports Medicine
http://www.sportsmed.org

CANADIAN RESOURCES

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

References

Adhesive capsulitis of shoulder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 17, 2014. Accessed December 17, 2014.
Adhesive capsulitis (frozen shoulder). Palo Alto Medical Foundation website. Available at: http://www.pamf.org/sports/king/adhesive%5Fcaps.html. Accessed December 17, 2014.
Ewald A. Adhesive capsulitis: A review. Am Fam Physician. 2011;83(4):417-422.
Examination under anesthesia. University of Washington Orthopaedics and Sports Medicine website. Available at: http://www.orthop.washington.edu/?q=patient-care/articles/shoulder/examination-under-anesthesia.html. Updated February 4, 2013. Accessed December 17, 2014.
Frozen shoulder. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00071. Updated January 2011. Accessed December 17, 2014.
Shoulder arthroscopy. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00589. April 2011. Accessed December 17, 2014
Warner JP. Frozen shoulder: Diagnosis and management. J Am Acad Orthop Surg. 1997;5:130-140.
Shoulder surgery. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00066. Updated August 2009. Accessed December 17, 2014.

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