Shoulder Manipulation - Should I Or Should I Not?

To start with, let me say up front that I've never had a shoulder manipulation under anesthesia. I treated my own frozen shoulder with great success (with a little help now and then from co-workers and my wife). I have however treated many a patient after having this procedure, the vast majority of which I did not have the opportunity to treat conservatively prior to the procedure. This makes the argument as to whether it was truly beneficial over tried and true physical therapy difficult to support.

I can say this however, not one single soul came to me after a shoulder manipulation with full range of motion. This makes sense though when one considers what takes place during this procedure. The idea is to take a shoulder which is frozen due to "tiny adhesions" around the joint capsule and forcefully take it through it's full range while the patient is asleep. Sounds simple, right? What typically takes place though is additional trauma to the shoulder's joint capsule, and/or possibly to the soft tissue surrounding the shoulder complex. This leads to a natural imflammatory reaction after the event, followed by swelling, muscle guarding, and believe it or not, more scar tissue eventually laid down in the shoulder.

The hopes of a quick fix solution can quickly fade as now more therapy and joint mobilization is required to return the shoulder to a functional state. The point of stating all of this is not to imply that a shoulder manipulation is never necessary. There are, in fact, some cases where this is the best option -- usually because the patient was inconsistent or non-compliant with their conservative program, or possibly because their pain threshhold was so low that they could not endure any amount of stretching or exercise during therapy sessions. The main point is to educate the patient that this procedure is not meant to be a quick fix, but rather a last resort if all else fails.

A properly designed program of stretching and movement can, in most cases, return a great deal if not all of a shoulder's previous range of motion. If results are not coming as quickly a one desires then he/she should consider the therapist's experience in treating frozen shoulder syndrome, how long the patient has had the condition, and how long they have tried conservative measures. My experience has taught me that persistence and properly applied exercise is the key to treating adhesive capsulitis successfully. Again, a shoulder manipulation should be the last in line of treatment options.