Frozen Shoulder Manipulation Or Physical Therapy - What's Best?

Of all the remedies and solutions available for treating adhesive capsulitis, the two treatments that receive the most attention are the frozen shoulder manipulation and physical therapy. A manipulation under anesthesia (MUA) conjures ideas of an instant cure while PT is viewed as the longer route to a normal functioning shoulder. In either case, therapy is still part of the treatment - or at least it better be. So the question often asked is that between the two procedures, "which is best?" The answer depends on an individual's circumstances and expectations.

A frozen shoulder manipulation is typically performed by an orthopedic physician. The patient is prepped and given a general anesthesia. The affected shoulder is then carried to its end point of motion followed by a quick thrust into a normal range. This is hopefully done in each plane of motion: Forward elevation, abduction (out to the side and overhead), external rotation (rotating the arm/shoulder towards the patient's back), internal rotation (rotating the shoulder towards the front of the body), and across the body. Extension is rarely performed as this motion is not usually deficient with this condition. What is important to achieve normal motion is to stabilize the scapulae (shoulder blade) during each of these thrusts. If not done in this manner, the shoulder may appear to be carried to full range of motion, but is actually not because the shoulder blade is simply going along for the ride. This can lead to a poor outcome with this treatment. With that said, a frozen shoulder manipulation should be performed by a competent clinician with experience in this procedure.

Physical therapy for a frozen shoulder is likewise best performed under the guidance of a therapist with experience in this area. Just because a therapist has a license doesn't mean they can provide the best treatment plan. One is best served to do a little investigation about a therapist's credentials and experience before blindly following his or her lead. This is why you can see so many forum or blog posts on the internet by unhappy patients who have tried therapy with minimal to no results. The clinical process is simple for a good outcome with physical therapy:  1) Pain/muscle spasm control, 2) Proper manual joint mobilization, 3) Home exercise prescription with correct frequency and intensity, 4) measures for gain, and 5) appropriate follow-up. If this process is followed by a clinician experienced in the treatment of adhesive capsulitis the outcome will be good and only conservative measures need to be used. With this I must confess that in my opinion therapy is the best solution overall. As i said before, in either case therapy will be needed as even in the case of an MUA the shoulder will quickly stiffen and scar tissue will form, potentially causing a greater dysfunction than before.

These days it is crucial that the patient take some of the responsibility for their care by doing their due diligence in regards to the treatments that are recommended to them. Even though a frozen shoulder manipulation seems to be the quicker cure, physical therapy in the long run can provide better and more lasting results if the patient chooses their therapist wisely.