Manual manipulation of the affected shoulder should be performed by a skilled manual practitioner. The goal of the manipulation is to manually break free restrictive adhesions and to restore motion. Manipulation bears the risk of tearing the shoulder joint capsule or causing a disruption of internal structures.Chiropractic manipulation of shoulder.The patient can expect the practitioner to manually move the shoulder in a manner that will open the joint and place tension on the adhesions and contractures. Sometimes quick impulses are utilized to mobilize the restrictions.
Myofascial Mobilization or “Release”
Soft tissue manipulation of the shoulder, frequently called myofascial release or soft tissue mobilization, is used to free adhesions that limit motion and create pain. Myofascial release is typically a slow stretching of soft tissues that is performed while applying a sustained pressure to connective tissue of the involved structures.
In the event that more conservative measures do not work, more intrusive treatments can be employed. These interventions include steroidal injections, manipulation-under-anesthesia (MUA), and surgery. Steroid injections appear to be as effective as MUA but have less of the dangers associated with anaesthesia and sedation. Surgery is usually reserved for more resistant cases of adhesive capsulitis.
In cases resistant to other treatment, manipulation-under-anesthesia (MUA) may be indicated. In MUA, the patient is sedated to reduce the level of pain and muscle resistance. The orthopaedic surgeon manipulates the shoulder to break free the adhesions. An intensive regime of physical therapy is required for a couple of weeks following MUA to prevent new adhesions from forming following the manipulation.
Contraindications for MUA include:
- Insulin-dependent diabetics
- Those at greater risk for fractures such as the elderly or those with osteoporosis.
- Those with bleeding disorders
- Patients with risks to anaesthesia
In cases that are resistant to all other forms of treatment orthopaedic surgery may be utilized to remove the restrictive adhesions.