Frozen shoulder, medically known as adhesive capsulitis, causes significant stiffness and pain in the shoulder joint. This occurs when the capsule of connective tissue surrounding the joint thickens and tightens, forming scar tissue or adhesions that severely limit motion. While many cases resolve with conservative treatments, joint manipulation offers an intensive option when stiffness persists. This procedure, typically performed as Manipulation Under Anesthesia (MUA), aims to forcibly restore the shoulder’s range of motion.
The Manipulation Procedure
Manipulation Under Anesthesia (MUA) is performed in an operating room by an orthopedic surgeon while the patient is fully unconscious under general anesthesia or deep sedation. The primary goal is to forcibly break the scar tissue and adhesions within the joint capsule that restrict movement. Anesthesia relaxes the muscles, allowing the surgeon to achieve a greater range of motion.
The surgeon applies controlled, forceful movements in specific directions—such as abduction, external rotation, and internal rotation—to stretch and tear the tightly contracted joint capsule. This immediately restores a greater passive range of motion. The procedure typically lasts less than an hour and is often combined with a nerve block for pain management. Some surgeons may perform an arthroscopy immediately afterward to visualize the joint and surgically release any remaining tight bands of tissue.
Criteria for Selecting Manipulation
Joint manipulation is used for patients who have not responded to several months of non-operative treatment, such as physical therapy and steroid injections. It is considered an aggressive, second-line treatment when chronic shoulder stiffness significantly limits function.
Manipulation is most effective and safest during the “frozen” phase, characterized by established stiffness and lessening pain. It is avoided during the initial, highly inflammatory “freezing” phase, as forceful movement could exacerbate inflammation. Patients with advanced osteoporosis or certain types of diabetes may be less ideal candidates due to increased risks. The decision often hinges on the degree of passive external rotation, as severe limitation is a strong indicator for the procedure.
Immediate Post-Procedure Rehabilitation
Immediate, aggressive physical therapy is necessary for the success of Manipulation Under Anesthesia. The motion gained must be actively maintained to prevent the rapid reformation of scar tissue. Therapy often begins the same day as the MUA or within 24 hours.
The initial phase focuses on maximizing passive range of motion (PROM) and beginning light active range of motion (AROM) exercises. Patients are taught specific stretches, such as pendulum and wand exercises, to perform multiple times daily at home. The shoulder will be intensely sore, requiring a robust pain management plan, including prescribed oral medication and ice therapy. This aggressive approach is maintained over the first six to eight weeks to solidify motion gains and transition the shoulder toward normal function.
Potential Risks and Safety Concerns
While MUA is effective for restoring motion, forceful manipulation carries potential risks. The most serious complication, though rare, is a fracture of the humerus (upper arm bone) due to the high forces applied. Damage to soft tissues, including the labrum and rotator cuff tendons, is also a risk.
Nerve injury, particularly to the brachial plexus, can occur from excessive traction or stretching. The overall complication rate for MUA is low, but risks are higher in patients with poor bone quality or certain pre-existing conditions. Stiffness may recur, requiring further intervention if post-procedure physical therapy is not diligently followed.