Shoulder > Frozen Shoulder > Treatments

   Manipulation Under Anesthesia

Treatment Introduction

If your frozen shoulder has failed to respond to conservative treatment consisting of rest, anti-inflammatory medication and physical therapy, your physician may suggest manipulation under anesthesia. In this procedure, your physician moves your shoulder through its complete range of motion while you are anesthetized. This effectively tears the scar tissue that has formed in your shoulder joint capsule and allows for freer movement of your shoulder. While many patients report significant reduction in pain and increased range of motion after this procedure, there is a small risk of vascular or neurologic injury, injury to your shoulder’s articular cartilage, or fracture of the humerus.

The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery. Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a shoulder sling, ice packs or coolers, or heating pads. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for manipulation of your shoulder. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your physician or an assistant about this. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your shoulder may be shaved, though this is not always necessary. You will wear a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant, and meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because you will be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Wear a soft, comfortable shirt that will not irritate your skin when worn under a shoulder sling.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Manipulation of your shoulder is a relatively simple and brief procedure that is performed in a hospital or outpatient clinic.

   You usually are given an interscalene block, also referred to as regional anesthesia, to numb your shoulder and neck area. This is administered with an injection in the side of your neck.

   You also are put under general anesthesia, and may be given a mild sedative to help you relax.

   While lying on your back, the physician takes your arm and moves it through its range of motion.

   You usually are taken directly to the physical therapy area of the medical center to begin passive motion exercises.

The amount of pain you experience following manipulation of your frozen shoulder can vary greatly. The regional anesthetic usually wears off in about two hours. General anesthesia wears off in about an hour. You can expect to be given pain medication as needed. Be sure to ask for medication – which could be in various forms, such as local blocks, IV narcotics, or orals - as soon as you feel pain coming on, because pain medication works best on pain that is building rather than on pain that is already present. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. Ice also helps control pain and swelling. As soon as possible after surgery, you may begin exercises using a continuous passive motion machine (CPM). Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital.

Following manipulation of your frozen shoulder, and depending on the degree of pain you are experiencing, your physician may want you to focus on relieving your pain rather than increasing your range of motion. This involves rest, ice, medication, and in some cases, immobilization of your shoulder. You will be asked to refrain from using the affected shoulder as much as possible. You should avoid putting strain on your shoulder, raising your arm over your head, or lifting heavy objects. Physicians often prescribe a removable sling to immobilize your shoulder, but will want you to wear for as short a period of time as possible as motion is important during this time. Depending on the severity of your pain, your physician also may prescribe non-steroidal anti-inflammatory medications. Icing your shoulder for 20 to 30 minutes at a time, three or four times a day, also can help relieve pain and inflammation. Some patients are given corticosteroid injections to ease pain. The amount and frequency can vary and you will likely wear a sling for at least a few days. Rehabilitation, using the exercises you learned at the hospital, usually can begin immediately.

Once your pain has decreased enough to allow you to move your shoulder comfortably on your own, you usually can begin performing basic stretching exercises aimed at increasing your shoulder’s range of motion. Some of these include a pendulum-like motion, in which you lean over with your affected arm hanging down and your other arm extended and resting on a table to support your body, and then make small circles with your affected arm. The next step is to perform this exercise while holding a light weight. Other exercises focus on flexing your shoulder forward and back with gentle motions, and some use apparatus such as a wand or pulley system. All involve the unaffected arm "leading" the affected arm so that the affected arm does not have to push against resistance. As in all exercises, proceed gradually. Do not pursue an aggressive exercise program if you experience pain or stiffness.

FORMAL PHYSICAL THERAPY

A physical therapist may use heat or ultrasound to ease the pain in your shoulder and allow you to exercise more comfortably and efficiently. Your physician also may suggest an injection of a long-lasting anesthetic before you perform supervised stretching exercises. Your physical therapist then takes you through a series of passive movements aimed at regaining range of motion in your shoulder.

It is not uncommon for sufferers of frozen shoulder to experience residual symptoms for years after the initial diagnosis. These generally include mild pain and a small loss of range of motion in the shoulder that usually does not affect your ability to perform everyday functions. There is no way to truly protect yourself from a recurrence of frozen shoulder, but physical therapy is recommended to help strengthen and stabilize the joint. There is no way to truly protect yourself from a recurrence of frozen shoulder, but physical therapy is recommended to help strengthen and stabilize the joint.