Adhesive Capsulitis — (Manipulation Under Anesthesia / Distention)

University of Delaware Physical Therapy · UDPT Clinical Team

Weight-Bearing

N/A (shoulder); PT begins day of MD procedure

Key Restrictions

Ice only for pain (heat may increase stiffness first days); moist heat allowed after 3 days; increased recurrence risk in diabetes; discharge ROM goal: full or >= 80% of uninvolved and functional with ADLs; patient marks ROM on wall at discharge and returns if it drops 2 inches and does not improve with increased stretching within 1 week

Timeline & Phases

Weeks 1-2 (PT 4-5x/week wk 1, 3x/week wk 2: GHJ mobs and stretching in procedure order, AAROM, ice/TENS PRN); Weeks 3-4 (1-2x/week: IR stretch behind back, isometrics, scapular strengthening if near full ROM); Weeks 5-6 (1-2x/week: isotonics, sport/work specific rehab, HEP if functional with ADLs); 10-15 visits expected

Notes

University of Delaware PT Clinic; adhesive capsulitis; MD procedure: posterior/inferior GHJ mobs then sequential stretches (horizontal ADD, inferior mob, ABD, flexion, IR at 90° ABD, ER at 90° ABD, ER at 0° ABD, horizontal ADD with IR); clinical decision: MUA + regional scalene block if IR/ER arc < 70° (IR < 25°, ER < 45°, ABD < 75°); office distention used when arc > 70° and ADLs limited; isolation of GHJ motion (Codman exercises); AAROM used to reduce guarding with PROM; normal scapulohumeral rhythm target by weeks 3-4

Surgeon / Author

UDPT Clinical Team