Surgical options for adhesive capsulitis include joint manipulation under anesthesia and capsular release. Manipulation involves placing the patient under general anesthesia and manipulating the humerus to disrupt adhesions. There is moderate evidence that this alleviates pain and facilitates recovery of motion when it is followed by early physical therapy. 35 , 36 Manipulation under anesthesia is associated with a risk of iatrogenic proximal humeral fracture, glenohumeral dislocation, and rotator cuff tearing. It generally should be avoided in patients with osteoporosis or significant osteopenia, with a history of glenohumeral instability, or who have previously undergone manipulation with subsequent recurrence.
Frozen shoulder is also referred to as adhesive capsulitis, painful stiff shoulder, and periarthritis. We will use the term "frozen shoulder" throughout this review. This topic will review the diagnosis and management of frozen shoulder. Evaluation of the patient with undifferentiated shoulder pain and other specific causes of shoulder pain or dysfunction are discussed separately. (See "Evaluation of the patient with shoulder complaints" and "Rotator cuff tendinopathy" and "Presentation and diagnosis of rotator cuff tears" .)