Medical Director, Lake Minnetonka Mobile Wellness, Minnetonka, MN 55305, USA; Physiology Professor, Minnesota State Colleges and Universities, Minnesota, USAUnited States
Also available as PDF (figures and tables appear in the PDF).
using manipulation, active release therapy, and electronic acupuncture. She had not responded to typical physical therapy but did respond to active release therapy along with adjunctive manipulation and acupuncture. In our course of treatment we wanted to see if we could significantly improve pain-free range of motion and normal; function without using invasive treatments like surgery and manipulation under anesthesia. Over a course of five weeks, using a soft tissue manipulation technique known as active release technique along with electrified acupuncture and home exercises, we were able to increase her range of motion to near normal and her function to normal. She was not forced to miss any work because of the treatment and can now do all the things she needs to do for work
Keywords: Frozen shoulder, Adhesive capsulitis, Manipulation, Active release therapy, Non-invasive treatment; Frozen shoulder; Adhesive capsulitis; Manipulation; Active release therapy; Non-invasive treatment
Treatment consisted of axial manipulation of the right shoulder,
muscles and connective tissues to help elite athletes return to peak performance following injuries. It involves putting significant pressure over a tissue while moving it through its range of motion.3 When performed correctly, you can typically see increased range of motion within minutes. It does require a high pain tolerance from the patient, but it is very effective at increasing range of motion. ART has been used to treat many conditions including tennis elbow, plantar fasciitis, and rotator cuff injuries, but never frozen shoulder. Because of the ability to isolate the region of the shoulder capsule that was primarily affected by the adhesions, it made sense to try to break them up with ART. In this treatment, the thumb was used to put deep pressure into the Since most of the common treatments have questionable shoulder capsule and used the other hand to move the shoulder success or significant possible drawbacks, many patients will opt through the motions of the shoulder. There was also a patient for no treatment or live with the limited restrictions that typical who actively moves her shoulder in all directions while putting physical therapy offers. Unfortunately, this can mean limitations on pressure over the superior and anterior portions of the capsule. activities related to work or to daily activities.
The electrical acupuncture into the same spots in the capsule was used to prevent reactive inflammation following the ART and to
increase regional levels of enkephalins, endorphins, and white blood cells.4 In addition, the patient was advised to perform a A 45-year-old woman was presented with a one-year history of standard range of motion exercises for adhesive capsulitis and frozen shoulder which developed after she had run into a post gave her TheraBands and exercises to perform that would inwith her arm outstretched. She did develop a hematoma followcrease her strength into abduction, flexion, and external rotation ing the injury and, when the hematoma resorbed, she was left so, as we increased her range of motion, we would also increase with frozen shoulder. Diagnostic imaging demonstrated mild arher strength and stability.
thritis in her acromioclavicular joint, but not enough to limit motion. She had tried acupuncture and physical therapy with some
success, but still had significantly reduced passive and active range of motion in her right shoulder. As a right hand dominant emer- Our course of treatment lasted about 4-weeks and included 8 gency physician, frozen shoulder was limiting her ability to do her treatments. By the end of our course of treatment her active work and had prevented her from playing tennis for over a year. range of motion had returned to normal with minimal pain at Osteol Rheumatol Open J. 2020; 3(1): 1-3. doi: 10.17140/ORHOJ-3-111
end range of motion. While she had a little weakness in her susuggest/promote additional trials of treatment using only ART praspinatus she was not limited at all in her activities and was able to treat adhesive capsulitis and compare that to ART and acuto manage any residual pain with over the counter medication. puncture with electrical stimulation.
She was able to flex her right shoulder to 175 degrees, abduct it to 180 degrees, and externally rotate to 85 degrees. Her muscle
strength was normal in all ranges of motion and only caused minor pain at the onset of resisted abduction.
The authors have received written informed consent from the patient.
While ART is not a new concept and is used regularly in the practice of physical therapy and chiropractic, its use here was somewhat novel for the treatment of adhesive capsulitis. It has been shown to decrease pain and increase pain-free range of motion in patients with restrictions due to adhesions in soft tissues. Since a treatment like manipulation under anesthesia is performed to break up those adhesions in the shoulder capsule, it only makes sense that a less invasive process that can break up adhesions would likewise be effective without the risks of general anesthesia or the risks to the bony and muscular tissues of the shoulder that are associated with manipulation under anesthesia. In this case, the results were fast and successful in part due to the use of this technique and the use of acupuncture with electrical stimulation, but also because of the patients adherence to her home exercise protocols. The results of this treatment regimen would strongly