Translational Manipulation After Failed Arthroscopic Capsular Release for Recalcitrant Adhesive Capsulitis: A Case Report

ObjectiveThis article reports the use of translational manipulation after failed arthroscopic capsular release for adhesive capsulitis.Clinical FeaturesThe patient was a 40-year-old woman, insulin-dependent diabetic with the insidious onset of right shoulder adhesive capsulitis. The patient underwent physical therapy 3 times a week for 6 weeks with minimal changes in her range of motion or pain. After failing physical therapy, the patient had arthroscopic capsular release and long-lever arm rotational manipulation of the right shoulder. The patient participated in physical therapy again, failing to regain her range of motion.Intervention and OutcomeSubsequently, the patient underwent interscalene block and translational manipulation by the same therapist followed by physical therapy. The patient's range-of-motion measures, strength testing, pain scale measurements, and functional scoring were recorded throughout her rehabilitation. She returned 2 years postdischarge for the same tests and measurements.ConclusionAdhesive capsulitis in association with diabetes mellitus poses a serious treatment dilemma. Arthroscopic release may have limited benefits secondary to limited release and/or postoperative pain limiting rehabilitation. Translational manipulation under interscalene block may be considered in this difficult treatment group.