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I have a shoulder problem that's been diagnosed as adhesive capsulitis. The surgeon says she can either manipulate the arm while I'm asleep under anesthesia or she can go in and snip the adhesions holding the joint from moving. Which approach is best and why?

Many surgeons prefer to start treatment of adhesive capsulitis with conservative measures such as antiinflammatory medications and physical therapy. If a nonoperative approach is given a concerted effort with no change, then surgery may be the next step. Assuming you have already completed at least three to six months of treatment with no change or a worsening of symptoms, then surgery is required. And manipulation or arthroscopic capsular release are, indeed, the two main choices. Manipulation refers to a procedure in which the surgeon passively moves the patient's arm through its full range-of-motion. The patient is sedated or anesthetized and completely relaxed so it is possible to complete this type of movement. Being anesthetized or sedated means there is no pain for the patient. And that means there's no muscle splinting and guarding preventing motion. Some surgeons prefer to try manipulation first because it is noninvasive. No incisions or puncture holes are required to gain access to the joint. But other surgeons feel that arthroscopic capsular release is a better approach. Although the joint is entered, the surgeon is able to look inside and make a complete inspection of the joint. In this way, it is possible to both confirm the diagnosis and treat as specifically as possible. With arthroscopy, the capsule can be cut or even partially removed to free up motion. Studies comparing the two methods of treatment show better pain relief and function after arthroscopic capsular release. Regardless of the approach, the postoperative care is very, very important. Every effort must be made to maintain the motion gained. Patient cooperation with positioning, physical therapy, and follow-up is essential for the best results. Expect to be diligent with all instructions for weeks if not months and you'll likely have a very positive outcome.

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