Francesca Galiano
06/09/2023 - Last update 14/11/2023

Leonid Tafler, Abbey Santanello, Yelizaveta Lysakova | Year 2022

The Function of Osteopathic Medicine in the Treatment of Adhesive Capsulitis


Adhesive capsulitis and/or frozen shoulder

Type of study:

Case Report

Date of publication of the study’:



Purpose of the study

  • Objective: to show the usefulness of OMT in restoring function in a case of adhesive capsulitis
  • Measured outcomes: evaluation of the symptoms


  • Number: 1
  • Description: a 58-year-old woman with no particular medical history, who had been complaining of pain, stiffness, and decreased range of motion (ROM) in both shoulders for 1 year, as well as severe weakness in both arms.

The symptoms appeared 10 minutes after she had started swimming, performing a series of movements with her arms above her head without having done a proper warm-up. She felt a sharp stabbing pain in her shoulder and back, followed by a sense of weakness in both arms, as a consequence she had to be helped to reach the pool’s edge. From then on, the pain became chronic and dull and remained debilitating as it prevented her from performing the simplest daily tasks, first of all getting dressed. Before the injury, the patient had an active life: she walked and performed power exercises, also using rubber bands and weights.

Orthopedic and radiological examinations revealed severe joint arthropathy, in response to which one surgeon recommended arthroplasty to the left shoulder, while another surgeon recommended prosthetic surgery to both shoulders. As an alternative the patient underwent some weekly sessions of physiotherapy, through which she noticed only some slight improvements.

At this point, 13 months after the injury, she arrived at the osteopathic clinic.

The osteopathic evaluation revealed widespread pain in the arms, limited ROM bilaterally, and a weak grip (2 out of 6) in both hands, as well as some pathological changes at the cervical and thoracic level and chronic strong muscle spasms at the trapezius level.

Therefore, in view of the clinical history, a diagnosis of adhesive capsulitis was issued.

Interventions and evaluations

  • Assessment of the symptoms
  • Several OMT sessions
  • OMT: high-velocity low-amplitude techniques applied to the cervical and thoracic regions; Spencer techniques under anesthesia.


Immediately after the first session, the patient reported immediate relief: increased strength, decreased pain by 50%, and improved ROM.

After 2 months of OMT, as the ROM in the shoulders did not improve, the practitioners switched to performing OMT under anesthesia, which restored the ROM to 90%.
From then on, every 2-3 months for 2 years the patient kept returning for some follow-up visits, after which she reported being able to perform most activities requiring the use of her arms with ease. Sometimes she needed assistance when she had to raise her arms far above her head (eg, getting something from the overhead cupboard). However, she was able to return to her exercise program.


OMT, in combination with anesthesia, has been shown to be able to restore full (or nearly full) function in a woman with a condition of adhesive capsulitis.

Adhesive capsulitis remains often undiagnosed because chronic muscle spasms and cervical changes are not taken under consideration, despite their centrality in the diagnosis of this condition.

The use of anesthesia (eg, propofol), and the subsequent relaxation of muscle fibers and nociceptive pathways, helps OMT to resolve the somatic dysfunction – an approach used since the 1930s – where other conservative approaches have failed or as an alternative to surgery. In particular, fibrotic tissues and scars caused by chronic inflammation can be smoothed under anesthesia.

The review of Osteopedia

By Marco Chiera

Strengths: OMT allowed a positive outcome by acting non-invasively when two surgeons had recommended invasive surgeries instead, which, according to what is emerging in the literature, may not have actually improved the problem; evaluation over the long term (2 years).

Limits: like any case report, it is difficult to generalize its results; generalization is also difficult because capsulitis tends to resolve on its own, just within a time frame comparable to the length of the study. The study talks of “pain fibers” when in fact there are only nociceptive fibers since pain is a response processed by the body, if not even an experience, but not a stimulus.

The difference between adhesive capsulitis and frozen shoulder is not discussed. In fact they are different conditions but easily confused with one another – also because they are often considered synonyms. They have different pathogenetic mechanisms and developments, therefore it is important to know how to distinguish them.

Riflessione: the authors report that osteopathy has a comprehensive approach, but the approach shown seems only structural: for while it is true that structure governs function, it is also true that function governs structure. And it is precisely here that the difference between adhesive capsulitis, a typically structural disorder with tissue alteration, and frozen shoulder, a functional disorder (eg, purely neurological or other systems) that results in pain and limited ROM, plays out.

Having used anesthesia is a central aspect because it may have altered the action of the OMT. Under anesthesia, in fact, the authors were able to perform movements that they could not before, which sent specific proprioceptive and interoceptive impulses to the central nervous system. These impulses, and not the tissue modification (assuming there was any) may have been the mediators of the effect of OMT.

No such conclusion can be drawn from this case report, but for this very reason more attention should be paid to structure and function and, therefore, the difference between adhesive capsulitis and frozen shoulder.

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