The Function of Osteopathic Medicine in the Treatment of Adhesive Capsulitis

Participants

• 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.

Results

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.

Discussion

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.