Traditional methods of treatment
Most treatment methods begin with a conservative approach aimed at increasing the range of motion in the glenohumeral joint. Therapeutic movements, such as Codman's pendulum exercises (seen to the left), are often used. In this exercise, the patient/client will let the shoulder hang while slowly swinging it like a pendulum. This action encourages a gradual increase in range of motion. Care should be taken with rehabilitative exercise, as progress may be slow. If the exercises are performed too vigorously further capsular tearing might occur, aggravating the problem.

Strength-training programs are also used with the idea of increasing stamina in the supporting muscles. It is thought that increased muscular endurance decreases the load on the capsule in certain shoulder movements. However, overly aggressive strength training is likely to increase pain sensations and lead to further capsular restriction. In addition to strength training, anti-inflammatory medications may be used. These include oral medications as well as corticosteroid injections in the shoulder, although the benefits of this approach are controversial. The injections have long-term detrimental effects on the integrity of connective tissue. They have been proven to cause degeneration in connective tissues if done too frequently. For conditions where it is even questionable that there is a true inflammatory problem, they are often discouraged.

If conservative treatment is not successful, a more aggressive approach is sometimes used. While the capsule may be surgically mobilized, a more common procedure is forced manipulation. The shoulder is anesthetized and the joint is forcibly moved through its range of motion, essentially tearing the capsular adhesion free. Though this procedure can produce dramatic improvements in motion, it can be very painful when the anesthesia wears off. If the patient does not continue adequate movement, even more capsular adhesion may occur as a result of the treatment.

References