Is there evidence that performing joint manipulation under local anesthetic block might be more effective than continuing a program of joint mobilization, stretching, and mobility exercises in a woman with recalcitrant adhesive capsulitis of the shoulder?

A 45-year-old woman was referred by her health care provider to our outpatient physical therapy department with a 6-month history of pain and stiffness in her left shoulder and inability to perform her normal daily activities (eg, bathing, grooming, cleaning the house, and cooking). She particularly reported difficulty with overhead tasks such as washing her hair. She reported a gradual onset of left shoulder pain and stiffness without any known precipitating incident. Previous physical therapy intervention over a period of 6 weeks—consisting of passive joint mobilization, range-of-motion (ROM) exercises, and muscle stretching—had not been effective in improving her function or diminishing her pain. In addition, this patient had received local anti-inflammatory steroid injections with no reported improvements in mobility, function, or pain. Because the injections did not produce improvements in these areas, she declined a referral for another trial of injections. The initial examination of the patient revealed generally decreased ROM in the left shoulder. Range of motion was assessed with the patient in the supine position using procedures described by Norkin and White.1 We found that both passive and active ROM were limited to 115 degrees of flexion, 50 degrees of abduction, 25 degrees of internal rotation, and 5 degrees of external rotation. Previous studies have found the reliability of measuring ROM with a standard goniometer in this fashion to range from moderate to high, particularly for intrarater reliability.2–5