“RESTORING SHOULDER MOBILITY THROUGH THORACIC MANIPULATION IN ADHESIVE CAPSULITIS: A CLINICAL CASE REPORT”

Abstract

Background: Adhesive capsulitis (AC), or frozen shoulder, is characterized by progressive pain and restriction of shoulder range of motion (ROM). While conventional physiotherapy focuses on the shoulder complex, emerging evidence suggests a role for the regional interdependence model, where thoracic spine dysfunction may contribute to shoulder symptoms. Case Presentation: A 45-year-old male presented with a 3-month history of right shoulder pain and stiffness, diagnosed with idiopathic adhesive capsulitis (Stage II, frozen phase). Initial treatment with a 2-week structured physiotherapy program (including moist heat, pendulum exercises, Spencer techniques, Maitland mobilizations, and progressive strengthening) yielded minimal improvement in pain and ROM. Intervention: Following the lack of progress, high-velocity, low-amplitude (HVLA) thrust manipulation was applied to the thoracic spine twice daily for three consecutive days. Outcomes: Immediate and significant improvements were noted post-intervention. Pain on the Visual Analogue Scale (VAS) decreased from 8/10 to 2/10. Shoulder ROM improved markedly: flexion increased from 70° to 140°, abduction from 55° to 150°, and external rotation from 15° to 50°. The patient regained independence in daily activities. Conclusion: This case demonstrates that thoracic spine HVLA manipulation can rapidly improve pain and restore functional ROM in a patient with AC who was unresponsive to conventional shoulder-focused therapy. It supports the principle of regional interdependence in shoulder rehabilitation. Thoracic assessment and manipulation should be considered as an adjunct intervention in the management of adhesive capsulitis, particularly when progress with standard care plateaus.