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Closed Manipulation

Tightening or stiffness in a joint may allow for correction by the use of non-surgical options like physical therapy or steroid injections. There are also times where the stiffness is sometimes addressed by a forcible, closed manipulation of the joint by an orthopedic surgeon.

Adhesive capsulitis (frozen shoulder) is a tightening in the shoulder joint. It decreases the range of motion in the shoulder and causes pain. The shoulder does not have full range of motion even when a therapist tries to move the shoulder. It is caused by tightening of the soft tissue and formation of scar tissue.

During closed manipulation, the doctor moves the arm at the shoulder joint. This is done to break up adhesions and loosen the stiff joint. The goal of the procedure is to improve range-of-motion by breaking up scar tissue. If the closed manipulation is not successful, you may need arthroscopic surgery.

Your doctor may choose either general anesthesia or local anesthesia (numb up the area) for the surgery. The procedure takes approximately 45-60 minutes. You will feel no pain during the procedure. You will have soreness after the procedure. The doctor will give you pain medicine. You will be monitored by nurses in the recovery room. Once you recover from the anesthesia, you will be able to go home.

After a total knee arthroplasty (TKA) some patients may not regain full range of motion. For these people, surgical manipulation of the knee may be required to restore motion to the knee.

Surgical manipulation of the knee is done under general anesthesia or with an epidural. The patient is usually positioned on his back, and an assistant holds the heel while passive extension is performed by the surgeon. The knee is then flexed until the knee moves more freely. This is done to tear away scar tissue that has formed in the joint as a result of the surgery. The surgeon repeats the flexion and extension movements until the knee moves more easily.

A patient who has not achieved at least 100 degrees of flexion (bending) by four to eight weeks following surgery may be a candidate for surgical manipulation. Surgical manipulation is not generally recommended until the patient undergoes physical therapy and other means of achieving normal range of motion.


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