Manipulation Under Anesthesia and Prolotherapy for Adhesive Capsulitis and Rotator Cuff Tear: A Case Report With 7-Year Follow-Up

Objective

The objective of this case study is to describe the history, presentation, treatment, and outcome of a patient receiving manipulation under anesthesia (MUA) followed by prolotherapy for adhesive capsulitis and rotator cuff tear.

Clinical Features

A 50-year-old male patient had a 6-month history of chronic shoulder pain. His range of motion was markedly reduced in all planes. His intractable shoulder pain and dysfunction were refractory to chiropractic manipulation, physical therapy, and steroid injections. At presentation, he was taking hydrocodone 5/325 every 8 hours for pain without pain relief. Pain was preventing the patient from sleeping through the night. Magnetic resonance imaging showed adhesive capsulitis and distal infraspinatus partial-thickness tendon tear.

Intervention and Outcome

After completing medical clearance, the patient received a 3-day serial MUA. He participated in a course of post-MUA therapy for 4 weeks and thereafter received 6 total dextrose-based prolotherapy injections of the infraspinatus tendon over the subsequent 8 weeks. His self-rated pain rating scale improved from a 77 out of 100 to 11 out of 100. His range of motion returned to within normal limits in all planes and was bilaterally equal.

Conclusion

This patient with adhesive capsulitis and rotator cuff tear responded favorably to MUA and dextrose-based prolotherapy. Results were maintained 7 years after treatment.