Silent Manipulation for Frozen Shoulder: A Narrative Review of Its Origins, Philosophy, and Technical Approach

Silent Manipulation for Frozen Shoulder: A Narrative Review of Its Origins, Philosophy, and Technical Approach

Frozen shoulder (adhesive capsulitis) affects 2%–5% of the general population and up to 20% of diabetic patients, causing progressive pain and global restriction of shoulder motion lasting 18–30 months or longer. Silent manipulation—shoulder manipulation performed under ultrasound-guided cervical nerve root block with the patient awake—offers effective treatment for refractory cases, achieving a rapid range of motion (ROM) restoration with favorable safety compared to manipulation under general anesthesia or arthroscopic capsular release. This comprehensive technical manual synthesizes evidence and clinical experience from Japan where silent manipulation has been refined over decades. We detail patient selection criteria, pre-procedure evaluation including ROM assessment and magnetic resonance imaging findings, ultrasound-guided cervical nerve root block technique (C5–C7), intra-articular and periarticular corticosteroid injection, systematic manipulation protocols achieving 360°capsular release, post-procedure rehabilitation emphasizing rotator cuff re-education, and complication prevention strategies including local anesthetic systemic toxicity management. Published evidence demonstrates significant improvements in ROM and functional outcomes within weeks of the procedure, with sustained long-term benefits and minimal complications. Silent manipulation offers rapid symptom resolution, outpatient feasibility, cost-effectiveness, and avoidance of general anesthesia risks, representing a valuable treatment option for refractory frozen shoulder.