Restricted Shoulder Movement: Capsular Contracture or Cervical Referral — A Clinical Study

Abstract

When shoulder movements become restricted in all directions, the literature reports that contracture of the joint capsule is not present in every case. These findings suggest a different underlying pathology in some cases, which restricts shoulder movements in a manner resembling contracture. In order to investigate the concept of another mechanism, fourteen patients were selected with a specific pattern of shoulder stiffness: a gross restriction of lateral rotation associated with only moderate restrictions of abduction and medial rotation. The patients were treated with mobilization of the lower cervical spine, which resulted in an improvement in the range of lateral rotation of the shoulder, the most restricted movement. These results suggest a correlation between the cervical spine and shoulders with this pattern of movement restrictions.

The effects of spinal mobilization with arm movements on shoulder muscle strengthening

“…In many cases, manual therapy is performed on the spine to cure spinal problems. However, Schneider 15 ) noted that limited movement of the shoulder is not only caused by joint problems, but also by pain resulting from cervical nerve compression. Cyriax and Cyriax 16 ) stated that the reference pain that causes limited movement of the shoulder joint can originate in the neck.…”

Management of a Patient With Shoulder Pain and Disability: A Manual Physical Therapy Approach Addressing Impairments of the Cervical Spine and Upper Limb Neural Tissue

“…29 Despite limited evidence supporting the reliability and validity of cervical spine segmental mobility testing, examination was carried out based on evidence indicating the benefits of mobilization techniques in the presence of upper quarter joint mobility impairments associated with shoulder pain and disability. 3,4,22,35,43 Increased resistance was noted with posterior-to-anterior pressures over the right C5-6 segment. The patient reported local pain with pressures at this segment.…”

“…Studies examining the role of manual therapy for shoulder pain, including treatment of cervical spine impairments, have demonstrated positive results. 3,4,22,35,43 The benefit of cervical spine mobilization for patients with evidence of increased neural tissue mechanosensitivity has also been reported. 1,[11][12][13] In my clinical experience, interventions directed at impaired spinal segmental mobility can be particularly beneficial when the ability to directly address mobility of the upper extremity is limited due to excessive pain and guarding.…”

“…3,4,22,35,43 Bang and Deyle 3 demonstrated that manual therapy combined with exercise is better than exercise alone for improving outcomes in patients with shoulder impingement syndrome. In patients with shoulder pain diagnosed as originating from the shoulder girdle, Bergman et al 4 and Winters et al 43 demonstrated that manual therapy is an effective intervention.…”

“…6 Studies investigating the role of manual therapy in the management of shoulder disorders have suggested that addressing impairments of the upper quarter, including the cervical and upper thoracic spine, may have a positive effect on patient outcomes. 3,4,22,35,43 However, the varied inclusion criteria utilized in these studies make it difficult to draw a definitive conclusion regarding the utility of these interventions. Additionally, the manual therapy interventions utilized in these studies were directed at multiple sources, including the cervical and upper thoracic spine, upper rib articulations, glenohumeral joint, and acromioclavicular joint.…”