BACKGROUND AND PURPOSE: Shoulder stiffness, including adhesive capsulitis or frozen shoulder, is characterized by a decrease in shoulder range of motion. Adhesive capsulitis affects about 3% of the population, being most common in women between the ages of 40 and 70. This condition progresses in 4 stages and is considered a self-limiting condition that can last from 12 months to 42 months. Many treatments are used for adhesive capsulitis. Manipulation is often the treatment of choice even though there is a dearth of high level evidence to support it. In our literature search, we considered any skilled passive movements of the shoulder that were applied at varying speeds and amplitudes as a manipulation. The purpose of our systematic review of the literature was to determine the effects of shoulder manipulation on increasing range of motion in patients with stiff shoulders, compared to home based exercise programs. METHODS: A literature search was performed using the following databases: SPORTDiscus, CINAHL, Cochrane, PEDro, Scopus, and Medline. Papers were selected based on the inclusion criteria of: primary diagnosis of idiopathic shoulder adhesive capsulitis, manipulation as a primary intervention, published between January 2000 and September 2011, and available in English. Exclusion criteria included: manipulation under anesthesia, shoulder stiffness as a result of injury, or surgery to the affected shoulder. FINDINGS: Of the 280 papers identified from a multi database search only 5 satisfied the inclusion and exclusion criteria. Two papers were randomized controlled trials and 3 papers were cohort studies. Varied results were found as to whether adding manipulation to the exercise programs of patients presenting with adhesive capsulitis enhances treatment effectiveness or restores motion. CONCLUSION: Several studies suggest improvement of range of motion with this method of treatment, but lack true controls that would allow for distinction between benefits derived from treatment in comparison to the natural history of the disorder. CLINICAL RELEVANCE: Based on the current literature it is not possible to discern whether manipulation in conjunction with a traditional exercise program leads to an increase range of motion in this population.

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