Anterior-inferior capsular length insufficiency in the painful shoulder

Our clinic's initial attempts to document shoulder capsular laxity made us increasingly aware of the presence of subtle restricted passive shoulder movement in patients with a variety of shoulder diagnoses. The purpose of this study is to describe the evaluation, physical therapy treatment, pathomechanics, and implications of a continuum of anterior-inferior capsular length insufficiency and shoulder pain. One hundred fifty-six patients with the diagnoses of shoulder pain, impingement, rotator cuff tendinitis, and frozen shoulder were found to have capsular length insufficiency and were treated by mobilization techniques deemed as manual decompression. Eighty-three percent displayed good to excellent outcomes for decreasing pain, increasing range of motion, and meeting functional goals. Recent literature has supported the concept that capsular ligaments not only provide restraint, but are specifically oriented to guide and center the humeral head on the glenoid during shoulder movements. These patients presented with abnormal glenohumeral mechanics due to anterior capsular ligament length insufficiency. Glenohumeral ligament length insufficiency can be the primary cause of shoulder pain, ranging from frozen shoulder to impingement-like symptoms. Proper capsular ligament length can be restored with manual techniques. All patients with shoulder pain should have capsular ligament length assessment to ensure proper glenohumeral mechanics.