Factors affecting short- and long-term outcomes of manipulation under anaesthesia in patients with adhesive capsulitis of the shoulder

Abstract

Background: The present study aimed to evaluate and determine the factors that affect short-and long-term outcome following manipulation under anaesthesia (MUA) of patients with adhesive capsulitis. Methods: Patients recruited from January 1999 to January 2010 were retrospectively analyzed and classified as having primary or secondary adhesive capsulitis. All patients were assessed for range of movement (ROM) and Oxford Shoulder Scores (OSS) before and immediately postoperatively, as well as for OSS more than 1 year post MUA. Results: In total, 295 patients (315 shoulders) were sequentially recruited, and information was collected at baseline, as well as at a mean follow-up of 28 days and 3.6 years. A significant improvement in OSS and ROM was noted 1 month post MUA (p < 0.0001) with females benefiting more than males (p < 0.0025). Long-term follow-up revealed that the improvement in OSS was maintained (p < 0.0001). Secondary adhesive capsulitis significantly reduced the efficacy of MUA as assessed by ROM (p < 0.0001). Other factors (age, initial ROM and OSS, and length of symptoms prior to MUA) did not significantly affect the outcome over the short-or long-term. Conclusions: The findings of the present study show that all patient groups had a significantly improved ROM and OSS in the short-term with long-term maintenance of improved OSS.

Can manipulation under anesthesia alone provide clinical outcomes similar to arthroscopic circumferential capsular release in primary frozen shoulder (FS)?: the necessity of arthroscopic capsular release in primary FS

“…However, in our study, diabetic patients showed slightly worse outcomes compared with non-diabetic patients although outcome variables in the ACR group were not significantly different. We observed no differences in any outcome variables in the MUA group, a finding that is consistent with those of other reports and suggests that diabetes is not a contraindication for MUA [16,18,31,34]. Regarding recurrence after surgery, Jenkins et al reported that re-…”

“…FS is strongly associated with diabetes and is two to four times more common in diabetic patients than in the general population [32][33][34][35][36]. FS in patients with diabetes tends to have a more severe and protracted course, and to be difficult to treat [32,37,38].…”

Treatment Strategy for Frozen Shoulder

“…The recurrence rate after MUA varies from 3% to 40% 585960). Jenkins et al59) reported that 36% of patients who had diabetic FS required a repeat MUA versus 15% for nondiabetic shoulders.…”

Management of post-traumatic stiffness of the shoulder following upper limb trauma with manipulation under anaesthetic

“…Despite our short follow-up time, we have previously presented work showing that OSS is maintained in the longer term for patients following MUA. 7,16 We have also shown that patients usually respond to MUA within a very short time frame, usually within a few days, and certainly within 3 weeks, such that, if no or minimal improvement is shown at followup, then further progress is unlikely. However, we attempt further non-operative treatment in these patients unless (or until) they make no further progress and therefore the offer of a repeat MUA at this stage is justified.…”

“…Despite our short follow-up time, we have previously presented work showing that OSS is maintained in the longer term for patients following MUA. 7,16…”