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

Lancaster, S.; Grove, Thomas; Woods, David

doi:10.1177/1758573217693974

Cited by 10 publications

(8 citation statements)

References 16 publications

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“…In a study of 73 patients undergoing open reduction internal fixation (ORIF) for proximal humerus fractures, Clavert et al 18 found that PTS developed in 4.1% of patients. In a study by Lancaster et al 19 on 64 patients with PTS after upper limb trauma, manipulation under anesthesia (MUA) was a successful intervention for improving ROM and Oxford Shoulder Scores. The improvement in ROM after MUA was similar to that observed in patients who underwent MUA for idiopathic AC.…”

Section: Risk Factorsmentioning

confidence: 99%

Treatment of Adhesive Capsulitis of the Shoulder

Redler

Dennis²

2019

J Am Acad Orthop Surg

117

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Adhesive capsulitis presents clinically as limited, active and passive range of motion caused by the formation of adhesions of the glenohumeral joint capsule. Radiographically, it is thickening of the capsule and rotator interval. The pathology of the disease, and its classification, relates to inflammation and formation of extensive scar tissue. Risk factors include diabetes, hyperthyroidism, and previous cervical spine surgery. Nonsurgical management includes physical therapy, corticosteroid injections, extracorporeal shock wave therapy, calcitonin, ultrasonography-guided hydrodissection, and hyaluronic acid injections. Most patients will see complete resolution of symptoms with nonsurgical management, and there appears to be a role of early corticosteroid injection in shortening the overall duration of symptoms. Surgical intervention, including manipulation under anesthesia, arthroscopic capsular release both limited and circumferential, and the authors' technique are described in this article. Complications include fracture, glenoid and labral injuries, neurapraxia, and rotator cuff pathology. Postoperative care should always include early physical therapy.

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Section: Risk Factorsmentioning

confidence: 99%

Treatment of Adhesive Capsulitis of the Shoulder

Redler

Dennis²

2019

J Am Acad Orthop Surg

117

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“…These are different from other causes of stiffness, which may co-exist. A predisposition to inflammation, pain, prolonged immobilization, and other factors may additionally result in a chronic capsular fibrotic reaction ( 3 ). Soft tissue contractures may occur in various tissues including capsular synovial lining, and musculotendinous units.…”

Section: Pathophysiologymentioning

confidence: 99%

“…The use of mobilization under anesthesia (MUA) is controversial. A study investigating the outcome of MUA in patients with primary frozen shoulder compared to those with refractory post-traumatic stiffness, including 55% of PHFs treated non-operatively, was reported ( 3 ). Both groups benefited from MUA, and no significant differences between the groups were found.…”

Section: Treatmentmentioning

confidence: 99%

“…It is the commonest surgical procedure even if other causes exist, such as bony or implant impingement. This is due to the frequent finding of capsular contracture associated with various extraarticular causes for stiffness ( 3 ). Arthrolysis was initially described as an open procedure ( 9 , 27 ); however recently, arthroscopic arthrolysis is considered the gold standard ( 9 , 12 , 26 , 28 , 29 , 30 , 31 , 32 ).…”

Section: Treatmentmentioning

confidence: 99%

“…Stiffness after PHF develops in a significant proportion of patients, even in undisplaced fractures managed conservatively ( 3 ). PHFs with secondary stiffness are associated with higher rates of employment absence and higher costs for the healthcare system ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

How to treat stiffness after proximal humeral fractures?

2023

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Shoulder stiffness is a frequent complication after proximal humeral fractures treated with or without surgery. Shoulder stiffness is associated with high rates of absence from work and a significant financial burden for the healthcare system. Secondary stiffness is characterized by additional extracapsular adhesions, including subacromial, subcoracoid, and subdeltoid spaces, usually derived from post-fracture or post-surgical extraarticular hematomas. Several secondary causes may coexist with capsular and extracapsular adhesions decreasing the shoulder motion, such as malunion, nonunion, metalwork failure, infection, and osteoarthritis, among others. Conservative treatment, usually prescribed for primary shoulder stiffness, has shown unfavorable results in secondary stiffness, and surgical intervention may be required. Surgical interventions need to be patient-specific. Usually, open or arthroscopic fibro-arthrolysis and subacromial release are performed, together with plate removal and biceps tenotomy/tenodesis. In severe osteoarthritis, shoulder replacement may be indicated. Ruling out infection is recommended in every case.

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Shoulder Post-traumatic Stiffness

Charalambous

2019

The Shoulder Made Easy

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

Abstract: MUA results for PTS following upper limb fracture are comparable to MUA for PFS. We therefore recommend MUA in PTS cases where conservative methods have failed.

Cited by 10 publications

References 16 publications

Treatment of Adhesive Capsulitis of the Shoulder

Treatment of Adhesive Capsulitis of the Shoulder

How to treat stiffness after proximal humeral fractures?

Shoulder Post-traumatic Stiffness

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