Manipulation under anesthesia for primary frozen shoulder: Effect on early recovery and return to activity

Varjonen²,

2015

Scand J Surg

Background and Aims: idiopathic frozen shoulder can be successfully treated conservatively. manipulation under anesthesia, in randomized controlled studies, has proven to bring no additional benefit to other treatments. however, manipulation under anesthesia still is a used method mainly among patients with unbearable pain or too longstanding restriction of shoulder motion. manipulation under anesthesia may lead to significant improvement in shoulder motion and function. however, the best timing for manipulation under anesthesia is still unclear. we therefore investigated whether timing of manipulation under anesthesia has influence on the results of manipulation under anesthesia, concerning range of motion, pain, and function.Material and Methods: we followed 57 patients (65 shoulders; 31 in women) at 2-14 years after manipulation under anesthesia evaluating range of motion, pain, and function. their mean age at manipulation under anesthesia was 54.0 years. a total of 10 patients had diabetes. the time between the onset of symptoms and manipulation averaged 8.8 months. we formed two groups, those mobilized between 6 and 9 months after the onset of symptoms (Group a, 25 shoulders), and the others (Group b, 40 shoulders). we recorded visual analog scale pain, range of motion, simple shoulder test, and constantmurley scores.Results: patients manipulated between 6 and 9 months after the onset of symptoms had significantly better abduction and external rotation, less pain at rest and at night, and better simple shoulder test than the others.Conclusions: it seems that timing has statistically significant influence on results of manipulation of the idiopathic frozen shoulder. the best time for manipulation under anesthesia, if non-operative treatment has failed to alleviate pain or limitation of shoulder

Section: Introductionmentioning

confidence: 99%

Optimal time for manipulation of frozen shoulder may be between 6 and 9 months

Varjonen²,

2015

Scand J Surg

The Journal of Bone and Joint Surgery. British volume

“…3 Further treatment, including surgery, is reserved for resistant cases or functionally compromised patients. Options include manipulation under anaesthesia [4][5][6] with or without corticosteroid and local anaesthetic injection, arthroscopic release 7 and open release. 8 Our preference is for manipulation under anaesthetic (MUA) with a corticosteroid (depo-medrone) and local anaesthetic (bupivacaine) injection.…”

mentioning

confidence: 99%

Treatment of frozen shoulder by manipulation under anaesthetic and injection

Thomas

Jenkins

Owen

et al. 2011

The effect of timing of a manipulation under anaesthetic (MUA) and injection of corticosteroid and local anaesthetic for the treatment of frozen shoulder has attracted little attention to date. All studies describe a period of conservative treatment before proceeding to an MUA. Delay has been associated with a poorer outcome. We present a retrospective review of a prospectively collected, single-surgeon, consecutive series of 246 patients with a primary frozen shoulder treated by MUA within four weeks of presentation. The mean duration of presenting symptoms was 28 weeks (6 to 156), and time to initial post-operative assessment was 26 days (5 to 126). The Oxford shoulder score (OSS) improved by a mean of 16 points (Wilcoxon signed-ranks test, p < 0.001) with a mean OSS at this time of 43 (7 to 48). Linear regression analysis showed no correlation between the duration of presenting symptoms and OSS at initial follow-up (R2 < 0.001) or peri-operative change in OSS (R2 < 0.001) or OSS at long-term follow-up (R2 < 0.03). Further analysis at a mean of 42 months (8 to 127) revealed a sustained improvement with a mean OSS of 44 (16 to 48). A good outcome follows an MUA and injection of corticosteroid and local anaesthetic in patients with primary frozen shoulder, independent of the duration of the presenting symptoms, and this improvement is maintained in the long term.

International Orthopaedics

“…We reserve arthroscopy for cases when the diagnosis is uncertain. Dodenhoff et al [7] reported a significant improvement in early shoulder function after manipulation under anaesthesia in primary frozen shoulder. We would like to emphasise the importance of the characteristic feeling of tearing during manipulation as a diagnostic tool.…”

Section: Discussionmentioning

confidence: 97%

Manipulation under anaesthesia for frozen shoulder

Othman

Taylor

2002

Following manipulation of frozen shoulders under general anaesthesia, we reviewed 74 shoulders at an average of 3 weeks and again at an average of 33 months following the manipulation. We used an adjusted Constant score by excluding the abduction strength measurement. The maximum score was therefore 75 points. The average pre-manipulation score was 24.7 points. At 3 weeks after manipulation this score improved to 54.9 points. At the last follow-up (average 33 months) the score was 72.4 points. We have shown that manipulation under general anaesthesia speeds up recovery of frozen shoulders, and the range of movement improves rapidly.Résumé Nous avons manipulé des épaules gelées sous anesthésie générale. Nous avons examiné 74 épaules à une moyenne de trois semaines et une moyenne de 33 mois qui suivent la manipulation. Nous avons utilisé le score de Constant ajusté en excluant la mesure de la force d'abduction avec, en conséquence, un score maximal de 75 points. Le score moyen avant manipulation était 24.7 points. Trois semaines après la manipulation il était amélioré à 54.9 points. Au dernier examen (moyenne 33 mois) il était de 72.4 points. Nous avons montré que la manipulation sous anesthésie générale accélère la récupération et l'amplitude des mouvements s'améliore rapidement.