Outcome of manipulation under anesthesia with or without intra-articular steroid injection for treating frozen shoulder

Abstract

Manipulation under anesthesia (MUA) combined with intra-articular steroid injection (ISI) is preferred in management of the refractory frozen shoulder (FS). This study aimed to evaluate the effect of MUA with ISI or not on pain severity and function of the shoulder. Data on 141 patients receiving MUA with primary FS refractory to conservative treatments for at least 1 month were retrospectively obtained from medical records. We performed propensity score matching analysis between patients receiving MUA only and those receiving MUA plus ISI, and then conducted logistic regression analysis to identify the risk factors for the need to other treatments during 6-month follow-up. More improvement in terms of the SPADI pain scores and passive ROM at 2 weeks after first intervention remained in patients receiving MUA plus ISI after matching. The need to other treatments during 6-month follow-up occurred in 10.6% patients (n = 141). Logistic regression analysis revealed that a repeat MUA 1 week after first intervention was a protective factor (OR 0.042; 95% CI 0.011–0.162; P = .000) and duration of disease was the only one risk factor (OR 1.080; 95% CI 1.020–1.144; P = .008) for the need to other treatments during follow-up. ISI immediately following MUA provided additional benefits in rapid relief of pain and disability for patients with refractory FS. Pain and disability of the shoulder may be rapidly alleviated by an earlier MUA from the onset of the symptoms and a repeat MUA 1 week after first intervention.

Comparison of efficacy three-site versus single-site steroid injections for the treatment of adhesive capsulitis

“…For the most part, AC is diagnosed clinically. Even so, results from MRI scans, such as thickening of the axilla with decreased capsule volume, loss of sub-coracoid fat, and distension of the superior sub Scapularis bursa, can be useful [ 14 ]. In studies, ultrasound has also been found to be a reliable diagnostic tool for the detection of thickening of the Coraco Humeral ligament in AC [ 1 ].…”

Prevalence of Diabetes and Its Effect on the Course and Treatment of Frozen Shoulder

“…This finding is a good guide in the treatment of frozen shoulder and indicates sufficient accuracy in examining and treating frozen shoulder in diabetic patients, especially diabetic patients with poor control. Although some studies revealed that shoulder pain in diabetes was often more resistant to conventional treatment, it can be resolved without any treatment in some cases and can improve from stage one to stage three (thawing) within a few months [27] [28] [29].…”

Ultrasound Features of Adhesive Capsulitis

“…Manipulation under anaesthesia alone or in addition to arthroscopic capsular release (limited or circumferential) can be performed. However, this procedure requires expertise because of its potential complications [ 35 , 36 ].…”