Treatment of frozen shoulder by manipulation under anaesthetic and injection

Abstract

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.

Manipulation Under Anesthesia for Frozen Shoulders

“…The average premanipulation range of motion was 69° in fl exion and 54° in abduction, suggesting that these patients were in their "frozen phase." A more recent retrospective analysis of 246 patients treated with MUA in their frozen phase revealed that the duration of symptoms and the OSS or the change in OSS had no correlation [ 51 ]. In this study, the mean duration of presenting symptoms was 28 weeks, ranging from 6 weeks to 156 weeks.…”

“…Numerous authors have reported no complications with this procedure [ 1 , 11 , 18 , 40 , 41 , 46 , 49 , 53 ]. Thomas et al performed MUA in 246 patients, in which there were no fractures or dislocations, no symptoms of acute rotator cuff tear, no neurological or other iatrogenic injuries [ 51 ]. Ibrahim et al reported one case of vasovagal episode during the procedure among 42 cases [ 20 ].…”

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

“…This same study group has analyzed the effect of the timing of MUA on outcome further and has shown that the benefit of MUA is independent of the duration of symptoms, such that prolonging conservative management is not detrimental to the final outcome. 4 Given that we had quite a broad age range (25 years to 81 years), we were surprised that age did not make a significant difference to outcome over the short-or longterm, albeit that the younger age group tended to include the diabetic patients. This has not been analyzed further.…”

The management of secondary frozen shoulder after anterior shoulder dislocation – The results of manipulation under anaesthesia and injection

“…Unfortunately, it remains not fully understood and this interesting subgroup of patients has had little attention in the literature to date to provide guidance on the natural history of their condition or their management. Having previously shown that treatment with MUA and injection in primary frozen shoulder results in good outcomes and is safe, 5 we cautiously treated this cohort of patients similarly.…”

“…5,6 Having previously found that treatment with an MUA and injection in primary frozen shoulder results in good outcomes and is safe, 5 we treated this group of patients similarly. There was however concern in this group of patients that the frozen shoulder or contracted capsule may help to provide some stability to the shoulder and that MUA and injection may actually induce recurrent instability of the shoulder joint by releasing the contracted capsule.…”