Mid-Long Term Results of Manipulation and Arthroscopic Release in Frozen Shoulder

Abstract

Objective:Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. Methods:A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. Results:Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients’ values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. Conclusion:Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series.

Functional outcome of manipulation under anaesthesia for the treatment of frozen shoulder

“…7,20 Previous reports mention that type 1 diabetics are at increased risk of having frozen shoulder than type 2 diabetes mellitus. 3,21 Patients with higher HbA1C levels or when diabetes mellitus has been present for a long period (>13 years), are at increased risk for developing adhesive capsulitis. 22,23 Ando and coauthors, in a comparative study, showed excellent clinical results of MUA both in the idiopathic and diabetic frozen shoulders, however poor outcome recorded in diabetic group in comparison with idiopathic group.…”

“…These findings correlate with other reports. 3,18 It shows that frozen shoulder affects females more than males and frequently involves the patients of 4 th to 6 th decades. 1 Codman reported frozen shoulder difficult to define, difficult to treat and difficult to explain in term of pathology.…”

“…1,2 It was first reported corporating the periarticular soft tissues of the shoulder by Duplay in 1872. 3 Codman created the term "frozen shoulder" in 1934. 4 Pathologically, a multifactorial fibroproliferative disorder with retracted and thickened joint capsule and reduced volume of joint often < 5mL instead of around 20mL.…”

Treatment of a rotator cuff tear combined with iatrogenic glenoid fracture and shoulder instability: A rare case report

“…, humeral fracture, glenohumeral dislocation, and brachial plexus injury)[ 3 , 8 ]. Therefore, performing an arthroscopic capsular release before a shoulder manipulation is suggested to decrease the incidence of complications[ 3 , 9 , 10 ]. However, some surgeons still prefer to perform the manipulation before arthroscopy to facilitate the performance of the arthroscopy, and the use of an arthroscope after manipulation could increase the release and address any concomitant problems[ 9 - 12 ].…”