Long-Term Outcomes Following Manipulation Under Anaesthetic for Patients with Primary and Secondary Frozen Shoulder

Abstract

Background Frozen Shoulder (FS) is a common, debilitating condition for which manipulation under anaesthetic (MUA) is a non-invasive and effective treatment option. Current literature evaluates short to medium-term outcomes, but there is a paucity of long-term (>10 years) studies. Knowledge of long-term outcomes is also needed to evaluate whether FS or its treatment pre-disposes to other shoulder pathology in the long-term. Methods A retrospective analysis of 398 shoulders undergoing MUA for FS between Jan 1999 and Jan 2010; 240 complete datasets were obtained. Outcomes were Oxford Shoulder Score (OSS), recurrence and development of other shoulder pathology (arthritis or rotator cuff tear). Results At long-term follow-up (mean 13.2 years), 71.3% had no symptoms (OSS 48), 16.6% had minor symptoms (OSS 42–47) and 12.1% had significant symptoms (OSS < 42). There were 4/240 (1.7%) self-reported recurrences > 5 years after initial MUA and 2/240 (0.8%) repeat MUAs. In the long-term 6.7% developed rotator cuff pathology and 3.8% shoulder OA. Discussion This study suggests that long-term outcome after MUA for FS is favourable. Late recurrence of FS is uncommon and the development of OA or rotator cuff pathology is no greater than that of the general population.

Recurrence of the frozen shoulder after hydrodilatation, what is the true incidence?

“…Non-diabetic patients had a 15.5% incidence of repeat MUA within 1 year, 2.4% at 1-5 years and 1% at more than 5 years from initial MUA. 38 We have found that, by using ultrasound-guided injections, targeting the thickened rotator interval, 25 mL appears to be a sufficient volume of injection to have an efficacious response, has a low recurrence rate, and is well tolerated by the patient without requiring additional analgesia. It has the additional advantage of being able to visualise the rotator cuff and diagnose any additional pathology at the same time.…”

“…Non-diabetic patients had a 15.5% incidence of repeat MUA within 1 year, 2.4% at 1–5 years and 1% at more than 5 years from initial MUA. 38…”

“…It is a single surgeon series and definitions of recurrence or need for further intervention are subjective. We are aware that recurrence may occur at any stage after the procedure, although has been shown to be most common within the first year after MUA, 38 so our follow-up interval of a mean of 9 months may be too short to capture all recurrences which may subsequently occur.…”

“…All methods have an incidence of failure to improve and recurrence, but the reported rates of reintervention for HD (2-36%) [33][34][35][36] have been significantly lower than for MUA (15-40%). 26,37,38 However, studies showing a higher recurrence rate after MUA have been reported from an independent hospital setting compared to the low levels of reintervention following HD in the National Health Service (NHS) system. We, therefore, report our recurrence rate of FS after HD in an independent hospital setting.…”