COMPARISION OF MANIPULATION UNDER ANAESTHETIC AND DISTENSION INJECTIONS IN THE MANAGEMENT OF FROZEN SHOULDER

Abstract

Aims: To prospectively compare the progress and outcomes during a follow-up period of two years in patients who were in the ‘freezing phase’ of Primary (Idiopathic) Frozen Shoulder following either manipulation of the shoulder under general anaesthetic (MUA) or intra-articular shoulder joint distension injections using steroid and local anaesthetic.

Methods: 53 consecutive patients aged between 40 and 75 years with Frozen Shoulder were randomised to receive either MUA followed by out-patient physiotherapy or up to 3 distension injections at six weekly intervals in the first 12 weeks. Outcomes were measured using Constant-Murley Shoulder Function Assessment Score (CS), Visual Analogue Score (VAS) for pain level, and the SF-36 Health Evaluation Questionnaire. All patients were reviewed at 2, 6 and12 weeks, then at 6, 9, 12, 18 and 24 months. At each visit the CS and the VAS were repeated. The SF-36 was undertaken at initial and final visits.

Results: Group 1 (MUA) contained 28 patients of which 15 (54%) were female. Group 2 (Distension Injection) contained 25 patients of which 20 (80%) were female. No statistical difference was identified between the 2 groups in terms of outcome for the affected shoulders, for the SF36 scores, CS and the VAS. Maximum benefit was seen by 12 weeks in both groups. In group 2 this equated to 2 distension injections. No complications were noted in either group.

Conclusion: Frozen Shoulder is accepted to be a self-limiting condition with resolution by 2 years from onset. Any treatment aims to reduce this period of pain and disability. The potential risks of MUA include fracture and rotator cuff ruptures are well documented in the literature. Distension injections are easily performed in clinic without the need for admission, a general anaesthetic, or the risk of the complications associated with MUA. In view of there being no difference between the treatment modalities we recommend the use of 2 distension injections as the first line treatment for Frozen Shoulder.