Manipulation under anaesthetic (MUA) is a recognised form of
treatment for patients with a frozen shoulder. However, not all
patients benefit. Some have persistent or recurrent symptoms. There
are no clear recommendations in the literature on the optimal management
of recurrent frozen shoulder after a MUA. We aimed to address this
issue in this study. We analysed a prospectively collected, single-surgeon, consecutive
series of patients who underwent MUA for frozen shoulder between
January 1999 and December 2015. The Oxford Shoulder Scores (OSS)
and range of movement were the outcome measures. Aims
Patients and Methods
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.
