Outcome audit: Clinical outcome of stage 2 frozen shoulder treated with Manipulation Under Anaesthesia (MUA) + injection

S. Kavin

Registrar- Department of Orthopedics, Kauvery Hospital, Cantonment

Introduction

Adhesive Capsulitis/Peri-Arthritis Scapulo humerale is a condition that affected 2–4 % population. Mostly women have the greater risk than men and the common affected age group was 50 years. According to Codman et al, it is difficult to define, treat and explain.

Differential Diagnosis

  • Rotator cuff pathology
  • AC joint Arthritis
  • Subacromial Bursitis
  • Glenohumeral joint Osteoarthritis
  • Cervical Radiculopathy

Stages of disease

  • Stage 1: Pain (inflammation) – Freezing phase
  • Stage 2: pain + Stiffness – Frozen phase
  • Stage 3: Recovery of ROM – Thawing phase.

PrimarySecondary
Diabetes Mellitus Trauma
Thyroid Disorders Immobilization
IdiopathicNeurological conditions
Post cardiac procedure

Inclusion criteria

  • Age 18–70 yrs
  • Frozen shoulder stage -2
  • Conservative treatment for at least 6 weeks
  • No signs of Osteoarthritis

Exclusion Criteria

  • Previous shoulder surgery
  • Inflammatory joint disease
  • Rotator cuff tear – evidence
  • Disorder of upper limb
  • Contraindication to steroid
  • Shoulder pathology

Aim

To assess the clinical outcome of stage two frozen shoulder managed with MUA + injection.

Materials and Methods

Study Details

  • Retrospective outcome study
  • Duration: 2022–2025
  • Sample size: 27
  • Lost to contact: 6
  • Study group: 21
  • Location: KCN, Trichy

Technique of MUA and injection

  • Supine position
  • Nerve Block/TIVA
  • Anterior Glenohumeral injection
  • Saline infiltration > Depomedrol 2ml > Local Anesthetic Bupivacaine: 0.5% 10 ml
  • Manipulation

Methods

  • Data
  • Telephonic Information – Physiotherapist
  • Patient Reported Outcome
  • Oxford Shoulder score
  • Oxford Shoulder Score (0-48): Better outcome – 48

Bad outcome – 0

Results and Discussion

Complications:  NIL

  • Glenoid Rim fractures
  • Shoulder Dislocation
  • fracture of Humerus
  • Infection
  • Stiffness
  • Oxford Shoulder Score.

Drawbacks of current study

Do not have Pre procedure ROM or score

No Comparative arm

Literature review

  • Kraal T, The B, Boer R, van den Borne MP, Koenraadt K, Goossens P, Eygendaal D. Manipulation under anesthesia versus physiotherapy treatment in stage two of a frozen shoulder: a study protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2017 Oct 11;18(1):412
  • Sundararajan SR, Dsouza T, Rajagopalakrishnan R, Bt P, Arumugam P, Rajasekaran S. Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder – a prospective randomised study. Int Orthop. 2022 Nov;46(11):2593-2601. doi: 10.1007/s00264-022-05558-z

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