Video: How I Do It - Use of Codman’s Paradox to Perform Safe and Simple Manipulation Under Anaesthetic for Release of Contracture in Frozen Shoulder

Background: Frozen shoulder remains an enigma. Although previously thought that it is to resolve by 2-3 years, recent studies demonstrated that pain and limitation of movement can remain much longer with major implications on function, satisfaction and quality of life.

Manipulation under anaesthetic (MUA) has been shown to be successful in relieving pain and restoring function. Yet, concerns raised regarding its safety and the risks of complications.

We utilise Codman’s paradox to manipulate the shoulder in a controlled manner, avoiding rotational torque on the humerus, thus avoiding the risk of complications such as iatrogenic fractures.

Aim: Description of the technique and assessment of shoulder function in the early post MUA period.

Methods: 212 patients (224 shoulders) underwent MUA using Codman’s paradox for frozen shoulder between 2005 and 2013. 85 males (88 shoulders), 127 females (136 shoulders), 39 diabetic, 62 following strain/trauma and 123 idiopathic frozen shoulder.

All evaluated clinically, preoperatively and postoperatively, at 3 weeks and 3 months, for Constant score (CS), pain, range of motion (ROM), satisfaction and subjective shoulder value (SSV).

Results: No complications observed. No fractures, dislocations or nerve injury.

At 3 weeks, significant improvement in CS from 30.7 preoperatively to 66.0. Forward elevation (FE) improved from 91º to 154º, Abduction (Abd) from 69º to 150º, Active internal rotation (AIR) from 12º to 62º, and Active External rotation (AER) from 10º to 46º.

Pain score and SSV improved from 4.4/15 to 9.6/15 and 1.5/10 to 6.5/10 respectively. (p<0.001).

At 3 months, CS rose to 70.0. ROM improved to 160º FE, 156º Abd, 66º AIR and 50º AER. Pain score and SSV improved to 10.4/15 and 6.7/10 respectively. (p<0.001).

Conclusion: Use of Codman’s paradox provides safe and efficient way to perform MUA for frozen shoulder. It results in dramatic early improvement in ROM, functional outcomes and high satisfaction, as early as 3 weeks postoperatively.