Manipulation under Anaesthetic for Frozen Shoulder Using Codman’s Paradox - Safe and Early Return of Function

Purpose: Although previously frozen shoulder was thought to resolve by 2-3 years, recent studies demonstrated the symptoms can remain for much longer. Manipulation under anaesthetic (MUA) has been shown to be successful in relieving pain and restoring function. Yet, concerns been raised regarding its safety and the risks of complications. We utilise Codman’s paradox to manipulate the shoulder, avoiding rotational torque on the humerus. The aim of our study was to asses shoulder function in the early post MUA period.

Methods: 212 consecutive patients (224 shoulders) (mean age 52.4 years) underwent MUA using Codman’s paradox for frozen shoulder as sole procedure between 2005 and 2013. All evaluated clinically, preoperatively and postoperatively, at 3 weeks and 3 months, for Constant score (CS), pain, range of motion (ROM), patient satisfaction and subjective shoulder value (SSV).

Results: At 3 weeks and 3 months, a significant improvement was found in CS from 30.7 to 66 and 70 respectively. Forward elevation improved from 91º to 154º and 160 º, Abduction from 69º to 150º and 156 º, Internal rotation from 12º to 62º and 66 º, and External rotation from 10º to 46º and 50 º. Pain score improved from 4.4/15 to 9.6/15 and 10.4/15, SSV improved from 1.5/10 to 6.5/10 and 6.7/10. (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.