Manipulation under Anaesthesia for Frozen Shoulder - Safe and Early Return of Function

Background: 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 this study is to describe the technique and assessment of shoulder function in the early post MUA period.

Methods: A retrospective review was conducted of patients who underwent MUA for idiopathic frozen shoulder in ourinstitute between 2012 and 2017. Our search results yielded45 patients (mean age 49.2 years). 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 33.5 to 67 and 75 respectively. Forward elevation improved from 85º to 150º and 162 º, Abduction from 65º to 145º and 156 º, Internal rotation from 10º to 60º and 66 º, and External rotation from 8º to 40º and 55 º. Pain score improved from 4/15 to 9.9/15 and 12/15, SSV improved from 1.7/10 to 6/10 and 7/10.

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 after the procedure.