Manipulation under anaesthetic for frozen shoulder using Codman’s paradox: a safe and early return of function

Oren Tsvieli, Ehud Atoun, Paolo Consigliere, Ioannis Polyzois, Joanna Walecka, Rajib Pradhan, Giorgio Ippolito, Ehud Rath, Ofer Levy

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Purpose: Although previously frozen shoulder was thought to resolve by two to three 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 have 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: Two hundred twelve 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 were evaluated clinically, preoperatively and postoperatively, at three weeks and three months, for Constant score (CS), pain, range of motion (ROM), patient satisfaction and subjective shoulder value (SSV). Results: At three weeks and three months, a significant improvement was found in CS from 30.7 to 66 and 70 respectively. Forward elevation improved from 91° to 154° and 160 °, abduction from 69° to 150° and 156 °, internal rotation from 12° to 62° and 66 °, and external rotation from 10° to 46° and 50 °. 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 a 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 three weeks post-operatively.

Original languageEnglish
Pages (from-to)339-344
Number of pages6
JournalInternational Orthopaedics
Issue number2
StatePublished - 1 Feb 2018


  • Anasthesia
  • Codman
  • Frozen
  • Manipulation
  • Range of motion
  • Shoulder

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Manipulation under anaesthetic for frozen shoulder using Codman’s paradox: a safe and early return of function'. Together they form a unique fingerprint.

Cite this