TY - JOUR
T1 - Manipulation under anaesthetic for frozen shoulder using Codman’s paradox
T2 - a safe and early return of function
AU - Tsvieli, Oren
AU - Atoun, Ehud
AU - Consigliere, Paolo
AU - Polyzois, Ioannis
AU - Walecka, Joanna
AU - Pradhan, Rajib
AU - Ippolito, Giorgio
AU - Rath, Ehud
AU - Levy, Ofer
N1 - Publisher Copyright:
© 2017, SICOT aisbl.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - 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.
AB - 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.
KW - Anasthesia
KW - Codman
KW - Frozen
KW - Manipulation
KW - Range of motion
KW - Shoulder
UR - http://www.scopus.com/inward/record.url?scp=85023191495&partnerID=8YFLogxK
U2 - 10.1007/s00264-017-3558-3
DO - 10.1007/s00264-017-3558-3
M3 - Article
AN - SCOPUS:85023191495
VL - 42
SP - 339
EP - 344
JO - International Orthopaedics
JF - International Orthopaedics
SN - 0341-2695
IS - 2
ER -