Mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Xiaolong , LI Yan , MU Miduo , YANG Aining , CHEN Qianbo , CHEN Wan ,  ZHOU Binghua ,  TANG Kanglai

Department of Orthopaedics/Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China;

Corresponding author：

ZHOU Binghua, Email: yijian510868@hotmail.com; TANG Kanglai, Email: tangkanglai@hotmail.com

Keywords：

Primary frozen shoulder; manipulation under anesthesia; arthroscopy; capsular release; mid-term effectiveness

DOI：

10.7507/1002-1892.201911033

Video：

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Objective To evaluate mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder.Methods Between January 2013 and December 2017, 33 patients of primary frozen shoulder were treated with manipulation under anesthesia combined with 360° arthroscopic capsular release and subacromial debridement. There were 10 males and 23 females, aged from 37 to 65 years, with a mean age of 50.9 years. The affected shoulder on left side in 17 cases and on right side in 16 cases. The disease duration was 6-13 months (mean, 8.4 months). Before and after operation, the visual analogue scale (VAS) score was used to evaluate the shoulder joint pain, Constant score was used to evaluate the shoulder joint function, and the flexion, abduction, and external rotation of shoulder joint were recorded. The internal rotation function was assessed based on the vertebral plane that the thumb could reach after internal rotation of the affected shoulder joint (the rank of internal rotation vertebra). X-ray film was taken to measure the distance of the subacromial space.Results There was no fracture or labrum tear in all patients, and all the incisions healed by first intention. All the 33 patients were followed up 20-31 months, with an average of 24.1 months. During the follow-up, there was no complication such as wound infection and nerve injury. At last follow-up, the range of motion of shoulder flexion, abduction, and external rotation, the rank of internal rotation vertebra, the VAS score, Constant score, and subacromial space were significantly improved when compared with preoperative ones (P<0.05).Conclusion Manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement can achieve a good mid-term effectiveness without complication for primary frozen shoulder.

Citation： ZHENG Xiaolong, LI Yan, MU Miduo, YANG Aining, CHEN Qianbo, CHEN Wan, ZHOU Binghua, TANG Kanglai. Mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 737-743. doi: 10.7507/1002-1892.201911033 Copy

1.	Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg (Br), 1995, 77(5): 677-683.
2.	卫宏图, 陆继收, 刘艳华, 等. 中老年人群原发性“肩痛”流行病学调查. 中国全科医学, 2011, 14(18): 2066-2068.
3.	Itoi E, Arce G, Bain GI, et al. Shoulder stiffness: current concepts and concerns. Arthroscopy, 2016, 32(7): 1402-1414.
4.	陆振飞, 王建华, 徐兵, 等. 经冈上肌入路全关节镜下松解治疗重度原发性冻结肩的疗效观察. 中国修复重建外科杂志, 2017, 31(7): 773-777.
5.	Cho CH, Kim DH, Lee YK. Serial comparison of clinical outcomes after arthroscopic capsular release for refractory frozen shoulder with and without diabetes. Arthroscopy, 2016, 32(8): 1515-1520.
6.	Yukata K, Goto T, Sakai T, et al. Ultrasound-guided coracohumeral ligament release. Orthop Traumatol Surg Res, 2018, 104(6): 823-827.
7.	Sasanuma H, Sugimoto H, Kanaya Y, et al. Magnetic resonance imaging and short-term clinical results of severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block. J Shoulder Elbow Surg, 2016, 25(1): e13-e20.
8.	Tsvieli O, Atoun E, Consigliere P, et al. Manipulation under anaesthetic for frozen shoulder using Codman’s paradox: a safe and early return of function. Int Orthop, 2018, 42(2): 339-344.
9.	Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg, 2005, 14(1): 16-21.
10.	Yoo YS, Song HS. Locked bucket-handle type bony Bankart lesion resulting from manipulation. Knee Surg Sports Traumatol Arthrosc, 2016, 24(6): 1896-1899.
11.	喻飞, 刁乃成, 杨波, 等. 关节镜松解术结合麻醉下手法松解治疗冻结肩. 中华骨与关节外科杂志, 2014, 7(3): 193-196.
12.	Gallacher S, Beazley JC, Evans J, et al. A randomized controlled trial of arthroscopic capsular release versus hydrodilatation in the treatment of primary frozen shoulder. J Shoulder Elbow Surg, 2018, 27(8): 1401-1406.
13.	Kwaees TA, Charalambous CP. Surgical and non-surgical treatment of frozen shoulder. Survey on surgeons treatment preferences. Muscles Ligaments Tendons J, 2015, 4(4): 420-424.
14.	Price MR, Tillett ED, Acland RD, et al. Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective. J Bone Joint Surg (Am), 2004, 86(10): 2135-2142.
15.	Juel NG, Natvig B. Shoulder diagnoses in secondary care, a one year cohort. BMC Musculoskelet Disord, 2014, 15: 89.
16.	Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. Br J Sports Med, 2011, 45(1): 49-56.
17.	Griesser MJ, Harris JD, Campbell JE, et al. Adhesive capsulitis of the shoulder: a systematic review of the effectiveness of intra-articular corticosteroid injections. J Bone Joint Surg (Am), 2011, 93(18): 1727-1733.
18.	孙东, 唐康来, 许建中. 关于改良 Nevaiser 入路进行盂肱关节穿刺的准确性探讨. 中国矫形外科杂志, 2009, 17(10): 750-752.
19.	Mitchell C, Adebajo A, Hay E, et al. Shoulder pain: diagnosis and management in primary care. BMJ, 2005, 331(7525): 1124-1128.
20.	Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg (Am), 2000, 82(10): 1398-1407.
21.	Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up. J Bone Joint Surg (Am), 1992, 74(5): 738-746.
22.	Yoon JP, Chung SW, Lee BJ, et al. Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3242-3250.
23.	Song KD, Kwon JW, Yoon YC, et al. Indirect MR arthrographic findings of adhesive capsulitis. AJR Am J Roentgenol, 2011, 197(6): W1105-W1109.
24.	Farrell CM, Sperling JW, Cofield RH. Manipulation for frozen shoulder: long-term results. J Shoulder Elbow Surg, 2005, 14(5): 480-484.
25.	Wang JP, Huang TF, Hung SC, et al. Comparison of idiopathic, post-trauma and post-surgery frozen shoulder after manipulation under anesthesia. Int Orthop, 2007, 31(3): 333-337.
26.	Leonidou A, Woods DA. A preliminary study of manipulation under anaesthesia for secondary frozen shoulder following breast cancer treatment. Ann R Coll Surg Engl, 2014, 96(2): 111-115.
27.	Woods DA, Loganathan K. Recurrence of frozen shoulder after manipulation under anaesthetic (MUA): the results of repeating the MUA. Bone Joint J, 2017, 99-B(6): 812-817.
28.	Cvetanovich GL, Leroux TS, Bernardoni ED, et al. Clinical outcomes of arthroscopic 360° capsular release for idiopathic adhesive capsulitis in the lateral decubitus position. Arthroscopy, 2018, 34(3): 764-770.
29.	Waszczykowski M, Polguj M, Fabiś J. The impact of arthroscopic capsular release in patients with primary frozen shoulder on shoulder muscular strength. Biomed Res Int, 2014, 2014: 834283.
30.	Sun Q, Liu M, Wu Q. Therapeutic effect of shoulder arthroscopic release on frozen shoulder and its effect on fibrogenic cytokines and inflammatory factors. Int J Clin Exp Med, 2018, 11(3): 2882-2889.
31.	O’Brien SJ, Neves MC, Arnoczky SP, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med, 1990, 18(5): 449-456.
32.	Fernandes MR. Arthroscopic treatment of refractory adhesive capsulitis of the shoulder. Rev Col Bras Cir, 2014, 41(1): 30-35.
33.	Warner JJ, Allen A, Marks PH, et al. Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder. J Bone Joint Surg (Am), 1996, 78(12): 1808-1816.
34.	Arce G. Primary frozen shoulder syndrome: arthroscopic capsular release. Arthrosc Tech, 2015, 4(6): e717-e720.
35.	Le Lievre HM, Murrell GA. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg (Am), 2012, 94(13): 1208-1216.
36.	唐新, 黄富国, 陈刚, 等. 一期手法松解关节镜下肩袖修补术治疗肩袖撕裂合并冻结肩的临床疗效. 中国修复重建外科杂志, 2018, 32(1): 1-6.
37.	Bidwai AS, Mayne AI, Nielsen M, et al. Limited capsular release and controlled manipulation under anaesthesia for the treatment of frozen shoulder. Shoulder Elbow, 2016, 8(1): 9-13.
38.	Robinson PM, Norris J, Roberts CP. Randomized controlled trial of supervised physiotherapy versus a home exercise program after hydrodilatation for the management of primary frozen shoulder. J Shoulder Elbow Surg, 2017, 26(5): 757-765.
39.	Russell S, Jariwala A, Conlon R, et al. A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder. J Shoulder Elbow Surg, 2014, 23(4): 500-507.
40.	Chen HC, Chuang TY, Lin PC, et al. Effects of messages delivered by mobile phone on increasing compliance with shoulder exercises among patients with a frozen shoulder. J Nurs Scholarsh, 2017, 49(4): 429-437.
41.	Sveistrup H, McComas J, Thornton M, et al. Experimental studies of virtual reality-delivered compared to conventional exercise programs for rehabilitation. Cyberpsychol Behav, 2003, 6(3): 245-249.
42.	Vastamäki H, Varjonen L, Vastamäki M. Optimal time for manipulation of frozen shoulder may be between 6 and 9 months. Scand J Surg, 2015, 104(4): 260-266.
43.	Thomas WJ, Jenkins EF, Owen JM, et al. Treatment of frozen shoulder by manipulation under anaesthetic and injection: does the timing of treatment affect the outcome? J Bone Joint Surg (Br), 2011, 93(10): 1377-1381.
44.	Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy, 2017, 103(1): 40-47.
45.	Whelton C, Peach CA. Review of diabetic frozen shoulder. Eur J Orthop Surg Traumatol, 2018, 28(3): 363-371.
46.	Lho YM, Ha E, Cho CH, et al. Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder. J Shoulder Elbow Surg, 2013, 22(5): 666-672.

1. Bunker TD, Anthony PP. The pathology of frozen shoulder. A Dupuytren-like disease. J Bone Joint Surg (Br), 1995, 77(5): 677-683.
2. 卫宏图, 陆继收, 刘艳华, 等. 中老年人群原发性“肩痛”流行病学调查. 中国全科医学, 2011, 14(18): 2066-2068.
3. Itoi E, Arce G, Bain GI, et al. Shoulder stiffness: current concepts and concerns. Arthroscopy, 2016, 32(7): 1402-1414.
4. 陆振飞, 王建华, 徐兵, 等. 经冈上肌入路全关节镜下松解治疗重度原发性冻结肩的疗效观察. 中国修复重建外科杂志, 2017, 31(7): 773-777.
5. Cho CH, Kim DH, Lee YK. Serial comparison of clinical outcomes after arthroscopic capsular release for refractory frozen shoulder with and without diabetes. Arthroscopy, 2016, 32(8): 1515-1520.
6. Yukata K, Goto T, Sakai T, et al. Ultrasound-guided coracohumeral ligament release. Orthop Traumatol Surg Res, 2018, 104(6): 823-827.
7. Sasanuma H, Sugimoto H, Kanaya Y, et al. Magnetic resonance imaging and short-term clinical results of severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block. J Shoulder Elbow Surg, 2016, 25(1): e13-e20.
8. Tsvieli O, Atoun E, Consigliere P, et al. Manipulation under anaesthetic for frozen shoulder using Codman’s paradox: a safe and early return of function. Int Orthop, 2018, 42(2): 339-344.
9. Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg, 2005, 14(1): 16-21.
10. Yoo YS, Song HS. Locked bucket-handle type bony Bankart lesion resulting from manipulation. Knee Surg Sports Traumatol Arthrosc, 2016, 24(6): 1896-1899.
11. 喻飞, 刁乃成, 杨波, 等. 关节镜松解术结合麻醉下手法松解治疗冻结肩. 中华骨与关节外科杂志, 2014, 7(3): 193-196.
12. Gallacher S, Beazley JC, Evans J, et al. A randomized controlled trial of arthroscopic capsular release versus hydrodilatation in the treatment of primary frozen shoulder. J Shoulder Elbow Surg, 2018, 27(8): 1401-1406.
13. Kwaees TA, Charalambous CP. Surgical and non-surgical treatment of frozen shoulder. Survey on surgeons treatment preferences. Muscles Ligaments Tendons J, 2015, 4(4): 420-424.
14. Price MR, Tillett ED, Acland RD, et al. Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective. J Bone Joint Surg (Am), 2004, 86(10): 2135-2142.
15. Juel NG, Natvig B. Shoulder diagnoses in secondary care, a one year cohort. BMC Musculoskelet Disord, 2014, 15: 89.
16. Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions—systematic review. Br J Sports Med, 2011, 45(1): 49-56.
17. Griesser MJ, Harris JD, Campbell JE, et al. Adhesive capsulitis of the shoulder: a systematic review of the effectiveness of intra-articular corticosteroid injections. J Bone Joint Surg (Am), 2011, 93(18): 1727-1733.
18. 孙东, 唐康来, 许建中. 关于改良 Nevaiser 入路进行盂肱关节穿刺的准确性探讨. 中国矫形外科杂志, 2009, 17(10): 750-752.
19. Mitchell C, Adebajo A, Hay E, et al. Shoulder pain: diagnosis and management in primary care. BMJ, 2005, 331(7525): 1124-1128.
20. Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg (Am), 2000, 82(10): 1398-1407.
21. Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder. A long-term follow-up. J Bone Joint Surg (Am), 1992, 74(5): 738-746.
22. Yoon JP, Chung SW, Lee BJ, et al. Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder. Knee Surg Sports Traumatol Arthrosc, 2017, 25(10): 3242-3250.
23. Song KD, Kwon JW, Yoon YC, et al. Indirect MR arthrographic findings of adhesive capsulitis. AJR Am J Roentgenol, 2011, 197(6): W1105-W1109.
24. Farrell CM, Sperling JW, Cofield RH. Manipulation for frozen shoulder: long-term results. J Shoulder Elbow Surg, 2005, 14(5): 480-484.
25. Wang JP, Huang TF, Hung SC, et al. Comparison of idiopathic, post-trauma and post-surgery frozen shoulder after manipulation under anesthesia. Int Orthop, 2007, 31(3): 333-337.
26. Leonidou A, Woods DA. A preliminary study of manipulation under anaesthesia for secondary frozen shoulder following breast cancer treatment. Ann R Coll Surg Engl, 2014, 96(2): 111-115.
27. Woods DA, Loganathan K. Recurrence of frozen shoulder after manipulation under anaesthetic (MUA): the results of repeating the MUA. Bone Joint J, 2017, 99-B(6): 812-817.
28. Cvetanovich GL, Leroux TS, Bernardoni ED, et al. Clinical outcomes of arthroscopic 360° capsular release for idiopathic adhesive capsulitis in the lateral decubitus position. Arthroscopy, 2018, 34(3): 764-770.
29. Waszczykowski M, Polguj M, Fabiś J. The impact of arthroscopic capsular release in patients with primary frozen shoulder on shoulder muscular strength. Biomed Res Int, 2014, 2014: 834283.
30. Sun Q, Liu M, Wu Q. Therapeutic effect of shoulder arthroscopic release on frozen shoulder and its effect on fibrogenic cytokines and inflammatory factors. Int J Clin Exp Med, 2018, 11(3): 2882-2889.
31. O’Brien SJ, Neves MC, Arnoczky SP, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med, 1990, 18(5): 449-456.
32. Fernandes MR. Arthroscopic treatment of refractory adhesive capsulitis of the shoulder. Rev Col Bras Cir, 2014, 41(1): 30-35.
33. Warner JJ, Allen A, Marks PH, et al. Arthroscopic release for chronic, refractory adhesive capsulitis of the shoulder. J Bone Joint Surg (Am), 1996, 78(12): 1808-1816.
34. Arce G. Primary frozen shoulder syndrome: arthroscopic capsular release. Arthrosc Tech, 2015, 4(6): e717-e720.
35. Le Lievre HM, Murrell GA. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg (Am), 2012, 94(13): 1208-1216.
36. 唐新, 黄富国, 陈刚, 等. 一期手法松解关节镜下肩袖修补术治疗肩袖撕裂合并冻结肩的临床疗效. 中国修复重建外科杂志, 2018, 32(1): 1-6.
37. Bidwai AS, Mayne AI, Nielsen M, et al. Limited capsular release and controlled manipulation under anaesthesia for the treatment of frozen shoulder. Shoulder Elbow, 2016, 8(1): 9-13.
38. Robinson PM, Norris J, Roberts CP. Randomized controlled trial of supervised physiotherapy versus a home exercise program after hydrodilatation for the management of primary frozen shoulder. J Shoulder Elbow Surg, 2017, 26(5): 757-765.
39. Russell S, Jariwala A, Conlon R, et al. A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder. J Shoulder Elbow Surg, 2014, 23(4): 500-507.
40. Chen HC, Chuang TY, Lin PC, et al. Effects of messages delivered by mobile phone on increasing compliance with shoulder exercises among patients with a frozen shoulder. J Nurs Scholarsh, 2017, 49(4): 429-437.
41. Sveistrup H, McComas J, Thornton M, et al. Experimental studies of virtual reality-delivered compared to conventional exercise programs for rehabilitation. Cyberpsychol Behav, 2003, 6(3): 245-249.
42. Vastamäki H, Varjonen L, Vastamäki M. Optimal time for manipulation of frozen shoulder may be between 6 and 9 months. Scand J Surg, 2015, 104(4): 260-266.
43. Thomas WJ, Jenkins EF, Owen JM, et al. Treatment of frozen shoulder by manipulation under anaesthetic and injection: does the timing of treatment affect the outcome? J Bone Joint Surg (Br), 2011, 93(10): 1377-1381.
44. Wong CK, Levine WN, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy, 2017, 103(1): 40-47.
45. Whelton C, Peach CA. Review of diabetic frozen shoulder. Eur J Orthop Surg Traumatol, 2018, 28(3): 363-371.
46. Lho YM, Ha E, Cho CH, et al. Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder. J Shoulder Elbow Surg, 2013, 22(5): 666-672.

Chinese Journal of Reparative and Reconstructive Surgery

Mid-term effectiveness of manipulation under anesthesia combined with arthroscopic capsular release and subacromial debridement for primary frozen shoulder

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