1. ASC Bidwai, M Nielsen, P Brownson - Liverpool Upper Limb Unit (UK)
Limited Capsular Release and controlled Manipulation Under Anaesthesia for the treatment of Frozen Shoulder Syndrome
Introduction
To determine the results of limited anterior capsular release technique and controlled manipulation under anaesthesia (MUA) for the treatment of primary frozen shoulder syndrome.
Outcome measures included Patient-Related Outcomes Measure, range of motion and re- intervention rates.
Rotator interval and coraco-humeral ligament release was completed using a radio-frequency electrode. The anterior-inferior capsule alone was released in a controlled manner from the subscapularis tendon with an arthroscopic punch to create a crease in the capsular tissue, without the risk of thermal necrosis.
Gentle manipulation was used to complete the surgical procedure.
Methods
Review of prospectively collected data of patients undergoing capsular release with MUA in a single surgeon series, with a minimum follow-up of six months from index procedure.
Results
54 procedures were performed in 52 patients.
Mean age 50 years, range M: F 12:42
The median post-operative Oxford score was 41 with an average improvement of 24 points. Forward flexion, abduction and external rotation improved by an average of 110, 109 and 44 degrees respectively. There was a highly statistically significant improvement in both pain and function modules of the Oxford Shoulder Score (p<0.005) and range of motion (p<0.005) at six months.
17 patients were diabetics. There was no significant difference in preoperative and postoperative Oxford Shoulder Scores or range of motion between the diabetic and the non-diabetic groups.
No patients required surgical re-intervention.
Discussion
We have been able to demonstrate significant improvement in Oxford Shoulder Score and range of motion outcome for patients under going a limited capsular release and a controlled MUA in isolation without the need for a secondary surgical intervention. A combination of limited release along with an MUA for the treatment of primary frozen shoulder syndrome is a safe and effective procedure resulting in marked improvement in pain, function and range of motion.
ASC Bidwai, M Nielsen, P Brownson - Liverpool Upper Limb Unit (UK)