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13-02-2012 | Radiology | Article

Manipulation, capsular distension both effective for treating ‘frozen shoulder’


Free abstract

MedWire News: Manipulation under anesthesia (MUA) and capsular distension are both effective treatment options for patients with adhesive capsulitis of the shoulder (frozen shoulder), report researchers.

MUA resulted in better shoulder abduction than capsular distension at 6 months after the procedure, they say. However, there was no significant difference between the two groups in external rotation or pain relief achieved.

Traditionally, adhesive capsulitis has been considered a benign and self-limiting condition, which typically recovers within 2 years of onset, write Chye Yew Ng (Wrightington Hospital, Wigan, UK) and colleagues in Shoulder and Elbow. "However, this view has been challenged by studies showing the persistence of shoulder pain or stiffness in a significant proportion of patients well beyond 2 years."

The team investigated the relative effectiveness of two treatment options - MUA and capsular distension - in 28 patients (30 shoulders) presenting for the first time to the orthopedic or physiotherapy clinic with idiopathic adhesive capsulitis of the shoulder. Fifteen shoulders were randomized into each arm of the study.

MUA was performed by a consultant orthopedic surgeon; the patient was supine, and the shoulder was manipulated under general anesthesia with muscle paralysis. Capsular distension was performed by a consultant musculoskeletal radiologist using fluoroscopy under aseptic conditions.

Outcome variables were range of motion of the affected shoulder at 6 months and pain visual analogue score (VAS; range of 0 to 10, with 0 indicating no pain and 10 the worst pain). The Disabilities of the Arm, Shoulder, and Hand (DASH) score was also assessed.

In the MUA group, all outcome variables improved significantly from baseline to 6 weeks postprocedure, reports the team. In the distension group, significant improvements were noted in abduction, external rotation, and DASH.

When the groups were compared, the MUA group achieved significantly greater mean abduction than the distension group after 6 months, at 163 versus 130.7°. However, there was no statistically significant difference between the groups for external rotation (40.3 vs 40.3°).

Both the MUA and distension groups improved their pain VAS and DASH scores after 6 months, but there was no statistically significant difference noted between the groups (1.5 vs 2.9 and 12.4 vs 25.1, respectively).

The authors note that MUA is a more costly procedure than capsular distension, and is associated with the risks for general anesthesia.

However, they conclude that MUA and capsular distension are both "safe and effective treatment options for patients with adhesive capsulitis of the shoulder."

By Nikki Withers

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