THE RESISTANT FROZEN SHOULDER - MANIPULATION VERSUS ARTHROSCOPIC RELEASE

Frozen shoulder is often a self-limited disease, but approximately 10% of patients have longterm problems, Arthroscopy was done in 40 patien ts with persistent pain, stiffness, and functional loss for at least 1 year without improvement despite conventional treatment, In the first 20 patients, manipulation was done with an arthroscopy before and aft erward; in the second 20 patients, the contracted structures were divi ded through arthroscopy, This was a prospective cohort study; 2 patien ts were not available for followup, The arthroscopic division procedur e was done in 4 sequential steps: (1) resection of the inflammatory sy novium in the interval area between the subscapularis and supraspinatu s; (2) progressive division of the anterior superior glenohumeral liga ment and anterior capsule; (3) division of the subscapularis tendon bu t not muscle; and (4) division of the inferior capsule, The results we re assessed independently on the basis of pain, stiffness, and functio n. The followup varied from 2 to 5 years after intervention, Patients treated with arthroscopy and manipulation did as well as the patients treated with arthroscopic division for restoration of range of movemen t, However, the patients in the arthroscopic division group had signif icantly better pain relief and restoration of function, Fifteen of 20 patients treated with arthroscopic division had an excellent result co mpared with 7 of 18 patients treated with arthroscopy and manipulation . Patients with diabetes did worse initially, but the outcome was simi lar to patients without diabetes, Patients with diabetes in particular may benefit from early intervention.