Dj. Ogilvieharris et al., THE RESISTANT FROZEN SHOULDER - MANIPULATION VERSUS ARTHROSCOPIC RELEASE, Clinical orthopaedics and related research, (319), 1995, pp. 238-248
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.