Manipulation under anesthesia for primary frozen shoulder: Effect on earlyrecovery and return to activity

Frozen shoulder is still an enigma of shoulder surgery. It is reported that at 2 years from onset, most patients will have recovered whether treated o r not. However, the duration of morbidity has major implications for patien t Function and satisfaction. In view of this fact, we have focused on the e arly effect of manipulation under anesthesia on shoulder function. We prosp ectively assessed 39 shoulders in 37 patients who were given the diagnosis of primary frozen shoulder between June 1997 and June 1998 and were treated with manipulation under anesthesia of the affected shoulder. The median pr eoperative Constant score rose from 24 of 100 to 63 of 100 at 3 to 6 weeks and to 69 of 100 at 3 months. Improvement was maintained at a mean follow-u p of 11 months after surgery (range 6 to 18 months). Overall, 94% of patien ts were satisfied with the procedure. At 3 months 59% (23 shoulders) were r ated as having no or mild disability only, 28.2% (11 shoulders) as having a moderate degree of disability, and 12.8% (5 shoulders) as having a severe degree of disability. Of the 5 cases scoring less than 50 of 100 (mean 40) at 3-month follow-up, 1 had unmasked symptoms of a subacromial impingement syndrome that has required further treatment. There was no relationship bet ween the initial Constant score or the initial range of movement after mani pulation and the eventual result. We recommend the use of manipulation unde r anesthetic in primary Frozen shoulder to restore early range of movement and to improve early function in this often protracted and frustrating cond ition.