Functional outcome of manipulation under anaesthesia for the treatment of frozen shoulder

2020 ◽  
Vol 14 (1) ◽  
pp. 34-40
Author(s):  
Yasir Arfat ◽  
Muhammad Umer Anwer ◽  
Maria Imdad ◽  
Faheem Ahmad Usmani ◽  
Sana Imdad ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Treatment Modalities ◽  
Unknown Etiology ◽  
Early Recovery ◽  
Duration Of Symptoms ◽  
Manipulation Under Anaesthesia

Background: Frozen shoulder is defined as painful progressive loss of shoulder movements with unknown etiology. It is a self-limiting disease with the natural history of 18-30 months but with residual pain and restriction of shoulder movement. Its incidence is 2-5%. Various treatment modalities include benign neglect, physical therapy, non-steroidal anti-inflammatory medications, oral glucocorticoids, distention arthrography, intra articular steroid injections, closed manipulation under anaesthesia (MUA) and arthroscopic release of joint capsule. MUA regarding pain control and range of motion is safe, yields immediate results and is very cost effective. The purpose of this study was to ascertain the functional outcome of manipulation under anaesthesia and physiotherapy for the treatment of frozen shoulder in term of safety, cost effectiveness and immediate results. Patients and Methods: In the 6 months study period, 50 patients with adhesive capsulitis were included by non-probability purposive sampling. Manipulation of shoulders was done under general anaesthesia and after the MUA intra articular injection of a mixture of corticosteroid and local anaesthetic was injected. Postoperatively, all patients underwent physiotherapy. Functional outcome was measured using Shoulder Pain and Disability Index (SPADI) preoperatively and postoperatively at 1st, 2nd and 3rd week follow up. Results: Out of 50 patients, 32 (64%) were females and 18 (36%) were males having female to male ratio of 1.8:1. Average age was 51 years and average duration of symptoms preceding to MUA was 4 months and 27 days. The average pain score decreased from 92.52% to 18.08% and the average disability score reduced from 95% to 17.10%, both at 3rd week postoperative follow up. There were no procedure-related complications. Conclusion: Manipulation under anaesthesia along with physiotherapy diminishes pain and disability, improves range of motion and expedites early recovery of function in patients having frozen shoulder.

scholarly journals Factors Affecting the Outcomes of Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986762 ◽  
Author(s):  
Syed M. Rizvi ◽  
Ahmed J. Harisha ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Linear Regression Analysis ◽  
Frozen Shoulder ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Capsular Release ◽  
Arthroscopic Capsular Release

Background: Arthroscopic capsular release has been shown to provide excellent short- and long-term outcomes in patients with idiopathic frozen shoulder. Some surgeons delay surgery in the belief that operating in the early stages of adhesive capsulitis results in a poorer prognosis. However, it is unclear which factors, particularly the stage of the disorder, affect the surgical outcome of this procedure. Hypothesis: Patients who undergo capsular release during the early symptomatic stage of idiopathic adhesive capsulitis would have less improvement in range of motion compared with those who undergo surgery at a later stage. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 189 shoulders with idiopathic adhesive capsulitis that underwent arthroscopic capsular release were evaluated. All patients completed a L’Insalata questionnaire and had their range of motion and strength tested prior to surgery and at 1, 6, and 12 weeks and 6 months post–capsular release. Post hoc, patients were grouped by whether they had symptoms lasting <10 months (shorter symptoms group; n = 131) or ≥10 months (longer symptoms group; n = 38). Multiple linear regression analysis was performed to determine which preoperative factors were independently associated with a favorable outcome. Results: Patients in the shorter symptoms group were more restricted prior to surgery than were those in the longer symptoms group (mean ± SEM: external rotation, 17° ± 2° vs 27° ± 4° [ P = .04]; abduction, 78° ± 3° vs 92° ± 6° [ P = .04]; internal rotation, S3 ± 1 vs S1 ± 1 [ P = .03]). The shorter symptoms group had greater postoperative improvement in internal rotation (from S3 ± 1 preoperatively to T12 ± 1 vertebral levels) compared with the longer symptoms cohort (from S1 ± 1 to L2 ± 1) ( P = .02). Conclusion: Patients with a frozen shoulder and a duration of symptoms <10 months made greater improvements in internal rotation and had similar final results for flexion, abduction, and external rotation following arthroscopic capsular release when compared with patients who had a longer duration of symptoms, so there is no reason to delay surgery.

scholarly journals Is manipulation under anaesthesia still a better option than intra articular steroid injection in primary frozen shoulder?

2020 ◽  
Vol 6 (2) ◽  
pp. 365
Author(s):  
Raghav Ravi Veeraraghavan ◽  
Venatius Varghese ◽  
Sanjay A. K. ◽  
Pravin Kumar Vanchi ◽  
Mohan Kumar Murugesan
Keyword(s):  
Steroid Injection ◽  
Adhesive Capsulitis ◽  
Initial Period ◽  
Frozen Shoulder ◽  
Pathologic Process ◽  
Painful Shoulder ◽  
Manipulation Under Anaesthesia ◽  
Analogue Scales ◽  
Equal Effectiveness

<p class="abstract"><strong>Background:</strong> Frozen shoulder, also known as adhesive capsulitis, is a common cause of a painful shoulder with restricted motion. The best treatment of frozen shoulder is prevention (secondary frozen shoulder), but early intervention is paramount; a good understanding of the pathologic process by the patient and the physician also is important. The aim of study is comparison between closed manipulation under anaesthesia and intra articular steroid injection in primary periarthritis shoulder.</p><p class="abstract"><strong>Methods:</strong> 30 patients each with primary frozen shoulder who were treated either with closed manipulation under anaesthesia and intra articular steroid injection. The patient is reassessed after 2 weeks, 1 month, 3 month and 6 months using shoulder pain and disability index (SPADI) and visual analogue scales (VAS) to compare the groups.<strong></strong></p><p class="abstract"><strong>Results:</strong> The SPADI index found to be better with patients under went closed manipulation under anaesthesia than intra articular steroid injection in the first 2 weeks. Follow up shows 1<sup>st</sup> group shows better outcome than 2<sup>nd</sup> group at 1 month, but later on 3 months and 6 months shows comparable results. VAS score shows initial period of improvement in pain with steroid injection (2<sup>nd</sup> group). Final follow up shows better pain relief with manipulation under anaesthesia group.</p><p class="abstract"><strong>Conclusions:</strong> The immediate treatment outcome is better with patients with primary frozen shoulder underwent closed manipulation under anaesthesia although following months outcome shows almost equal effectiveness with steroid injection.</p>

scholarly journals Comparison of functional outcome of ultrasound guided glenohumeral and subacromial methylprednisolone acetate injections in frozen shoulder

2018 ◽  
Vol 4 (6) ◽  
pp. 876
Author(s):  
Mayur Chopra ◽  
Attique Vasdev
Keyword(s):  
Functional Outcome ◽  
Early Stage ◽  
Constant Score ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Dash Score ◽  
Methylprednisolone Acetate ◽  
Ultrasound Guided ◽  
Group Constant

<p class="abstract"><strong>Background:</strong> Frozen shoulder also known as adhesive capsulitis is a common cause for limitation of motion and pain of the shoulder joint with an incidence of 2-5% in the general population. The aim of the study was to assess the functional outcome of ultrasound guided glenohumeral and subacromial methylprednisolone acetate steroid injection in patients with frozen shoulder.</p><p class="abstract"><strong>Methods:</strong> 120 patients with frozen shoulder were randomly divided into 2 groups according to site i.e. glenohumeral and subacromial. Ultrasound-guided methylprednisolone acetate (80 mg) injection was administered. At follow up pain was being measured using VAS scale and functional outcome was measured using the DASH score and Constant score at day 0, 1 followed by 1, 3, 6 weeks and  at 3 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> The VAS score of glenohumeral decreased from 6.5±0.95 to 2.25±0.86 at 3 months and in subacromial it decreased from 6.37±1.07 to 2.3±0.72. DASH score in glenohumeral group decreased from 66.95±9.9 to 27.45±9.31 at 3 months and in the subacromial group it decreased from 67.52±10.65 to 26.81±11.14 at 3 months. In glenohumeral group Constant score increased from 46.63±7.18 to 72.66±7.38 at 3 months and in the subacromial group it increased from 47.92±6.91 to 70.28±6.97 at 3 months.</p><p class="abstract"><strong>Conclusions:</strong> Spontaneous recovery does not necessarily occur even after a long period, so we recommend that these modalities should be offered to all patients with frozen shoulder and it would be of more value if carried out at an early stage of the disorder.</p>

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

scholarly journals Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review

2017 ◽  
Vol 11 (1) ◽  
pp. 65-76 ◽  
Author(s):  
Dimitrios Georgiannos ◽  
George Markopoulos ◽  
Eirini Devetzi ◽  
Ilias Bisbinas
Keyword(s):  
Conservative Management ◽  
Health Care Professionals ◽  
Adhesive Capsulitis ◽  
Suprascapular Nerve ◽  
Treatment Modalities ◽  
Published Evidence ◽  
Arthroscopic Capsular Release ◽  
Suprascapular Nerve Block ◽  
Manipulation Under Anaesthesia ◽  
Limiting Condition

Background:Adhesive capsulitis of the shoulder (ACS) is a common self-limiting condition characterized by disabling pain and restricted movements. Its pathophysiology is poorly understood, clinically it is characterized by stages of pain and stiffness, and finally often patients never recover fully. However, there is no consensus about available methods of treatment for ACS. The aims of this paper are to discuss and develop issues regarding approaches to management in ACS in the stages of it.Methods:A review of the literature was performed and guidelines for the treatment of that clinical entity for doctors and health care professionals are provided.Results:Anti-inflammatory medications, steroid and/or hyaluronate injections and physiotherapy is the mainstay of conservative management either alone in the first stages or in combination with other treatment modalities in the later stages. Next line of treatment, involving minor to moderate intervention, includes suprascapular nerve block, distension arthrography and manipulation under anaesthesia. In order to avoid complications of “blind intervention”, arthroscopic capsular release is gradually more commonly applied, and in recalcitrant severe cases open release is a useful option.Conclusion:Various modalities of conservative management and gradually more surgical release are applied. However, often clinicians choose on personal experience and training rather than on published evidence.

scholarly journals Urolithiasis Associated with Renal Impairment: Management and its Outcome

2019 ◽  
Vol 20 (1) ◽  
pp. 18-23
Author(s):  
Md Jamal E Rabby ◽  
Md Masud Zaman ◽  
Mohammad Ali ◽  
Md Kabirul Hassan ◽  
Md Shohidul Lslam ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Functional Outcome ◽  
Urinary Stone ◽  
Duration Of Symptoms ◽  
Baseline Serum ◽  
Stone Clearance ◽  
Stone Burden

Background: Urolithiasis may be associated with various degree of renal impairment secondaryto a combination of obstruction, urinary infection, long standing calculus, stone burden,frequent surgical intervention, and co-existing medical diseases. Objective: The purpose of the study is to predict the factors those have a significant impact foroutcome of the patients with renal impairment following treatment of urolithiasis. Methods: Fifty patients of urolithiasis with renal impairment were enrolled in this prospectivestudy, carried out between 1st July, 2008 and 30th June, 2009, at department of Surgery,Shaheed Ziaur Rahman Medical College Hospital, Bogra. Patients with renal impairment wasdefined as a baseline serum creatinine of >1.2mg/dl and/or on the basis of DTPA isotoperenogram findings (mild, moderate or severe impairment). Definite management was carriedout by means of open surgery, ESWL or in combinations available at study place. Follow-up after3 months, the postoperative renal functional outcome was defined as improved (>20% fall inserum creatinine), stabilized (<20% rise or <20% fall in serum creatinine), or deteriorated(>20% rise in serum creatinine). Renal function was also assessed by the impression madefrom the graph of DTPA isotope renogram (normal functioning or mild, moderate and severeimpairment). Predictive factors to be evaluated for the stone clearance and renal functionaloutcome were age of the patients, duration of symptomatology and urolithiasis, associateddiseases (hypertension and diabetes mellitus), stone burden, stone number and associatedurinary infection. Results: After 3 months of follow-up, the overall stone clearance rate was 76%. Out of 50patients, 27 patients (54%) showed improvement, 19 patients (38%) showed stabilization, and04 patients (08%) showed deterioration in their renal function. Age <40 years, duration ofsymptoms <6 months, stone burden <5 cm2 and single urinary stone were significant predictorsof subsequent good renal functional outcome. Conclusion: The renal recoverability rate after treatment of urinary stone disease could bepredicted by age, duration of symptoms, stone burden and stone number Journal of Surgical Sciences (2016) Vol. 20 (1) : 18-23

scholarly journals Functional outcome of patients undergoing lumbar discectomy

2018 ◽  
Vol 4 (3) ◽  
pp. 514
Author(s):  
Harpreet Singh ◽  
Parth B. Bhavsar ◽  
Ankit Singh ◽  
Saurin Patel
Keyword(s):  
Functional Outcome ◽  
Lumbar Disc ◽  
Subjective Evaluation ◽  
Lumbar Discectomy ◽  
Intervertebral Disc Herniation ◽  
Disc Prolapse ◽  
Duration Of Symptoms ◽  
Lumbar Disc Prolapse ◽  
Lumbar Intervertebral Disc Herniation

<p class="abstract"><strong>Background:</strong> Sciatica resulting from a lumbar intervertebral disc herniation is the most common cause of radicular leg pain in adult working population. It can be treated with both conservative and operative methods. In our study, surgical treatment of lumbar disc prolapse has been done by open discectomy. We wish to assess the outcome of surgery in patients with lumbar disc prolapse undergoing lumbar discectomy.</p><p class="abstract"><strong>Methods:</strong> 40 patients were included in this study and were followed up for up to 1 year postoperatively. We assessed the outcome of each patient with ODI and VAS post-operatively and on follow-up at 3 weeks, 6 months and 1 year. Subjective evaluation of the patient’s satisfaction at the final follow-up was also done.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that males had higher incidence of PIVD with an average duration of symptoms before surgery about 8.62 months. Left side was most involved and level l4-l5 was most involved level. The mean ODI and VAS score pre-operatively were 26.85±4.20 and 7.73±0.88 respectively, which changed to 4.48±5.15 and 1.70±1.57, respectively at 1 year post-operative follow-up. These were statistically highly significant. Most of the patients (34) gave a subjective evaluation as excellent at 1 year follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Our study established that open discectomy has a satisfactory functional outcome and leads to a significant improvement in the patients’ quality of life.</p>

scholarly journals Functional Outcome of Revision Osteosynthesis after failed surgical treatment of patellar fractures

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Elena Müller ◽  
Karl-Heinz Frosch
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Revision Surgery ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Fracture Dislocation ◽  
Secondary Fracture ◽  
Patellar Fractures ◽  
Tegner Score

Aims and Objectives: Patellar fractures account for approximately 1% of all skeletal fractures. They are rare, but due to the crucial function of the patella in the extensor mechanism of the knee they can lead to a serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study is to asses the functional outcome of patients after revision surgery in case of secondary fracture dislocation or remaining articular incongruity. Materials and Methods: The study was designed as a retrospective observatory study. We included all patients who underwent a revision surgery because of a remaining articular incongruity or a secondary fracture dislocation or re-fracture from January 2010 until december 2016. Results: Sixteen patients of mean age 51,8 years were included in the study with a mean follow-up period of 28,8 months. Fifteen patients had AO type C fractures, within ten a C3 fracture. Thirteen were initially treated with tension band wiring via k-wires or cannulated screws. The reason for a revision surgery were 5 times a remaining articular incongruity, 11 times a secondary fracture dislocation or re-fracture. We analysed pain, satisfaction, range of motion, Böstman-Score, Tegner-Score and KOOS and could extract follow-up data from 15 of the patients. All fractures healed, no articular incongruity remained. Mean pain measured with the visual analogue scale (0-10) was at rest 0,57 (range 0-3,5), on exertion 2,79 (range 0-8). The measurement of the range of motion compared with the opposite knee showed a complete extension. Mean Flexion was 120°, in the opposite knee 136° (p = 0,05). Mean postoperative Böstman-Score and Tegner-Score were 25,11 (good, max. 30) and 78,67 (moderate, max. 100). KOOS: symptoms 66,8 points, pain 77,55 points, ADL 75,67 points and qualitiy of life 56,25 points. Conclusion: Early revision surgery in case of secondary fracture dislocation, re-fracture or remaining articular incongruity leads to statisfactory functional outcomes. Furthermore in case of complexe fractures the tension band wiring technique shouldn’t be the first choice, alternatives like the plate osteosynthesis should be considered.

The efficacy of physiotherapy interventions in the treatment of adhesive capsulitis: A systematic review

2020 ◽  
pp. 1-11
Author(s):  
Piumi Nakandala ◽  
Indumathie Nanayakkara ◽  
Surangika Wadugodapitiya ◽  
Indika Gawarammana
Keyword(s):  
Physical Therapy ◽  
Functional Status ◽  
Critical Appraisal ◽  
Human Subjects ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Randomized Controlled ◽  
Search Terms ◽  
Evidence Database

BACKGROUND: Adhesive capsulitis is a debilitating condition which causes the capsule of the gleno-humeral joint to thicken and contract progressively. The effectiveness of various non-operative methods has been demonstrated to improve the pain, range of motion (ROM) and functional status of patients with adhesive capsulitis. OBJECTIVE: This study aims to review recent evidence on the efficacy of physiotherapy interventions in the treatment of adhesive capsulitis. METHODS: PubMed, Physiotherapy Evidence Database (PEDro), Science Direct and Cochrane databases were searched for studies published since 2013. The search terms included: Frozen shoulder, adhesive capsulitis, physical therapy, rehabilitation, manual therapy, mobilization, exercise, education, and electrotherapy. The search was limited to studies published in English and studies that used human subjects. RESULTS: Quality scores of 33 articles were reviewed according to the Sackett’s critical appraisal criteria and the grades of recommendation were determined for physiotherapy interventions used in the studies. CONCLUSION: The empirical evidence suggests that certain physical therapy techniques and modalities are strongly recommended for pain relief, improvement of ROM, and functional status in patients with adhesive capsulitis, while others are either moderately or mildly recommended. However, the efficacy of one treatment modality over another is uncertain. The poor methodological rigors demonstrated in most of the reviewed studies emphasize the urgent need of properly conducted, adequately sampled randomized controlled trials with adequate follow up to determine the superior combination of treatment.

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