Manipulation under anaesthesia for frozen shoulders: outdated technique or well-established quick fix?

Area of Science:

• Orthopedics
• Musculoskeletal Disorders
• Surgical Procedures

Background:

• Frozen shoulder (FS) is a debilitating condition affecting shoulder mobility and causing pain.
• Manipulation under anaesthesia (MUA) is a treatment option for FS, but its optimal application requires clarification.

Purpose of the Study:

• To review the current literature on Manipulation under anaesthesia (MUA) for frozen shoulder (FS).
• To evaluate the efficacy, indications, and complications associated with MUA for FS.
• To propose evidence-based criteria for patient selection for MUA in FS.

Main Methods:

• Systematic review of existing studies on MUA for FS.
• Analysis of reported outcomes, including range of motion, pain scores, and patient satisfaction.
• Assessment of complication rates and re-intervention rates.

Main Results:

• MUA significantly improves range of motion, Oxford shoulder score, and reduces pain in FS patients, with high satisfaction rates (approx. 85%).
• Current literature lacks clearly defined indications and consistent criteria for MUA in FS.
• Most studies lacked control groups, limiting firm conclusions on MUA's definitive role.
• Overall complication rate was 0.4%, with a 14% re-intervention rate.

Conclusions:

• MUA is effective for frozen shoulder but requires standardized indications and further research with control groups.
• Proposed criteria include patient inability to cope with symptoms, specific clinical signs of stage 2 idiopathic FS, limited external rotation, symptom duration, and failure to respond to corticosteroid infiltration.