Indwelling interscalene catheter anesthesia in the surgical management of stiff shoulder: a report of 100 consecutive cases.
One hundred consecutive stiff shoulders in 93 patients resistant to conservative therapy were treated with surgery and intermittent regional anesthesia via indwelling interscalene catheter. Each patient underwent manipulation and one of several operative treatments to release any additional contracture. The indwelling interscalene catheter remained in place and functioned well for an average of 3 days in 87 shoulders. At an average follow-up of 3.0 years, overall clinical results according to Neer's criteria were excellent in 39 shoulders (39%), satisfactory in 28 (28%), and unsatisfactory in 33 (33%). Patients reported no or mild pain in 83 (83%) of the shoulders in the study. At final follow-up, average gains in motion were 44 degrees of elevation (115 degrees to 159 degrees), 31 degrees of external rotation (22 degrees to 53 degrees), and 5 spine segments of internal rotation (L4 to T11). At final follow-up, 95% of the elevation and 79% of the external rotation achieved intraoperatively were maintained. The best results were obtained in those shoulders with idiopathic stiffness (88% excellent or satisfactory results); the worst results were in the postsurgical shoulders (47% excellent or satisfactory results). There were no catheter-related complications. The use of an indwelling interscalene catheter for postoperative pain control is a safe technique that facilitates early physical therapy in a patient population with a high risk of developing recurrent stiffness.
Cohen
N P
NP
Shoulder Service, New York Orthopaedic Hospital, Columbia-Presbyterian Medical Center, USA.
Levine
W N
WN
Marra
G
G
Pollock
R G
RG
Flatow
E L
EL
Brown
A R
AR
Bigliani
L U
LU
D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D010146:Pain / Q000209:etiology*; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome