title: Operative management of the frozen shoulder in patients with diabetes.
abstract: Forty-three patients with diabetes (47 shoulders) who had a manipulation under anesthesia only (24 shoulders), a manipulation under anesthesia followed by an arthroscopy (12 shoulders), or an arthroscopic release (11 shoulders) for a frozen shoulder were followed-up for a mean period of 35 months. The mean Constant score improved from 20.3 to 63.7 points (P <.001). The mean improvement in forward flexion was 71.7 degrees, in abduction 78.5 degrees, in external rotation with the arm at the side 36.3 degrees, and in internal rotation from the buttock to the first lumbar vertebra (P <.001 for all). When gentle manipulation with the patient under anesthesia was possible, the outcome was satisfactory in 13 of 15 shoulders (86.7%) in patients with non-insulin-dependent diabetes and in 17 of 21 shoulders (81%) in patients with insulin-dependent diabetes (P >.5). Insulin-dependent patients with diabetes were more likely to require an arthroscopic release than patients with non-insulin-dependent diabetes (P <.05). Most of our patients obtained their maximum relief of pain and functional recovery within 3 months of surgery. We recommend manipulation under anesthesia for the resistant frozen shoulder in patients with diabetes. Arthroscopic release is required when mobilization under anesthesia is not possible.
authors.affiliation: Royal Berkshire Hospital, Reading.
authors.forename: Samir N
authors.initials: SN
authors.lastname: Massoud
authors.forename: Eyiyemi O
authors.initials: EO
authors.lastname: Pearse
authors.forename: Ofer
authors.initials: O
authors.lastname: Levy
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Copeland
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D011336:Probability; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012785:Shoulder Joint; D016896:Treatment Outcome