title: Treatment of frozen shoulder by manipulation under anaesthetic and injection: does the timing of treatment affect the outcome?
abstract: The effect of timing of a manipulation under anaesthetic (MUA) and injection of corticosteroid and local anaesthetic for the treatment of frozen shoulder has attracted little attention to date. All studies describe a period of conservative treatment before proceeding to an MUA. Delay has been associated with a poorer outcome. We present a retrospective review of a prospectively collected, single-surgeon, consecutive series of 246 patients with a primary frozen shoulder treated by MUA within four weeks of presentation. The mean duration of presenting symptoms was 28 weeks (6 to 156), and time to initial post-operative assessment was 26 days (5 to 126). The Oxford shoulder score (OSS) improved by a mean of 16 points (Wilcoxon signed-ranks test, p < 0.001) with a mean OSS at this time of 43 (7 to 48). Linear regression analysis showed no correlation between the duration of presenting symptoms and OSS at initial follow-up  (R2 < 0.001) or peri-operative change in OSS (R2 < 0.001) or OSS at long-term follow-up  (R2 < 0.03). Further analysis at a mean of 42 months (8 to 127) revealed a sustained improvement with a mean OSS of 44 (16 to 48). A good outcome follows an MUA and injection of corticosteroid and local anaesthetic in patients with primary frozen shoulder, independent of the duration of the presenting symptoms, and this improvement is maintained in the long term.
authors.affiliation: Ridgeway Hospital, Swindon, United Kingdom, UK. williamthomas@doctors.doctors.org.uk
authors.forename: W J C
authors.initials: WJ
authors.lastname: Thomas
authors.forename: E F
authors.initials: EF
authors.lastname: Jenkins
authors.forename: J M
authors.initials: JM
authors.lastname: Owen
authors.forename: M J
authors.initials: MJ
authors.lastname: Sangster
authors.forename: R
authors.initials: R
authors.lastname: Kirubanandan
authors.forename: C
authors.initials: C
authors.lastname: Beynon
authors.forename: C
authors.initials: C
authors.lastname: Beyon
authors.forename: D A
authors.initials: DA
authors.lastname: Woods
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002062:Bursitis / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids