Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial
Background: Frozen shoulder (FS) is a common cause of shoulder pain and stiffness. Conservative treatment is sufficient for the majority of patients with long-term recovery of shoulder function. Manipulation under anesthesia (MUA) is known as a well-established treatment option if conservative treat...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266663832300275X |
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| author | Tim Kraal, MD, PhD Yordi de Wit, MD Bertram The, MD, PhD Leonieke van Boekel, PhD Iris Koenraadt-van Oost, MSc Ronald Boer, MD Maaike vd Borne, MD Pjotr Goossens, MSc Koen Koenraadt, PhD Denise Eygendaal, MD, PhD |
| author_facet | Tim Kraal, MD, PhD Yordi de Wit, MD Bertram The, MD, PhD Leonieke van Boekel, PhD Iris Koenraadt-van Oost, MSc Ronald Boer, MD Maaike vd Borne, MD Pjotr Goossens, MSc Koen Koenraadt, PhD Denise Eygendaal, MD, PhD |
| author_sort | Tim Kraal, MD, PhD |
| collection | DOAJ |
| description | Background: Frozen shoulder (FS) is a common cause of shoulder pain and stiffness. Conservative treatment is sufficient for the majority of patients with long-term recovery of shoulder function. Manipulation under anesthesia (MUA) is known as a well-established treatment option if conservative treatment fails. It is unknown whether MUA does indeed shorten the duration of symptoms or leads to a superior outcome compared to conservative treatment. The objective of the current trial is to evaluate the effectiveness of MUA followed by a physiotherapy (PT) program compared to a PT program alone in patients with stage 2 FS. Methods: A prospective, single-center randomized controlled trial was performed. Patients between 18 and 70 years old with stage 2 FS were deemed eligible if an initial course of conservative treatment consisting of PT and intra-articular corticosteroid infiltration was considered unsatisfactory. Patients were randomized, and data was collected with an online data management platform (CASTOR). MUA was performed by a single surgeon under interscalene block, and intensive PT treatment protocol was started within 4 hours after MUA. In the PT group, patients were referred to instructed physiotherapist, and treatment was guided by tissue irritability. The primary outcome was the Shoulder Pain and Disability Index (SPADI) score. Secondary outcomes were pain, range of motion (ROM), Oxford Shoulder Score, quality of life, and ability to work. Results: In total, 82 patients were included, 42 in the PT group and 40 in the MUA group. There was a significant improvement in SPADI, Oxford Shoulder Score, pain, ROM, and quality of life in both groups at 1-year follow-up. SPADI scores at three months were significantly improved in favor of MUA. MUA showed a significantly bigger increase in anteflexion and abduction compared to PT at all points of follow-up. No significant differences between both groups were found for all other parameters. No fractures, dislocations, or brachial plexus injuries occurred in this trial. Conclusion: MUA in stage 2 FS can be considered safe and results in a faster recovery of ROM and improved functional outcome, measured with SPADI scores, compared to PT alone in the short term. After 1 year, except for slightly better ROM scores for MUA, the result of MUA is equal to PT. |
| first_indexed | 2024-03-07T22:00:19Z |
| format | Article |
| id | doaj.art-aa667f30d1444006af21c916bba2c0e1 |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-03-07T22:00:19Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-aa667f30d1444006af21c916bba2c0e12024-02-24T04:55:36ZengElsevierJSES International2666-63832024-03-0182293298Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trialTim Kraal, MD, PhD0Yordi de Wit, MD1Bertram The, MD, PhD2Leonieke van Boekel, PhD3Iris Koenraadt-van Oost, MSc4Ronald Boer, MD5Maaike vd Borne, MD6Pjotr Goossens, MSc7Koen Koenraadt, PhD8Denise Eygendaal, MD, PhD9Department of Orthopedic Surgery, Flevo Hospital, Almere, the NetherlandsDepartment of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the Netherlands; Corresponding author: Yordi de Wit, MD, Department of Orthopedic Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, Netherlands.Department of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the NetherlandsDepartment of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the NetherlandsDepartment of Orthopedic Surgery, Amphia Hospital, Breda, the Netherlands; Foundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the NetherlandsDepartment of Orthopedic Surgery, Amphia Hospital, Breda, the NetherlandsDepartment of Orthopedic Surgery, Amphia Hospital, Breda, the NetherlandsDepartment of Orthopedic Surgery, Amphia Hospital, Breda, the NetherlandsFoundation for Orthopedic Research, Care & Education, Amphia Hospital, Breda, the NetherlandsDepartment of Orthopedic Surgery, Erasmus MC, Rotterdam, the NetherlandsBackground: Frozen shoulder (FS) is a common cause of shoulder pain and stiffness. Conservative treatment is sufficient for the majority of patients with long-term recovery of shoulder function. Manipulation under anesthesia (MUA) is known as a well-established treatment option if conservative treatment fails. It is unknown whether MUA does indeed shorten the duration of symptoms or leads to a superior outcome compared to conservative treatment. The objective of the current trial is to evaluate the effectiveness of MUA followed by a physiotherapy (PT) program compared to a PT program alone in patients with stage 2 FS. Methods: A prospective, single-center randomized controlled trial was performed. Patients between 18 and 70 years old with stage 2 FS were deemed eligible if an initial course of conservative treatment consisting of PT and intra-articular corticosteroid infiltration was considered unsatisfactory. Patients were randomized, and data was collected with an online data management platform (CASTOR). MUA was performed by a single surgeon under interscalene block, and intensive PT treatment protocol was started within 4 hours after MUA. In the PT group, patients were referred to instructed physiotherapist, and treatment was guided by tissue irritability. The primary outcome was the Shoulder Pain and Disability Index (SPADI) score. Secondary outcomes were pain, range of motion (ROM), Oxford Shoulder Score, quality of life, and ability to work. Results: In total, 82 patients were included, 42 in the PT group and 40 in the MUA group. There was a significant improvement in SPADI, Oxford Shoulder Score, pain, ROM, and quality of life in both groups at 1-year follow-up. SPADI scores at three months were significantly improved in favor of MUA. MUA showed a significantly bigger increase in anteflexion and abduction compared to PT at all points of follow-up. No significant differences between both groups were found for all other parameters. No fractures, dislocations, or brachial plexus injuries occurred in this trial. Conclusion: MUA in stage 2 FS can be considered safe and results in a faster recovery of ROM and improved functional outcome, measured with SPADI scores, compared to PT alone in the short term. After 1 year, except for slightly better ROM scores for MUA, the result of MUA is equal to PT.http://www.sciencedirect.com/science/article/pii/S266663832300275XFrozen shoulderManipulation under anesthesiaSPADIRange of motionRandomized controlled trialPhysiotherapy |
| spellingShingle | Tim Kraal, MD, PhD Yordi de Wit, MD Bertram The, MD, PhD Leonieke van Boekel, PhD Iris Koenraadt-van Oost, MSc Ronald Boer, MD Maaike vd Borne, MD Pjotr Goossens, MSc Koen Koenraadt, PhD Denise Eygendaal, MD, PhD Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial JSES International Frozen shoulder Manipulation under anesthesia SPADI Range of motion Randomized controlled trial Physiotherapy |
| title | Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial |
| title_full | Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial |
| title_fullStr | Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial |
| title_full_unstemmed | Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial |
| title_short | Improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder: a randomized controlled trial |
| title_sort | improved range of motion after manipulation under anesthesia versus physiotherapy for stage two frozen shoulder a randomized controlled trial |
| topic | Frozen shoulder Manipulation under anesthesia SPADI Range of motion Randomized controlled trial Physiotherapy |
| url | http://www.sciencedirect.com/science/article/pii/S266663832300275X |
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