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Xiao Y, Tang H, Meng J, Wu Y, Liu W, Liu P, Gao S. Similar outcomes between arthroscopic capsular release and manipulation under anaesthesia for frozen shoulder: A meta-analysis. Asian J Surg 2024:S1015-9584(24)00482-2. [PMID: 38531739 DOI: 10.1016/j.asjsur.2024.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/20/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
To compared the arthroscopic capsular release (ACR) with manipulation under anaesthesia (MUA) for the surgical treatment of frozen shoulder (FS) based on postoperative outcomes and complications. PubMed, Cochrane Library, Embase, and Web of Science were searched on October 2, 2023 to retrieve eligible studies that compared ACR with MUA in terms of clinical outcomes (pain visual analogue scale, external rotation, forward flexion and adverse events) for patients with FS. Mean differences (MD) were calculated for continuous outcomes and odds ratios (OR) were calculated for dichotomous outcomes. Six papers, including 5 clinical studies (a total of 690 shoulders), were included in the final meta-analysis. The forward flexion was found to be larger in the ACR group at 3 months (MD, 2.73; 95%CI, 0.42-5.04; I2 = 44%; P = 0.02) and 6 months (MD, 2.36; 95%CI, 1.29-3.44; I2 = 0%; P < 0.0001). Except for this, ACR was comparable with MUA in terms of pain visual analogue scale at 3, 6 and 12 months (p = 0.25, p = 0.11, p = 0.28, respectively), external rotation at 3, 6 and 12 months (p = 0.15, p = 0.52, p = 0.23, respectively), and forward flexion at 12 months (p = 0.08). There were no differences in complication rates between the two groups (OR, 0.82; 95%CI, 0.47-1.44; I2 = 0%; P = 0.50). In comparison with MUA, ACR demonstrated better outcomes for forward flexion at 3 and 6 months, while there were no significant differences between ACR and MUA in terms of pain visual analogue scale, external rotation and adverse events.
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Affiliation(s)
- Yifan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Yumei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Weijie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Pan Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China; Hunan Engineering Research Center of Osteoarthritis, Changsha, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Sundararajan SR, Dsouza T, Rajagopalakrishnan R, Bt P, Arumugam P, Rajasekaran S. Arthroscopic capsular release versus manipulation under anaesthesia for treating frozen shoulder - a prospective randomised study. INTERNATIONAL ORTHOPAEDICS 2022; 46:2593-2601. [PMID: 36048234 DOI: 10.1007/s00264-022-05558-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Arthroscopic capsular release (ACR) and Manipulation under anaesthesia(MUA) have been widely used in the treatment of frozen shoulder (FS). However, there is only limited Level-I evidence to prefer ACR over MUA. The purpose of our study was to conduct a randomised trial comparing ACR versus MUA to assess the difference in outcome, complications and cost-effectiveness of both procedures. METHODS From May 2020 to June 2021, patients presenting with FS were randomised into two groups ACR (n = 44) and MUA (n = 41). Patients with arthritis, full-thickness cuff tears, history of trauma/previous surgery around the shoulder were excluded from the study. Range of movement (ROM), pain grading using visual analogue scale (VAS), functional scores- UCLA, CONSTANT and EuroQol-5D scores were measured pre-operatively and post-operatively. MRI was done at three weeks post-operatively for screening complications of either procedure. Quality-adjusted life years (QALY) was used for cost-analysis. RESULTS Post-operatively, patients had significant improvement in pain, ROM and functional scores in both groups (P < 0.001) with no significant difference between groups at 24 weeks of follow-up. Diabetic patients undergoing ACR had lesser improvement in abduction and external rotation when compared to non-diabetic patients. Labral tears in MUA group and bone bruises in ACR group were the most common complications noted on the post-operative MRI. For ACR cost per QALY gained was 896 USD while that for MUA was 424 USD. CONCLUSION Both ACR and MUA resulted in good improvement in pain and shoulder function. Good outcomes, simple technique and better cost-effectiveness would still make MUA an attractive option over ACR for treating FS.
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Affiliation(s)
| | - Terence Dsouza
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Ramakanth Rajagopalakrishnan
- Department of Arthroscopy and Sports Medicine, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Pushpa Bt
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Palanisamy Arumugam
- Department of physiotherapy, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, Coimbatore, Tamil Nadu, 641043, India
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Pandey V, Chidambaram R, Modi A, Babhulkar A, Pardiwala DN, Willems WJ, Thilak J, Maheshwari J, Narang K, Kamat N, Gupta P, Reddy R, Desai S, Sundararajan S, Samanta S. Trends in Practice Among Shoulder Specialists in the Management of Frozen Shoulder: A Consensus Survey. Orthop J Sports Med 2022; 10:23259671221118834. [PMID: 36250030 PMCID: PMC9561673 DOI: 10.1177/23259671221118834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The management of frozen shoulder (FS) differs depending on experience level
and variation between scientific guidelines and actual practice. Purpose: To determine the current trends and practices in the management of FS among
shoulder specialists and compare them with senior shoulder specialists. Study Design: Consensus statement. Methods: A team of 15 senior shoulder specialists (faculty group) prepared a
questionnaire comprising 26 questions regarding the definition, terminology,
clinical signs, investigations, management, and prognosis of FS. The
questionnaire was mailed to all the registered shoulder specialists of
Shoulder and Elbow Society, India (SESI) (specialist group; n = 230), as
well as to the faculty group (n = 15). The responses of the 2 groups were
compared, and levels of consensus were determined: strong (>75%), broad
(60%-74.9%), inconclusive (40%-59.9%), or disagreement (<40%). Result: Overall, 142 of the 230 participants in the specialist group and all 15
participants in the faculty group responded to the survey. Both groups
strongly agreed that plain radiographs are required to rule out a secondary
cause of FS, routine magnetic resonance imaging is not indicated to confirm
FS, nonsteroidal anti-inflammatory drugs should be administered at bedtime,
steroid injection (triamcinolone or methylprednisolone) is the next best
option if analgesics fail to provide pain relief, passive physical therapy
should be avoided in the freezing phase, <10% of patients would require
any surgical intervention, and patients with diabetes and thyroid
dysfunction tend to fare poorly. There was broad agreement that routine
thyroid dysfunction screening is unnecessary for women, a single 40-mg
steroid injection via intra-articular route is preferred, and arthroscopic
capsular release (ACR) results in a better outcome than manipulation under
anesthesia (MUA). Agreement was inconclusive regarding the use of combined
random blood sugar (RBS) and glycosylated hemoglobin versus lone RBS to
screen for diabetes in patients with FS, preference of ACR versus MUA to
treat resistant FS, and the timing of surgical intervention. There was
disagreement over the most appropriate term for FS, the preferred physical
therapy modality for pain relief, the most important movement restriction
for early diagnosis of FS, and complications seen after MUA. Conclusion: This survey summarized the trend in prevalent practices regarding FS among
the shoulder specialists and senior shoulder surgeons of SESI.
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Affiliation(s)
- Vivek Pandey
- Vivek Pandey, MS(Orth), Department of Orthopaedics, Kasturba
Medical College, Manipal Academy of Higher Education, Manipal, India 576104
() (Twitter: @vivekortho007)
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Abstract
Among all the prevalent painful conditions of the shoulder, frozen shoulder remains one of the most debated and ill-understood conditions. It is a condition often associated with diabetes and thyroid dysfunction, and which should always be investigated in patients with a primary stiff shoulder. Though the duration of 'traditional clinicopathological staging' of frozen shoulder is not constant and varies with the intervention(s), the classification certainly helps the clinician in planning the treatment of frozen shoulder at various stages. Most patients respond very well to combination of conservative treatment resulting in gradual resolution of symptoms in 12-18 months. However, the most effective treatment in isolation is uncertain. Currently, resistant cases that do not respond to conservative treatment for 6-9 months could be offered surgical treatment as either arthroscopic capsular release or manipulation under anaesthesia. Though both invasive options are not clinically superior to another, but manipulation could result in unwarranted complications like fractures of humerus or rotator cuff tear.
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