Clinical Orthopaedics and Related Research®

, Volume 471, Issue 4, pp 1245–1250 | Cite as

Motion and Pain Relief Remain 23 Years After Manipulation Under Anesthesia for Frozen Shoulder

Clinical Research



Manipulation under anesthesia (MUA) as treatment for idiopathic frozen shoulder increases motion, provides pain relief, and restores function, but it is unclear whether the improvements persist long term.


We therefore investigated whether (1) ROM was restored, (2) pain was relieved, and (3) function was restored and maintained after several decades in patients with idiopathic frozen shoulder treated by MUA.


We followed 15 patients (16 shoulders; 12 in women) at 3 months, 7 years, and 19 to 30 years after MUA for frozen shoulder. Their mean age at MUA was 48.5 years. Four patients had diabetes. The time between the onset of symptoms and manipulation averaged 7.6 months. We determined pain by a patient-generated VAS (range, 0–10; 0 = none, 10 = maximal). We recorded ROM and Constant-Murley scores at last followup.


At 7 years, improvement had occurred in forward flexion to 155°, abduction to 175°, external rotation to 51°, and internal rotation to the T7 level. During the next 16 years, ROM deteriorated by 8° to 23° at last followup, but still equaled ROM of the contralateral shoulder. On the VAS, pain at last followup averaged 1.5 with exertion, 0.3 at rest, and 0.8 at night. The Constant-Murley score was 70 (range, 34–88); 12 patients reached the age- and sex-adjusted normal Constant-Murley score.


In this group of patients treatment of idiopathic frozen shoulder by MUA led to improvement in shoulder motion and function at a mean 23 years after the procedure.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.


  1. 1.
    Bulgen DY, Binder AI, Hazleman BL, Dutton J, Roberts S. Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis. 1984;43:353–360.PubMedCrossRefGoogle Scholar
  2. 2.
    Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.PubMedGoogle Scholar
  3. 3.
    Dodenhoff RM, Levy O, Wilson A, Copeland SA. Manipulation under anesthesia for primary frozen shoulder: effect on early recovery and return to activity. J Shoulder Elbow Surg. 2000;9:23–26.PubMedCrossRefGoogle Scholar
  4. 4.
    Farrell CM, Sperling JW, Cofield RH. Manipulation for frozen shoulder: long-term results. J Shoulder Elbow Surg. 2005;14:480–484.PubMedCrossRefGoogle Scholar
  5. 5.
    Flannery O, Mullett H, Colville J. Adhesive shoulder capsulitis: does the timing of manipulation influence outcome? Acta Orthop Belg. 2007;73:21–25.PubMedGoogle Scholar
  6. 6.
    Han SH, Oh KS, Han KJ, Jo J, Lee DH. Accuracy of measuring tape and vertebral-level methods to determine shoulder internal rotation. Clin Orthop Relat Res. 2012;470:562–566.PubMedCrossRefGoogle Scholar
  7. 7.
    Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Should Elbow Surg. 2011;20:502–514.CrossRefGoogle Scholar
  8. 8.
    Jacobs LG, Smith MG, Khan SA, Smith K, Joshi M. Manipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial. J Shoulder Elbow Surg. 2009;18:348–353.PubMedCrossRefGoogle Scholar
  9. 9.
    Jenkins EF, Thomas WJ, Corcoran JP, Kirubanandan R, Beynon CR, Sayers AE, Woods DA. The outcome of manipulation under general anesthesia for the management of frozen shoulder in patients with diabetes mellitus. J Shoulder Elbow Surg. 2012 January 21. [Epub ahead of print]Google Scholar
  10. 10.
    Katolik LI, Romeo AA, Cole BJ, Verma NN, Hayden JK, Bach BR. Normalization of the Constant score. J Shoulder Elbow Surg. 2005;14:279–285.PubMedCrossRefGoogle Scholar
  11. 11.
    Kivimäki J, Pohjolainen T, Malmivaara A, Kannisto M, Guillaume J, Seitsalo S, Nissinen M. Manipulation under anesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: a randomized, controlled trial with 125 patients. J Shoulder Elbow Surg. 2007;16:722–726.PubMedCrossRefGoogle Scholar
  12. 12.
    Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg. 2005;14:16–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Magnusson RA, Taylor DC. Glenoid fracture during manipulation under anesthesia for adhesive capsulitis: a case report. J Shoulder Elbow Surg. 2011;20:e23–e26.CrossRefGoogle Scholar
  14. 14.
    Massoud SN, Pearse EO, Levy O, Copeland SA. Operative management of the frozen shoulder in patients with diabetes. J Shoulder Elbow Surg. 2002;11:609–613.PubMedCrossRefGoogle Scholar
  15. 15.
    Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. Am J Sports Med. 2010;38:2346–2356.PubMedCrossRefGoogle Scholar
  16. 16.
    Ng CY, Amin AK, Narborough S, McMullan L, Cook R, Brenkel IJ. Manipulation under anaesthesia and early physiotherapy facilitate recovery of patients with frozen shoulder syndrome. Scott Med J. 2009;54:29–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Ogilvie-Harris DJ, Biggs DJ, Fitsialos DP, MacKay M. The resistant frozen shoulder: manipulation versus arthroscopic release. Clin Orthop Relat Res. 1995;319:238–248.PubMedGoogle Scholar
  18. 18.
    Othman A, Taylor G. Manipulation under anaesthesia for frozen shoulder. Int Orthop. 2002;26:268–270.PubMedCrossRefGoogle Scholar
  19. 19.
    Quraishi NA, Johnston P, Bayer J, Crowe M, Chakrabarti AJ. Thawing the frozen shoulder: a randomised trial comparing manipulation under anaesthesia with hydrodilatation. J Bone Joint Surg Br. 2007;89:1197–1200.PubMedCrossRefGoogle Scholar
  20. 20.
    Ramesh R, Smith S, Bunker T. Long term follow up after manipulation for frozen shoulder: is this as benign a disease as thought? J Orthop Med. 2003;25:46–48.Google Scholar
  21. 21.
    Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4:193–196.PubMedCrossRefGoogle Scholar
  22. 22.
    Reichmister JP, Friedman SL. Long-term functional results after manipulation of the frozen shoulder. Md Med J. 1999;48:7–11.PubMedGoogle Scholar
  23. 23.
    Simple Shoulder Test. February 10, 2005. Available at: Accessed August 3, 2012.
  24. 24.
    Thomas WJ, Jenkins EF, Owen JM, Sangster MJ, Kirubanandan R, Beynon C, Woods DA. Treatment of frozen shoulder by manipulation under anaesthetic and injection: does the timing of treatment affect the outcome? J Bone Joint Surg Br. 2011;93:1377–1381.PubMedCrossRefGoogle Scholar
  25. 25.
    Vastamäki H, Kettunen J, Vastamäki M. The natural history of idiopathic frozen shoulder: a 2- to 27-year followup study. Clin Orthop Relat Res. 2012;470;1133–1143.PubMedCrossRefGoogle Scholar
  26. 26.
    Vastamäki M. [Long-term results of the manipulated frozen shoulder] [in Finnish]. Suomen Ortopedia ja Traumatologia. 1992;15:389–390.Google Scholar
  27. 27.
    Wang JP, Huang TF, Hung SC, Ma HL, Wu JG, Chen TH. Comparison of idiopathic, post-trauma and post-surgery frozen shoulder after manipulation under anesthesia. Int Orthop. 2007;31:333–337.PubMedCrossRefGoogle Scholar
  28. 28.
    Wang JP, Huang TF, Ma HL, Hung SC, Chen TH, Liu CL. Manipulation under anaesthesia for frozen shoulder in patients with and without non-insulin dependent diabetes mellitus. Int Orthop. 2010;34:1227–1232.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  1. 1.ORTON Research Institute, Invalid FoundationHelsinkiFinland
  2. 2.ORTON Research Institute and ORTON Orthopaedic HospitalHelsinkiFinland
  3. 3.KaarinaFinland

Personalised recommendations