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Manipulation under anaesthetic for frozen shoulder using Codman’s paradox: a safe and early return of function

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Abstract

Purpose

Although previously frozen shoulder was thought to resolve by two to three years, recent studies demonstrated the symptoms can remain for much longer. Manipulation under anaesthetic (MUA) has been shown to be successful in relieving pain and restoring function. Yet, concerns have been raised regarding its safety and the risks of complications. We utilise Codman’s paradox to manipulate the shoulder, avoiding rotational torque on the humerus. The aim of our study was to asses shoulder function in the early post MUA period.

Methods

Two hundred twelve consecutive patients (224 shoulders) (mean age 52.4 years) underwent MUA using Codman’s paradox for frozen shoulder as sole procedure between 2005 and 2013. All were evaluated clinically, preoperatively and postoperatively, at three weeks and three months, for Constant score (CS), pain, range of motion (ROM), patient satisfaction and subjective shoulder value (SSV).

Results

At three weeks and three months, a significant improvement was found in CS from 30.7 to 66 and 70 respectively. Forward elevation improved from 91° to 154° and 160 °, abduction from 69° to 150° and 156 °, internal rotation from 12° to 62° and 66 °, and external rotation from 10° to 46° and 50 °. Pain score improved from 4.4/15 to 9.6/15 and 10.4/15, SSV improved from 1.5/10 to 6.5/10 and 6.7/10. (p<0.001).

Conclusion

Use of Codman’s paradox provides a safe and efficient way to perform MUA for frozen shoulder. It results in dramatic early improvement in ROM, functional outcomes and high satisfaction, as early as three weeks post-operatively.

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Authors and Affiliations

  1. Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK

    Oren Tsvieli, Paolo Consigliere, Ioannis Polyzois, Joanna Walecka, Rajib Pradhan, Giorgio Ippolito & Ofer Levy

  2. Faculty of Health Sciences, Ben-Gurion University of the Negev, Barzilai Medical Center Campus, Ashkelon, Israel

    Ehud Atoun

  3. Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel

    Ehud Rath

Authors
  1. Oren Tsvieli
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  2. Ehud Atoun
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  3. Paolo Consigliere
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  4. Ioannis Polyzois
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  5. Joanna Walecka
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  6. Rajib Pradhan
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  7. Giorgio Ippolito
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  8. Ehud Rath
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  9. Ofer Levy
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Corresponding author

Correspondence to Ehud Atoun.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Tsvieli, O., Atoun, E., Consigliere, P. et al. Manipulation under anaesthetic for frozen shoulder using Codman’s paradox: a safe and early return of function. International Orthopaedics (SICOT) 42, 339–344 (2018). https://doi.org/10.1007/s00264-017-3558-3

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  • DOI: https://doi.org/10.1007/s00264-017-3558-3

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