PROSPECTIVE ANALYSIS OF THE OUTCOME OF GLENO-HUMERAL MANIPULATION FOR ADHESIVE CAPSULITIS

Abstract

Aim: This prospective study was carried out to assess the outcome of manipulation of the shoulder as a treatment for adhesive capsulitis of the shoulder.

Method: 31 patients were followed prospectively for twelve months after shoulder manipulation for adhesive capsulitis. All patients underwent manipulation under general anaesthetic and scalene block followed by intra-artificial gleno-humeral injection of steroid and local anaesthetic. Postoperative physiotherapy was started on the day of surgery. Shoulder function was assessed with range of movement, Constant and Murley score and DASH score (Disability of the Arm, Shoulder and Hand by specialist upper limb physiotherapists, pre-operatively, and post – operatively at 6 weeks, 3, 6, and 12 months.

Results: The DASH score improved from a mean of 60.1 (range 27–98) pre-operatively to a mean of 24.1 (range 5–83) at final follow up. Constant scores improved from a mean of 34.4 (range 16–51) pre-operatively to 65.8 (range 35–88). The mean improvement in Constant scores was 31.5 points.

Pre-operative range of movement (expressed as a percentage of the total ROM of the unaffected side) was 51.5 % (range 23.8–67.2). The mean postoperative ROM was 85.4% (range 56.2 – 99.3). External rotation improved from 41.7% (range 23.5 – 81.5) of the unaffected side preoperatively to 77.7% (range 44.1 – 105.3) at final review. Abduction improved from 47.4 % (range 23.3 – 70.6) to 85.4% (range 49.7 – 100) and forward flexion improved from 59.1% (range 33.5 – 73.9) to 90o (range 64.3 – 100.6). No patients required further manipulation.

Conclusion: All outcome measure improved following treatment. These improvements were sustained at 12-month follow up. In particular, external rotation which was the most restricted movement pre-operatively was seen to improve and this improvement was maintained throughout follow-up. We conclude that manipulation of the shoulder under inter-scalene block and general anaesthetic for adhesive capsulitis results in a sustained improvement in function and movement.