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Journal of Shoulder and Elbow Surgery

Magnetic resonance imaging and short-term clinical results of severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block

Published:August 06, 2015DOI:https://doi.org/10.1016/j.jse.2015.06.019

      Background

      We evaluated the magnetic resonance (MR) imaging findings and short-term clinical outcomes of severe idiopathic frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block (MUC).

      Methods

      The subjects were 30 patients (average age, 55.2 years; 12 men, 18 women) with severe frozen shoulder. Severe idiopathic frozen shoulder was defined as follows: a range of motion (ROM) of ≤100° in forward flexion, ≤10° in external rotation, and at or below the fifth lumbar vertebral level in internal rotation. Before the manipulation, all patients had continued global ROM loss for at least 6 months. Before and after manipulation, they underwent MR imaging. MR images and clinical results were evaluated 1 month after the procedure.

      Results

      In terms of the capsule tear pattern, MR imaging showed 14 midsubstance tears and 15 humeral avulsions of glenohumeral ligament–like lesions. An anterior labrum tear occurred in 4 shoulders, whereas 15 shoulders showed a bone bruise in the posterosuperior and anteromedial portions of the humeral head despite no humeral shaft fracture. There were significant improvements in the ROM, Constant-Murley score, American Shoulder and Elbow Surgeons score, and Numeric Rating Scale score from before treatment to 1 month after the procedure.

      Conclusion

      MR imaging of patients with severe frozen shoulder after MUC showed 29 capsule tears, 4 labrum tears, and 15 bone bruises of the humeral head. Approximately 50% of patients are likely to experience bone bruising after MUC. Long-term follow-up of these patients should be performed carefully.

      Level of evidence

      Keywords

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      References

        • Amir-Us-Saqlain H.
        • Zubairi A.
        • Taufiq I.
        Functional outcome of frozen shoulder after manipulation under anaesthesia.
        J Pak Med Assoc. 2007; 57: 181-185
        • Birch R.
        • Jessop J.
        • Scott G.
        Brachial plexus palsy after manipulation of the shoulder.
        J Bone Joint Surg Br. 1991; 73: 172
        • Buchbinder R.
        • Hoving J.
        • Green S.
        • Hall S.
        • Forbes A.
        • Nash P.
        Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial.
        Ann Rheum Dis. 2004; 63: 1460-1469https://doi.org/10.1136/ard.2003.018218
        • Bui-Mansfield L.T.
        • Banks K.P.
        • Taylor D.C.
        Humeral avulsion of the glenohumeral ligaments: the HAGL lesion.
        Am J Sports Med. 2007; 35: 1960-1966https://doi.org/10.1177/0363546507301081
        • Codman E.A.
        The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa.
        Thomas Todd Co., Boston1934
        • Farrell C.M.
        • Sperling J.W.
        • Cofield R.H.
        Manipulation for frozen shoulder: long-term results.
        J Shoulder Elbow Surg. 2005; 14: 480-484https://doi.org/10.1016/j.jse.2005.02.012
        • Flannery O.
        • Mullett H.
        • Colville J.
        Adhesive shoulder capsulitis: does the timing of manipulation influence outcome?.
        Acta Orthop Belg. 2007; 73: 21-25
        • Gerber C.
        • Werner C.M.
        • Macy J.C.
        • Jacob H.A.
        • Nyffeler R.W.
        Effect of selective capsulorrhaphy on the passive range of motion of the glenohumeral joint.
        J Bone Joint Surg Am. 2003; 85: 48-55
        • Grant J.A.
        • Schroeder N.
        • Miller B.S.
        • Carpenter J.E.
        Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review.
        J Shoulder Elbow Surg. 2013; 22: 1135-1145https://doi.org/10.1016/j.jse.2013.01.010
        • Hand C.
        • Clipsham K.
        • Rees J.L.
        • Carr A.J.
        Long-term outcome of frozen shoulder.
        J Shoulder Elbow Surg. 2008; 17: 231-236https://doi.org/10.1016/j.jse.2007.05.009
        • Kapral S.
        • Greher M.
        • Huber G.
        • Willschke H.
        • Kettner S.
        • Kdolsky R.
        • et al.
        Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade.
        Reg Anesth Pain Med. 2008; 33: 253-258https://doi.org/10.1016/j.rapm.2007.10.011
        • Le Lievre H.M.
        • Murrell G.A.
        Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis.
        J Bone Joint Surg Am. 2012; 94: 1208-1216https://doi.org/10.2106/jbjs.j.00952
        • Lho Y.M.
        • Ha E.
        • Cho C.H.
        • Song K.S.
        • Min B.W.
        • Bae K.C.
        • et al.
        Inflammatory cytokines are overexpressed in the subacromial bursa of frozen shoulder.
        J Shoulder Elbow Surg. 2013; 22: 666-672https://doi.org/10.1016/j.jse.2012.06.014
        • Loew M.
        • Heichel T.O.
        • Lehner B.
        Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia.
        J Shoulder Elbow Surg. 2005; 14: 16-21https://doi.org/10.1016/j.jse.2004.04.004
        • Magnussen R.A.
        • Taylor D.C.
        Glenoid fracture during manipulation under anesthesia for adhesive capsulitis: a case report.
        J Shoulder Elbow Surg. 2011; 20: e23-e26https://doi.org/10.1016/j.jse.2010.11.024
        • Milch D.
        Brachial palsy after manipulation of frozen shoulder.
        N Engl J Med. 1954; 50: 429-430
        • Neal J.M.
        • Gerancher J.C.
        • Hebl J.R.
        • Ilfeld B.M.
        • McCartney C.J.
        • Franco C.D.
        • et al.
        Upper extremity regional anesthesia: essentials of our current understanding.
        Reg Anesth Pain Med. 2009; 34: 134-170https://doi.org/10.1097/AAP.0b013e31819624eb
        • Park Y.
        • Ahn J.K.
        • Sohn Y.
        • Jee H.
        • Lee J.H.
        • Kim J.
        • et al.
        Treatment effects of ultrasound guide selective nerve root block for lower cervical radicular pain: a retrospective study of 1-year follow-up.
        Ann Rehabil Med. 2013; 37: 658-667https://doi.org/10.5535/arm.2013.37.5.658
        • Pobiel R.S.
        • Schellhas K.P.
        • Eklund J.A.
        • Golden M.J.
        • Johnson B.A.
        • Chopra S.
        • et al.
        Selective cervical nerve root blockade: prospective study of immediate and longer term complications.
        AJNR Am J Neuroradiol. 2009; 30: 507-511https://doi.org/10.3174/ajnr.A1415
        • Reeves B.
        The natural history of the frozen shoulder syndrome.
        Scand J Rheumatol. 1975; 4: 193-196https://doi.org/10.3109/03009747509165255
        • Rodeo S.A.
        • Hannafin J.A.
        • Tom J.
        • Warren R.F.
        • Wickiewicz T.L.
        Immunolocalization of cytokines and their receptors in adhesive capsulitis of the shoulder.
        J Orthop Res. 1997; 15: 427-436
        • Roux P.P.
        • Barker P.A.
        Neurotrophin signaling through the p75 neurotrophin receptor.
        Prog Neurobiol. 2002; 67: 203-233https://doi.org/10.1016/S0301-0082(02)00016-3
        • Ryu J.D.
        • Kirpalani P.A.
        • Kim J.M.
        • Nam K.H.
        • Han C.W.
        • Han S.H.
        Expression of vascular endothelial growth factor and angiogenesis in the diabetic frozen shoulder.
        J Shoulder Elbow Surg. 2006; 15: 679-685https://doi.org/10.1016/j.jse.2006.01.002
        • Thomas W.J.
        • Jenkins E.F.
        • Owen J.M.
        • Sangster M.J.
        • Kirubanandan R.
        • Beynon C.
        • et al.
        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: 1377-1381https://doi.org/10.1302/0301-620x.93b10.27224
        • Vastamäki H.
        • Vastamäki M.
        Motion and pain relief remain 23 years after manipulation under anesthesia for frozen shoulder.
        Clin Orthop Relat Res. 2013; 471: 1245-1250https://doi.org/10.1007/s11999-012-2542-x
        • Vastamäki H.
        • Varjonen L.
        • Vastamäki M.
        Optimal time for manipulation of frozen shoulder may be between 6 and 9 months.
        Scand J Surg. 2015 Jan 26; ([Epub ahead of print])https://doi.org/10.1177/1457496914566637
        • Westergaard B.
        • Jensen K.
        • Lenz K.
        • Bendtsen T.F.
        • Vazin M.
        • Tanggaard K.
        • et al.
        A randomised controlled trial of ultrasound-guided blockade of the saphenous nerve and the posterior branch of the obturator nerve for postoperative analgesia after day-case knee arthroscopy.
        Anaesthesia. 2014; 69: 1337-1344https://doi.org/10.1111/anae.12794