OUTCOME OF MANIPULATION UNDER ANAESTHESIA WITH INTRAARTICULAR STEROID INJECTION FOR ADHESIVE CAPSULITIS OF THE SHOULDER: A RETROSPECTIVE TIME-BOUND SURGERY

Background: Adhesive capsulitis is a state of fibrosis with a decreased active and passive range of movements in two or more planes. Manipulation under anesthesia is an effective procedure that can remove the adhesions of the shoulder joint and girdle and relieve symptoms, thus improving the range of movements. There is a lack of a clear protocol for orthopedic surgeons to follow while treating adhesive capsulitis. We assume that manipulation under anesthesia with intraarticular steroid injection is a well-tolerated procedure and can yield satisfactory outcomes with a faster recovery of function than a conservative approach. Patient and Methods: We retrospectively reviewed the medical records of 63 patients in our hospital with adhesive capsulitis having unilateral involvement who were treated with manipulation under anesthesia between January 2020 and January 2023. Pain severity was evaluated by the shoulder pain and disability index (SPADI) and numerical pain rating scale (NPRS). Shoulder function was assessed by passive shoulder range of movements, which were measured by flexion, abduction and external rotation movements preoperatively; immediately after surgery; and at two weeks, one month, three months and 12 months. Results: Abduction improved from 83.40 ± 23.97° to 149.23 ± 2.34° at 12 months. Forward flexion improved from 77.60 ± 20.16° to 153.78 ± 1.42° at 12 months. The degree of external rotation improved from 22.60 ± 7.79° to 78.13 ± 5.24° at 12 months. The NRS score improved from 5.56 ± 0.58 to 1.00 ± 0.76 at 12 months. The SPADI score improved from 73.20 ± 9.00 to 26.40 ± 13.50 at 12 months. Forty-three (86%) patients reported reaching their preinjury status of functioning within 12 months. None of the patients experienced any perioperative complications. One patient experienced symptom recurrence at three months but improved with a short course of analgesics and physiotherapy. Conclusion: Manipulation under anesthesia is a short and easy technique for treating frozen shoulders refractory to conservative management. It is effective in patients secondary to diabetes, and 86% of patients reach their preinjury level of functioning.