Vastamäki H, Varjonen L, Vastamäki M
ORTON Research Institute and ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland.
Department of Surgery, Rauma Hospital, Rauma, Finland.
Scand J Surg. 2015 Dec;104(4):260-6. doi: 10.1177/1457496914566637. Epub 2015 Jan 26.
Idiopathic frozen shoulder can be successfully treated conservatively. Manipulation under anesthesia, in randomized controlled studies, has proven to bring no additional benefit to other treatments. However, manipulation under anesthesia still is a used method mainly among patients with unbearable pain or too longstanding restriction of shoulder motion. Manipulation under anesthesia may lead to significant improvement in shoulder motion and function. However, the best timing for manipulation under anesthesia is still unclear. We therefore investigated whether timing of manipulation under anesthesia has influence on the results of manipulation under anesthesia, concerning range of motion, pain, and function.
We followed 57 patients (65 shoulders; 31 in women) at 2-14 years after manipulation under anesthesia evaluating range of motion, pain, and function. Their mean age at manipulation under anesthesia was 54.0 years. A total of 10 patients had diabetes. The time between the onset of symptoms and manipulation averaged 8.8 months. We formed two groups, those mobilized between 6 and 9 months after the onset of symptoms (Group A, 25 shoulders), and the others (Group B, 40 shoulders). We recorded visual analog scale pain, range of motion, Simple Shoulder Test, and Constant-Murley scores.
Patients manipulated between 6 and 9 months after the onset of symptoms had significantly better abduction and external rotation, less pain at rest and at night, and better Simple Shoulder Test than the others.
It seems that timing has statistically significant influence on results of manipulation of the idiopathic frozen shoulder. The best time for manipulation under anesthesia, if non-operative treatment has failed to alleviate pain or limitation of shoulder motion is too cumbersome, might be between 6 and 9 months from the onset of the symptoms. However, the clinical importance of results can be questioned.
特发性冻结肩可通过保守治疗成功治愈。在随机对照研究中，麻醉下手法松解相较于其他治疗方法并未显示出额外的益处。然而，麻醉下手法松解仍是主要用于疼痛难以忍受或肩关节活动受限时间过长患者的一种治疗方法。麻醉下手法松解可能会使肩关节活动和功能得到显著改善。然而，麻醉下手法松解的最佳时机仍不明确。因此，我们研究了麻醉下手法松解的时机是否会对其在活动范围、疼痛和功能方面的治疗效果产生影响。
我们对57例患者（65个肩关节；女性31例）在麻醉下手法松解后2至14年进行随访，评估其活动范围、疼痛和功能。他们接受麻醉下手法松解时的平均年龄为54.0岁。共有10例患者患有糖尿病。症状出现至手法松解的平均时间为8.8个月。我们将患者分为两组，一组是在症状出现后6至9个月内行手法松解的患者（A组，25个肩关节），另一组是其他患者（B组，40个肩关节）。我们记录了视觉模拟评分法疼痛评分、活动范围、简易肩关节测试评分和Constant-Murley评分。
在症状出现后6至9个月内行手法松解的患者，其外展和外旋功能明显更好，静息和夜间疼痛更轻，简易肩关节测试结果也更好。
似乎时机对特发性冻结肩手法松解的效果具有统计学上的显著影响。如果非手术治疗未能缓解疼痛或肩关节活动受限过于严重，麻醉下手法松解的最佳时机可能是在症状出现后的6至9个月。然而，这些结果的临床重要性仍值得质疑。
