Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan.
Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan; Department of Orthopaedic Surgery, Aichi Medical University, Japan.
J Orthop Sci. 2022 Jan;27(1):122-125. doi: 10.1016/j.jos.2020.11.002. Epub 2020 Dec 25.
Although the clinical outcomes of manipulation under ultrasound-guided fifth and sixth cervical nerve root block for frozen shoulder have been reported, few studies have focused on the timing of manipulation. This study aimed to determine whether the timing of manipulation impacts the clinical outcomes.
We retrospectively reviewed the outcomes of 103 frozen shoulder patients (mean age 51.5 years) who underwent manipulation in one shoulder (n = 103 shoulders) between January 2012 and April 2019. Stiff shoulder was defined as limited range of motion in at least three directions, i.e., passive forward flexion of ≤100°, passive external rotation at the side of ≤10°, and internal rotation of ≤L5. The patients were categorized into two groups: those mobilized within 6 months after symptom onset (early group, 44 shoulders) and those mobilized >6 months after symptom onset (late group, 59 shoulders). The range of motion (forward flexion, external rotation, and internal rotation), Japanese Orthopaedic Association shoulder scores, Constant Shoulder Score, and University of California, Los Angeles scores before and 3, 6, and 12 months after manipulation were compared between groups.
The late group exhibited significant improvement in forward flexion, external rotation, internal rotation, Japanese Orthopaedic Association scores, Constant Shoulder Score, and University of California, Los Angeles scores at 3 months; forward flexion at 6 months; and forward flexion and University of California, Los Angeles scores at 12 months after manipulation compared to the early group.
Our results indicate that timing has a significant influence on the outcome of manipulation for frozen shoulders. The optimal time for manipulation may be >6 months after symptom onset. These findings can be applied in counselling for frozen shoulder patients and for improved outcomes after manipulation.
虽然超声引导下第五、六颈椎神经根阻滞治疗冻结肩的临床疗效已有报道，但很少有研究关注操作时机。本研究旨在确定操作时机是否会影响临床疗效。
我们回顾性分析了 2012 年 1 月至 2019 年 4 月期间在单肩接受操作的 103 例冻结肩患者（平均年龄 51.5 岁）的治疗结果（n=103 肩）。僵硬肩定义为至少三个方向的运动受限，即被动前屈角度≤100°，被动外展角度≤10°，内旋角度≤L5。患者分为两组：症状发作后 6 个月内进行操作的早期组（44 肩）和症状发作后 6 个月后进行操作的晚期组（59 肩）。比较两组患者治疗前后（操作前、操作后 3、6、12 个月）的关节活动度（前屈、外展、内旋）、日本骨科协会（JOA）评分、Constant 肩关节评分、加利福尼亚大学洛杉矶分校（UCLA）评分。
与早期组相比，晚期组在操作后 3 个月时的前屈、外展、内旋、JOA 评分、Constant 肩关节评分、UCLA 评分显著改善，在操作后 6 个月时的前屈、在操作后 12 个月时的前屈和 UCLA 评分也有显著改善。
我们的结果表明，时机对冻结肩的操作效果有显著影响。操作的最佳时间可能是症状发作后>6 个月。这些发现可用于冻结肩患者的咨询和操作后改善疗效。
