Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
J Shoulder Elbow Surg. 2021 Aug;30(8):e482-e492. doi: 10.1016/j.jse.2020.11.007. Epub 2021 Mar 12.
Studies on the effects of manipulation under anesthesia (MUA) for primary stiff shoulder when different comorbidities are present are lacking. Our aim was to assess how comorbidities influence the recovery speed and clinical outcomes after MUA.
Between April 2013 and September 2018, 281 consecutive primary stiff shoulders in the frozen phase treated with MUA were included in this study. We investigated the comorbidities of patients and divided them into the control (n = 203), diabetes mellitus (DM) (n = 32), hyperlipidemia (n = 26), and thyroid disorder (n = 20) groups. The range of motion (ROM) and clinical scores for each group before MUA and 1 week, 6 weeks, and 3 months after MUA were comparatively analyzed. We identified the ROM recovery time after MUA and the responsiveness to MUA. Then, subjects were subdivided into early and late recovery groups based on their recovery time and into successful and nonsuccessful MUA groups based on their responsiveness to MUA.
Significant improvements in ROM and clinical scores at 3 months after MUA were observed in all groups. Significant differences in ROM among the 4 groups were also observed during follow-up (P < .05). The DM group had significantly lower ROM values, even at 3 months after MUA, compared with the control group. The ROM recovery speed after MUA was slowest in the DM group, followed by the thyroid disorder, hyperlipidemia, and control groups. Most (90.6%) of the DM group experienced late recovery. The proportion of nonsuccessful MUA was higher in the DM and thyroid disorder groups than that in the control and hyperlipidemia groups (P = .004). During follow-up, there were no differences among groups regarding the visual analog scale, University of California at Los Angeles shoulder, and Constant scores.
The ROM recovery speed and responsiveness to MUA for primary stiff shoulder were poorer for the DM and thyroid disorder groups than for the control group. In particular, compared with any other disease, outcomes were poorer when the comorbidity was DM. If patients have comorbidities, then they should be informed before MUA that the comorbidity could affect the outcomes of treatment.
目前缺乏关于麻醉下手法松解术（MUA）治疗原发性冻结肩时不同合并症的效果研究。本研究旨在评估合并症如何影响 MUA 后的恢复速度和临床结果。
本研究纳入了 2013 年 4 月至 2018 年 9 月期间接受 MUA 治疗的 281 例原发性冻结肩患者。我们调查了患者的合并症，并将其分为对照组（n = 203）、糖尿病组（n = 32）、高脂血症组（n = 26）和甲状腺功能障碍组（n = 20）。比较分析了每组患者在 MUA 前、MUA 后 1 周、6 周和 3 个月时的关节活动度（ROM）和临床评分。我们确定了 MUA 后的 ROM 恢复时间和对 MUA 的反应性。然后，根据恢复时间将患者分为早期和晚期恢复组，并根据对 MUA 的反应性将患者分为成功和失败 MUA 组。
所有组在 MUA 后 3 个月时的 ROM 和临床评分均显著改善。在随访期间，4 组之间的 ROM 也存在显著差异（P <.05）。与对照组相比，糖尿病组的 ROM 值即使在 MUA 后 3 个月时也明显较低。MUA 后 ROM 恢复速度最慢的是糖尿病组，其次是甲状腺功能障碍组、高脂血症组和对照组。大多数（90.6%）糖尿病组患者恢复时间较晚。糖尿病组和甲状腺功能障碍组的 MUA 失败率高于对照组和高脂血症组（P =.004）。在随访期间，各组之间的视觉模拟评分、加州大学洛杉矶分校（UCLA）肩部评分和 Constant 评分无差异。
与对照组相比，糖尿病组和甲状腺功能障碍组原发性冻结肩的 ROM 恢复速度和对 MUA 的反应性较差。特别是与其他任何疾病相比，当合并症为糖尿病时，结果更差。如果患者有合并症，在接受 MUA 治疗前应告知其合并症可能会影响治疗效果。
