Takahashi Ryosuke, Sagami Ryosuke, Harada Yohei, Kajita Yukihiro
Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Ichinomiya, Aichi, Japan.
Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Hiroshima, Japan.
JSES Int. 2025 Jan 3;9(3):672-677. doi: 10.1016/j.jseint.2024.11.022. eCollection 2025 May.
Manipulation under ultrasound-guided cervical nerve root block (MUC) for frozen shoulder has successful clinical outcomes; however, some cases remain refractory. Therefore, we aimed to investigate the outcomes of MUC for frozen shoulder.
We retrospectively reviewed 126 frozen shoulders in 113 patients who underwent MUC. We defined frozen shoulder as a limited shoulder range of motion (ROM) (passive forward flexion <120°, external rotation <30°, or internal rotation lower than L3). Patients who fulfilled any one of the criteria were considered to have frozen shoulder. The refractory group included patients who fulfilled any of the criteria for frozen shoulder at 12 months after MUC; those in the success group fulfilled none of the criteria. The ROM, Constant Shoulder score, and University of California, Los Angeles score were evaluated before and 12 months after MUC. Multiple logistic regression analysis was performed to identify risk factors.
Twelve months after MUC, both the success (n = 112 frozen shoulders in 100 patients) and refractory groups (n = 14 frozen shoulders in 13 patients) showed significantly improved ROM and functional scores. Although the groups did not differ significantly before MUC, the refractory group showed significantly inferior outcomes to the success group at 12 months after MUC. Age and the presence of diabetes mellitus (DM) were significantly higher in the refractory group than in the success group. Multiple logistic regression analysis revealed older age and the presence of DM as independent risk factors for refractory clinical outcomes. Receiver operating characteristic curve analysis showed that the cutoff value of age for refractory of MUC was 56 years.
Older age and the presence of DM are negative prognostic factors for MUC in frozen shoulder. This result may be useful when counseling patients with these conditions.
超声引导下颈椎神经根阻滞手法治疗（MUC）肩周炎具有良好的临床效果；然而，仍有一些病例疗效不佳。因此，我们旨在研究MUC治疗肩周炎的效果。
我们回顾性分析了113例接受MUC治疗的126例肩周炎患者。我们将肩周炎定义为肩关节活动范围（ROM）受限（被动前屈<120°，外旋<30°，或内旋低于L3）。符合任何一项标准的患者被认为患有肩周炎。难治性组包括MUC后12个月符合肩周炎任何一项标准的患者；成功组则不符合任何标准。在MUC治疗前和治疗后12个月评估ROM、Constant肩关节评分和加州大学洛杉矶分校评分。进行多因素逻辑回归分析以确定危险因素。
MUC治疗12个月后，成功组（100例患者中的112例肩周炎）和难治性组（13例患者中的14例肩周炎）的ROM和功能评分均显著改善。虽然两组在MUC治疗前无显著差异，但难治性组在MUC治疗后12个月的疗效明显低于成功组。难治性组的年龄和糖尿病（DM）患病率显著高于成功组。多因素逻辑回归分析显示，年龄较大和患有DM是难治性临床结果的独立危险因素。受试者工作特征曲线分析显示，MUC难治性的年龄临界值为56岁。
年龄较大和患有DM是肩周炎MUC治疗的不良预后因素。这一结果在为患有这些疾病的患者提供咨询时可能会有所帮助。
