Efficacy of manipulation under anesthesia with ultrasound-guided platelet-rich plasma injection in shoulder stiffness concomitant with rotator cuff injury.

HYPOTHESIS AND BACKGROUND

Manipulation under anesthesia (MUA), combined with ultrasound-guided platelet-rich plasma injection, is expected to yield favorable functional outcomes in cases of shoulder stiffness concomitant with rotator cuff injury (RCI). Little has been reported on the efficacy of MUA with ultrasound-guided platelet-rich plasma injection for shoulder stiffness concomitant with RCI.

METHODS

Beginning from August 2023, 30 patients with shoulder stiffness accompanied by RCI were enrolled in the study. All participants underwent MUA, accompanied by ultrasound-guided platelet-rich plasma injection at our institution. We collected and evaluated demographic data for each subject, as well as their range of motion (ROM), visual analog scale pain scores, Constant-Murley Scores, Western Ontario Rotator Cuff Index, and magnetic resonance imaging images. These assessments were conducted before the operation and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperation.

RESULTS

All patients exhibited a significantly improved ROM following the operation: forward flexion increased from 58.70° ± 6.01° to 154° ± 3.59° ( < .05); abduction improved from 58.20° ± 6.88° to 126° ± 3.04° ( < .05); external rotation progressed from grade 1-2 to grade 3-4; internal rotation advanced from grade 1-2 to grade 4-5. Patients aged 51-60 experienced the most significant improvement in forward flexion, while those younger than 40 showed the greatest enhancement in abduction. The mean visual analog scale score at rest was 1.89, indicating a significant improvement from preoperative levels (8.07) ( < .05). A significant difference was observed in the Constant-Murley Score and the Western Ontario Rotator Cuff Index pre and postoperation, with scores changing from 35.80 ± 1.58 to 74.7 ± 1.13 and 163 ± 4.35 to 60.80 ± 1.87, respectively ( < .05). Female patients demonstrated better functional outcomes than male patients. Additionally, patients with intratendinous tears had more favorable results compared to those with subbursal or articular tears. It is important to note that 2 patients did not have ROM data at the 6-month, and 3 patients lacked ROM data at 1-year follow-up due to either retreatment or arthroscopic surgery.

CONCLUSION

Patients with shoulder stiffness and concomitant RCI can achieve satisfactory functional outcomes following MUA combined with ultrasound-guided platelet-rich plasma injection therapy. Further studies are necessary for a more detailed analysis of subgroups and for long-term follow-up.