Intra-articular lesions in primary frozen shoulder following manipulation under general anaesthesia

Authors: M. Leow

References: SECEC 2005

Abstract
AIM: Manipulation under anaesthesia is still a widely used treatment of stiff shoulders. The aim of this study was to find the potential of traumatic intra articular lesion following manipulation during general anaesthesia in patients with frozen shoulder.

METHOD: In a prospective trial conducted between 2001 and 2003 in 30 patients suffering from primary frozen shoulder, the affected shoulders were manipulated under a general anaesthetic. Exclusion criteria were secondary stiffness caused by rotator cuff tears and glenohumeral arthritis. After the manipulation each patient was examined by arthroscopy and any acute or chronic intra articular lesions were documented.

RESULTS: In all patients during manipulation a significant improvement in the range of motion was achieved. Under anaesthesia flexion improved on average from 70° ± 33° to 180° ± 15°, abduction from 50° ± 20° to 170° ± 25° and external rotation from -5° ± 10° to 40° ± 20°. Arthroscopy revealed haemarthrosis in all patients following manipulation. In 22 patients localised synovitis was detected in the area of the rotator interval, while in 8 patients disseminated synovitis was observed as a feature of adhesive capsulitis. After manipulation, the capsule was seen to be ruptured superiorly in 11 patients, while in 24 the anterior capsule was ruptured up to the infraglenoid pole and 16 patients each had a capsular lesion located posteriorly. In 18 patients no additional joint damage was found after manipulation. In 4 patients iatrogenic SLAP lesions were observed. Further injuries detected were 3 fresh partial tears of the Subscapularis tendon, 4 anterior labrale detachments (1 with a small osteochondral defect) and 2 tears of the MGHL.

CONCLUSION: Even though manipulation during anaesthesia is effective in terms of joint mobilisation, the method can be criticized because of the iatrogenic intra-articular damage it can cause.