Periarthritis shoulder – Effect of manipulation under general anesthesia on pain and range of movement

Introduction: Periarthritis shoulder is unique condition, in sense that same pathology does not affect any other joints in particular other than shoulder.2 Spontaneous occurrence of pain in shoulder unrelated to injury, but at times associated with injury in 20-30% of cases.2 Main aim of treatment is symptomatic pain relief followed by restoration of normal joint movements. Manipulation under General Anesthesia (MUA) appears to be mainstay of treatment for people who do not benefit by physiotherapy and universal shoulder mobilization exercises.3 Aim of Study: To study effect of manipulation under general anesthesia on Periarthritis shoulder. Objective: To study improvement in Range of Movements, Pain and Short DASH score. Materials and Methods: Study was carried out in Pushpagiri Institute of Medical Sciences and Research Centre during September 2010 to September 2012. 40 patients were selected for the study, underwent MUA with intra-articular steroid injection (40mg/ml methyl prednisolone), 2% Lignocaine (5ml) and Hydrodilation (40ml cold normal saline). They were started physiotherapy immediately and continued. Result: Among the 40 patients 6 patients never returned for follow-up. Data analysis of remaining 34 patients shows improvement in shoulder range of movement. Quick DASH score decreased from 83.72(S.D + 7.1) to 27.66 (S.D + 7.0). VAS score improved from 7.29 (S.D + 1.03) to 1.71 (S.D + 0.84). Conclusion: Periarthritis shoulder, treated with MUA with intra-articular steroid (steroid+Lignocaine) and hydrodilation (with normal saline) result in good immediate pain relief postoperatively and easy breakage of adhesions during the procedure. This followed by immediate physiotherapy decreases pain, adds good functional recovery and early return to daily activities of living. Physiotherapy and universal shoulder mobilization exercises should be continued thereafter to prevent recurrence of symptoms. Keywords: Frozen shoulder syndrome, Adhesive capsulitis, Periarth