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Use of Codman's Paradox to Perform Safe & Simple Manipulation Under Anaesthetic for Frozen Shoulder Release

February 19, 2016

Contributors: George Arealis, MD; IOANNIS POLYZOIS Sr, ChB; Oren Tsvieli, MD; Giorgio Ippolito, MD; RITEN PRADHAN; Ehud Atoun, MD; Ofer Levy, MD; Ofer Levy, MD

BACKGROUND: Frozen shoulder remains an enigma and controversial. It accepted that most patients would eventually recover good function after a two or more years period regardless of treatment or not. The long duration however has major implications on patient function, satisfaction, and overall quality of life. We focused on the early effect of simple technique of manipulation under anaesthetic (MUA) on shoulder function. In this technique, we utilise Codman's paradox to achieve rotational movements in a controlled manner, without creating rotational torque on the humerus, thus avoiding potential complications such as iatrogenic fractures. The purpose is to describe the technique and assessment of shoulder function in the early period following MUA using Codman's paradox.

METHODS: A total of 210 patients (214 shoulders) (mean age 52.3 years) that underwent MUA using Codman's paradox for frozen shoulder between 2005 and 2013. (85 males, 125 females), (158 idiopathic, 31 diabetic and the remaining post-traumatic frozen shoulders). All were evaluated clinically preoperatively and postoperatively for pain, range of motion (ROM), Constant score (CS), patient satisfaction, and simple shoulder value (SSV). Patients reviewed at 3 weeks and 3 months post MUA.

RESULTS: No complications were observed. No fractures, dislocations or nerve injury encountered. At 3 weeks, significant improvement in CS from 30.6 preoperatively to 67.7. Forward elevation improved from 90.9? to 151.7?, abduction from 69? to 146.5?, internal rotation (IR) from 11.8? to 62.4?, and external rotation (ER) from 9.4? to 47.6?. Pain score improved significantly from 4.5/15 to 9.7/15. Patient satisfaction improved from 1.5/10 to 6.4/10. All statistical significant (p<0.001). At=" 3=" months=", CS=" rose=" to=" 73.7.=" Forward=" elevation=" improved=" to=" 159.5?=", abduction=" to=" 156.1?=", internal=" rotation=" (IR=") to=" 66.4?=", and=" external=" rotation=" (ER=") to=" 50.3?.=" Pain=" score=" improved=" to=" 10.4="/15 and patient satisfaction to 6.7/10. All statistical significant (p<0.001).

CONCLUSION: Use of Codman's paradox provides safe and efficient way to perform MUA for frozen shoulder. It results in dramatic early improvement in ROM, functional outcomes, and high satisfaction, as early as 3 weeks postoperatively.

Results for "Shoulder and Elbow"

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