LAUSR

BACKGROUND Despite the fact that primary adhesive capsulitis of the glenohumeral joint is often considered to be a self-limiting condition, not all patients make a full recovery. Manipulation under anesthesia (MUA) is performed to forcibly rupture the contracted capsule in a controlled manner. However, the technique, timing, and use of additional injections are often debated. In this study we report the outcomes following the addition of capsular distension and counter-traction to MUA as a treatment for adhesive capsulitis. METHODS A retrospective case-cohort study comparing three groups: group 1; MUA alone (n=54), group 2; MUA with capsular distension (n=114), group 3; MUA with capsular distension and counter-traction (n=167). Re-MUA rate, Constant-Murley Shoulder (CMS) and visual analog scale (for pain) (VAS) scores were measured after six weeks and six months. RESULTS Re-MUA rate fell with the addition of both capsular distension and counter-traction: 63% in group 1, 39% in group 2, and 18% in group 3. Those in group 3 recorded the biggest improvement of CMS score after six weeks (+90% versus +68% for group 2 and +58% for group 1), with all groups showing improvements compared to pre-treatment. The only independent risk factor identified for re-MUA was smoking. If a second MUA was performed, CMS (+67%) and VAS (+61%) scores improved, but at six months CMS scores (74.57±7.6 versus 83.30±5.5) and the VAS score (10.57±1.8 versus 12.96±1.5) remained inferior to those who only needed a single MUA. DISCUSSION AND/OR CONCLUSION MUA combined with capsular distension and counter-traction reduces the need for a second MUA and results in a faster improvement of functional outcome (CMS score) and reduction of pain (VAS score) compared to MUA or MUA with capsular distension. The results of this case-cohort study are of clinical relevance since they show that the efficacy of an MUA can be improved through relatively simple adaptations of the treatment protocol.