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. 2023 Feb;105(2):136-141.
doi: 10.1308/rcsann.2022.0016. Epub 2022 May 26.

Optimising the use of physiotherapy resources after manipulation under anaesthetic for frozen shoulder

R Castelhano  1 , J Woods  2 , H Akehurst  3 , A Mitra  1 , M James  1 , B Berntzen  1 , P Dacombe  1 , A Tasker  1 , D Woods  1
Affiliations

Optimising the use of physiotherapy resources after manipulation under anaesthetic for frozen shoulder

R Castelhano et al. Ann R Coll Surg Engl. 2023 Feb.

Abstract

Introduction: Manipulation under anaesthetic (MUA) is a successful treatment for frozen shoulder (FS), and the recovery period and recurrence rates may be reduced by postoperative physiotherapy. This study evaluates two physiotherapy pathways for patients undergoing MUA for FS.

Methods: Between 2016 and 2018, 248 age- and sex-matched patients presented to either a NHS secondary care upper limb service or the lead author's independent practice with a diagnosis of FS. The patients had differential access to postprocedure physiotherapy based on which service they presented to. In Group 1, physiotherapy advice only was given to the patient. In Group 2, supervised hydrotherapy and physiotherapy occurred postoperatively. Pre- and postprocedure Oxford Shoulder Scores (OSS) were collected for each group. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on postoperative OSS.

Results: Group 2 showed a significantly greater improvement in postprocedure OSS when compared with Group 1 (18.2 vs 16.7) p<0.001). The estimated maximum effect of physiotherapy on postoperative OSS was an increase of 3.2.

Conclusion: Following MUA for FS, a statistically significant increase in OSS was detected in patients receiving postprocedure physiotherapy compared with advice alone. There was no difference in recurrence rates. The increase in OSS (3.2) is below the minimal clinically important difference, raising questions regarding the relative importance of postprocedure physiotherapy in a resource-limited environment.

Keywords: Manipulation under anaesthesia; Oxford Shoulder Score; Postoperative physiotherapy; Resources.

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Conflict of interest statement

The authors declared no potential conflict of interest with respect to research, authorship and/or publication of this article.

Figures

Figure 1
Figure 1
Recruitment and number of analysed patients. MUE = manipulation under anaesthetic
Figure 2
Figure 2
Pre- and postoperative OSS. OSS = Oxford Shoulder Score
See this image and copyright information in PMC

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