Effect of manipulation technique using ultrasound-guided cervical nerve root block on range of motion at the shoulder joint in frozen shoulder: a retrospective study

Abstract

Purpose: The aim of this study was to evaluate the range of motion (ROM) at the shoulder joint before and after silent manipulation.

Methods: This retrospective study included all patients who underwent silent manipulation at our institution between January 2013 and December 2017. In total, 1,665 shoulders in 1,610 patients (519 men, 1,146 women; mean age 55.4 ± 8.8 years) were treated during the study period. The mean symptom duration was 6.6 ± 7.1 months. ROM at the shoulder joint was measured in flexion, abduction, and external rotation before silent manipulation and at 1 week and 1, 2, and 3 months after the procedure.

Results: Mean ROM at the shoulder was 98.8° (95% confidence interval [CI] 97.9-99.8) before silent manipulation and 155.5° (154.1-156.8) after 3 months in flexion (p = 0.0000), 75.6° (74.5-76.8) and 152.9° (151.0-154.9), respectively, in abduction (p = 0.0000), and 12.7° (12.0-13.4) and 45.9° (44.4-47.4) in external rotation (p = 0.0000). All ROM values were significantly increased at all time points after the procedure. There were no unanticipated adverse events or serious adverse reactions.

Conclusions: This study reports on the efficacy and safety of manipulation using conduction anesthesia for shoulder contractures in a large group of patients. Silent manipulation can increase ROM at the shoulder safely and effectively.

Keywords: Adhesion; Frozen shoulder; Silent manipulation; Ultrasound-guided cervical nerve root block.

Fig. 1

Glenohumeral joint injection. a With the patient in the half side-lying or lateral recumbent position, 5 mL of 1% mepivacaine and 20 mg of triamcinolone are injected into the glenohumeral joint under ultrasound guidance. b The white arrowhead is the capsule, the black arrowhead is the humeral head, and the white arrow is the needle tip

Fig. 2

Ultrasound-guided C5 and C6 nerve root block. a With the patient in the half side-lying or lateral recumbent position, 12–15 mL of 1% mepivacaine is injected into the C5 and C6 nerve roots under ultrasound guidance. b Level where C5 and C6 form the truncus superior. The white arrowhead is C5, the black arrowheads are C6, and the white arrow is the needle tip. VA, vertebral artery

Fig. 3

Manipulation procedure. The shoulder is abducted to 90°, then externally rotated to 90°, and maximally abducted from that position. The utmost care is taken not to fracture the humerus due to excessive external force. Care must also be taken not to move the humeral head forward when performing maximal abduction. If the joint capsule is too stiff to allow maximum abduction, it should not be forced and the operator should proceed to the next step

Fig. 4

Horizontal adduction (a) to internal rotation (b) of the shoulder joint

Fig. 5

Abduction at 90°of external rotation (a) to adduction (b). Full adduction of the glenohumeral joint while preventing compensatory motions of the scapula

Fig. 6

Extended position to internal rotation. The doctor presses the patient’s scapula against the bed and holds it in place while extending and internally rotating the shoulder joint

Fig. 7

Range of motion in flexion, abduction and external rotation before and after manipulation. "n" indicates the number of shoulders evaluated. *Significant difference after silent manipulation (p = 0.0000)