Factors influencing prognosis of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder: A retrospective cohort study

doi:10.21203/rs.3.rs-3097098/v1

Download PDF

Research Article

Factors influencing prognosis of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder: A retrospective cohort study

https://doi.org/10.21203/rs.3.rs-3097098/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: Although successful clinical outcomes of manipulation under ultrasound-guided cervical nerve root block (MUC) for frozen shoulder have been reported, some cases remain refractory. This study aimed to investigate the prognostic factors of MUC for frozen shoulder.

Methods: We retrospectively reviewed 126 frozen shoulders in 113 patients (mean age 52.5±6.7 years) who underwent MUC. We defined frozen shoulder as a limited shoulder range of motion (ROM) (passive forward flexion < 120°, external rotation [ER] < 30°, or internal rotation [IR] lower than L3). Patients fulfilling any one criteria were considered to have frozen shoulder. The ROM, Japanese Orthopaedic Association (JOA) shoulder score, Constant Shoulder (CS) score, and University of California, Los Angeles (UCLA) score were evaluated before and 12 months after MUC. We defined as the refractory clinical outcome (refractory group) included patients who fulfilled any one of the criteria for frozen shoulder 12 months after MUC. We compared patients in the refractory group with those who did not fulfill any criteria (success group). Multiple logistic regression analysis was performed to identify risk factors using the following variables: sex, age, symptom duration before MUC, body mass index, diabetes mellitus (DM), affected side, initial ROM, and initial functional score.

Results: Patients who underwent MUC were retrospectively enrolled and divided into a success group (n=112 frozen shoulders in 100 patients) and a refractory group (n=14 frozen shoulders in 13 patients) based on their clinical outcome following MUC. Both the success and refractory groups showed significantly improved ROM and functional scores 12 months after MUC (P<.05). Although all ROM and functional scores before MUC showed no significant difference between the two groups, patients in the refractory group showed significantly inferior outcomes than those in the success group 12 months after MUC (P<.01). Age and the presence of DM were significantly higher in the refractory group (P<.05). Multiple logistic regression analysis revealed that age and the presence of DM were independent risk factors for refractory clinical outcomes after MUC (age; odds ratio 1.1, 95% confidence interval 1.0–1.2. P=.04, DM; odds ratio 9.6, 95% confidence interval 2.0–45.4. P=.004).

Conclusions: Higher age and the presence of DM are negative prognostic factors for MUC in frozen shoulder. These results may be useful when counselling patients with higher age and diabetes regarding the outcomes after MUC for frozen shoulder.

Level of evidence: Level III retrospective comparison study.

frozen shoulder

manipulation under ultrasound-guided cervical nerve root block

prognostic factor

Frozen shoulder is characterized by functional restriction of both the active and passive shoulder range of motion (ROM) and shoulder pain (1). It is one of the most commonly observed orthopedic conditions, with a prevalence of 2–5% in the general population, with a risk increase to 10–40% among patients with diabetes mellitus (DM) (2, 3). Moreover, some authors have reported poorer outcomes in patients with diabetic frozen shoulder (4–7). This condition commonly occurs in patients aged 40–60 years, with incidence peaking in the mid-50s (8). Although symptoms of frozen shoulder are general characterized as resolving within 2–3 years, some studies have indicated that pain and movement limitations may persist for a much longer period (8, 9).

The optimal management of frozen shoulder remains controversial. Various treatment modalities are available to decrease the time to recovery and improve the outcomes of this condition, such as nonsteroidal anti-inflammatory drug use, intra-articular corticosteroid injection, physical therapy, and hydrodilatation (10–12). Furthermore, manipulation under anesthesia or arthroscopic capsular release (ACR) can be performed in cases of persistent pain and long-term limited ROM (4, 13–21).

Manipulation under ultrasound-guided fifth and sixth cervical nerve root block (MUC) is a recognized treatment for patients with persistent frozen shoulder and has been established as a safe and effective method to eliminate pain and restore ROM (4, 14–17, 22). In our hospital, to shorten the duration of symptoms, MUC is performed in an outpatient setting without general anesthesia and hospitalization. However, some patients are refractory to MUC, and few studies have focused on the prognostic factors of MUC (5, 23). Therefore, this study was conducted to investigate the prognostic factors of MUC for frozen shoulder.

2.1. Study participants

We retrospectively reviewed the outcomes of MUC in patients with frozen shoulder between January 2015 and July 2021. All patients provided informed consent to participate in the present study, which was approved by our institutional review board (2023014). The inclusion criteria for MUC were as follows: [1] frozen shoulder, defined as limited shoulder ROM (passive forward flexion < 120°, external rotation [ER] < 30°, or internal rotation [IR] at the back lower than L3) (24). Patients fulfilling any one criteria were considered to have frozen shoulder [2] patients unresponsive to conservative therapy, such as oral nonsteroidal anti-inflammatory drug use, intra-articular steroid injection, or physical therapy, for at least 3 months. Patients with rotator cuff tears, shoulder osteoarthritis, calcified tendinitis, long head of the biceps injury, hemiplegia after stroke, bone metastasis in the shoulder region, history of shoulder fracture, history of shoulder surgery, or failure to attend 12 months follow-up were excluded. We defined as the good clinical outcome (success group) included patients who did not fulfill any criteria of frozen shoulder 12 months after MUC and as the refractory clinical outcome (refractory group) included patients who fulfilled any one of the criteria 12 months after MUC.

2.2. MUC procedure and post-MUC therapy

All MUC procedures were performed in the same standard manner (17), and the patients were treated by a single skilled surgeon. MUC was performed in an outpatient setting, with the patient placed in the supine position. The cervical nerve roots (C5 and C6) between the anterior and middle scalene muscles were identified using an ultrasound guide (SNiBLE; KONICA MINOLTA, Tokyo, Japan), and 15–20 mL of 1% lidocaine was injected into the C5/C6 region. Manipulation was initiated following the evaluation of immediate complications and confirmation of the absence of pain at the shoulder joint during passive forward flexion and abduction. Manipulation was initially performed in forward flexion for the inferior capsule tear and subsequently in external rotation for the anterior capsule tear. Thereafter, external rotation with the arm at the side and 90° abduction on the scapular plane was performed to complete the anterior and inferior capsule tears. Finally, internal rotation was performed with the arm at 90° abduction on the scapular plane and extension to the vertebral height of the dominant thumb of the patient to complete the anterior and superior capsule tears. After completion of the MUC, we measured the patients’ vital signs and injected 10 mL of 1% lidocaine and 2.5 mg of dexamethasone into the glenohumeral joint to prevent postprocedural pain. One day after MUC, we assessed any neurological and vascular injuries and conducted radiographic assessments to determine the presence of any major complications, such as pneumothorax and humeral fracture. If no complications were noted, the patients were encouraged to continue the shoulder rehabilitation program, which included passive and active ROM exercises. Rehabilitation was performed at least 3 months after MUC with the assistance of a physical therapist.

2.3. Clinical assessment

The ROM (forward flexion, ER, and IR), Japanese Orthopaedic Association (JOA) shoulder score, Constant Shoulder (CS) score, and University of California, Los Angeles (UCLA) score were evaluated both before and 12 months after MUC. Moreover, we compared the outcomes between the groups. Multiple logistic regression analysis was performed to identify the risk factors for refractory clinical outcomes 12 months after MUC using the following variables: sex, age, symptom duration before MUC, body mass index (BMI), DM, affected side, initial ROM, and initial functional score.

IR was defined as the highest vertebral body that the patient could reach using the thumb of the affected arm. IR was scored as follows: above T12, 6 points; above L5, 4 points; at the buttocks, 2 points; and below the buttocks, 0 points, in accordance with the JOA score.

2.4. Statistical analysis

The Chi-square test was used to compare categorical variables including sex, presence of DM, and the affected side between the two groups. Student’s t-test was used to compare age, symptom duration before MUC, BMI, ROM, and functional scores, while the unpaired t-test was applied to compare these variables within each group. Multiple logistic regression was performed for multivariate analysis of all data. All statistical analyses were performed using SPSS software (version 18.0; IBM Corp., Armonk, NY, USA). Statistical significance was set at P < .05.

A total of 175 MUC procedures were performed during the study period. After excluding 49 shoulders in 46 patients, 126 shoulders in 113 patients were included in the study (Fig. 1). The mean age of all patients was 52.5 ± 6.7 years, and the mean follow-up period was 15.3 ± 1.6 months. In this cohort, 13 (11.5%) patients had bilateral frozen shoulders. The patients were categorized into two groups; the successful MUC group (success group (88.5%), 112 shoulders in 100 patients, 35 men and 65 women; mean age, 52.1 ± 6.6 years), and the refractory clinical outcome group (refractory group (11.5%), 14 shoulders in 13 patients, 7 men and 6 women; mean age, 56 ± 6.5 years).

The demographic characteristics of the patients are shown in Table 1. Both the success and refractory groups showed significantly improved ROM and functional scores 12 months after MUC (P < .05) (Table 2). Comparison of the groups revealed no significantly difference in all ROM and functional scores before MUC, but significantly inferior scores in the refractory group than in the success group 12 months after MUC (P < .01) (Table 1, 3). Age and the presence of DM were significantly higher in the refractory group (P < .05) (Table 1). Multiple logistic regression analysis revealed that age and the presence of DM were independent risk factors for refractory clinical outcomes after MUC (age; odds ratio 1.1, 95% confidence interval 1.0–1.2. P = .04, DM; odds ratio 9.6, 95% confidence interval 2.0–45.4. P = .004). (Table 4). There were no complications such as fractures, shoulder dislocation, rotator cuff tears and neurological or other iatrogenic injuries.

Table 1

Patient’s demographics at baseline
Variables	success group (n = 100)	refractory group (n = 13)	P-value
Number of shoulders	112	14
Male / Female	35/65	7/6	.18
Age (years)	52.1 ± 6.6	56 ± 6.5	.02
Duration of symptoms before MUC (months)	10.9 ± 11.1	15.9 ± 30.1	.18
Body mass index (kg/m²)	22.6 ± 3.3	23.7 ± 4.5	.48
Diabetes mellitus (%)	14 (14%)	7 (53.8%)	< .01
Affected side (n)
dominant/non-dominant	60/52	11/3	.08
Preoperative findings
ROM
forward flexion (°)	99.1 ± 16.4	105 ± 13.4	.10
ER (°)	17.1 ± 13.7	22.1 ± 18.9	.11
IR (point)	1.6 ± 1.6	1.1 ± 1.5	.16
JOA score (point)	58.3 ± 7.9	59.5 ± 7.9	.3
CS score (point)	53.1 ± 8	54.2 ± 7.8	.31
UCLA score (point)	17.9 ± 3.2	18 ± 2.7	.45

Table 2

Clinical outcomes12 months after MUC
Variables	success group		P-value	refractory group		P-value
	Pre	Po12m		Pre	Po12m
ROM
forward flexion (°)	99.1 ± 16.4	166 ± 12.3	< .01	105 ± 13.4	148.2 ± 25.6	< .01
ER (°)	17.1 ± 13.7	57.7 ± 9.1	< .01	22.1 ± 18.9	33.5 ± 12.1	< .05
IR (point)	1.6 ± 1.6	5.1 ± 1	< .01	1.1 ± 1.5	3.9 ± 1.7	< .01
JOA score (point)	58.3 ± 7.9	93.7 ± 5.8	< .01	59.5 ± 7.9	83.4 ± 10.6	< .01
CS score (point)	53.1 ± 8	90.8 ± 7.1	< .01	54.2 ± 7.8	78.4 ± 10.8	< .01
UCLA score (point)	17.9 ± 3.2	32.2 ± 2.8	< .01	18 ± 2.7	27.2 ± 4.8	< .01

Table 3

Comparison of clinical outcomes12 months after MUC in the groups.
Variables	success group	refractory group	P-value
ROM
forward flexion (°)	166 ± 12.3	148.2 ± 25.6	< .01
ER (°)	57.7 ± 9.1	33.5 ± 12.1	< .01
IR (point)	5.1 ± 1	3.9 ± 1.7	< .01
JOA score (point)	93.7 ± 5.8	83.4 ± 10.6	< .01
CS score (point)	90.8 ± 7.1	78.4 ± 10.8	< .01
UCLA score (point)	32.2 ± 2.8	27.2 ± 4.8	< .01

Table 4

Multiple logistic regression analysis results.
Variables	Odds ratio	95% CI	P-value
Age	1.1	1.0-1.2	.04
DM	9.6	2.0-45.4	.004

Our results revealed that all ROM and functional scores were significantly improved 12 months after MUC in both the success and refractory groups. On comparing the groups, although all ROM and functional scores before MUC did not differ significantly between the two groups, those in the refractory group 12 months after MUC were significantly inferior than in the success group. Age and the presence of DM were significantly higher in the refractory group. Higher age and the presence of DM were negative prognostic factors of MUC.

While MUC provides improvements in shoulder pain and function (15–17), to our knowledge, no studies have focused on the relationship between patient’s age and clinical outcomes of frozen shoulder treated with MUC. Regarding factors affecting clinical outcomes of frozen shoulder after ACR, Rizvi et al. reported that regression analysis revealed that younger patients, females, and those with greater preoperative restrictions in ROM benefited the most from this procedure (25). In the present study, success group has significantly superior ROM and functional scores 12 months after MUC and patient’s age was significantly lower than in the refractory group. This is consistent with the result of Rizvi’s study, although the procedure is different. It is difficult to know the precise mechanism of the inferior clinical outcomes in the refractory group, but stiffness of the muscles, fascia, and subcutaneous tissues due to higher age might affect the outcomes.

DM has been associated with refractory outcomes of MUC and ACR for frozen shoulder in previous studies (4–7, 26, 27). Saito et al. compared patients with an ASES score of < 80 (poor clinical result group) with those with an American Shoulder and Elbow Surgeons (ASES) score of ≥ 80 (good clinical result group) and concluded that the initial numeric rating scale (NRS) score and the presence of DM were significantly higher in the poor clinical result group than in the good group. Moreover, multiple logistic regression analysis revealed that DM was the only independent risk factor for poor clinical outcomes after MUC (5). Ando et al. compared the clinical outcomes of MUC between patients with and without DM, and reported that patients with DM showed inferior recovery of Visual Analogue Scale (VAS), ROM, and functional scores compared to the non-DM group (4). Jenkins et al. reported that the patients with frozen shoulder showed that repeat MUC was required in 36% of patients with DM versus 15% of patients without DM (26). Our previous study compared the clinical outcomes of MUC between patients with and without DM and concluded that in patients with DM, ER at 12 months after MUC was significantly inferior to that in patients without DM (6). Yanlei et al. investigated the relationship between DM and ACR, and concluded that patients with DM had a higher rate of refractory postoperative improvement in ROM and shoulder function than those without DM (7). Cho et al. investigated the clinical outcomes after ACR of refractory frozen shoulder with and without DM, and concluded that although ACR showed satisfactory clinical outcomes with and without DM at the final follow-up, patients with DM had slower postoperative functional recovery until 12 months postoperatively (2). Mehta et al. reported that the clinical score 6 months post-ACR was significantly lower in patients with diabetes than in those without diabetes, with a tendency toward persistent limitation of motion 2 years postoperatively (3).

Patients with DM have a high risk of developing pain or other shoulder symptoms, and poor glycemic control may increase the risk of developing musculoskeletal disorders of the shoulder (28–30). Its mechanism is known to involve persistently high levels of glucose leading to the accumulation of advanced glycosylation end products that form cross-links with collagen, making it inelastic and more susceptible to degenerative processes (31). The amount of collagen produced in patients with diabetes is estimated to be at least twice the amount produced in non-diabetic patients of a similar age, leading to progressive changes that affect joint elasticity (32). All of these studies attempted to provide a rationale for the delay in response to treatment in patients with diabetes. Overall, existing research results indicate that the cause of frozen shoulder in patients with diabetes may be multifactorial.

Inferior clinical outcomes in patients with DM and the importance of perioperative glycemic control have been reported in other types of orthopedic surgeries. Our previous study investigated the association between perioperative glycemic control and clinical outcomes in patients with diabetes following arthroscopic rotator cuff repair (ARCR) (30). This study reported that the clinical outcomes of patients with poor postoperative glycemic control were significantly inferior to those of patients who successfully achieved glycemic control. However, some authors have reported that clinical outcomes after ARCR in diabetic patients with perioperative glycemic control are comparable to those in non-diabetic patients (33, 34). Patients with uncontrolled diabetes are more commonly admitted to the hospital for intensive glycemic control prior to surgery. These studies concluded that intensive glycemic control, both perioperatively and postoperatively, is imperative for the prevention of complications and optimization of success clinical outcomes after ARCR. In the present study, DM was found to be a negative prognostic factor for MUC in frozen shoulder. Therefore, we believe that intensive glycemic control, both perioperatively and at least 12 months postoperatively, is imperative to achieve successful clinical outcomes after MUC; this is consistent with the results of previous studies. A long-term follow-up study is necessary to evaluate the efficacy of MUC and comparison of patients with and without DM and patients with controlled and uncontrolled DM.

Our study has several limitations. First, this study had a retrospective design. Second, the sample size was small and the mean follow-up period was short, limiting the generalizability of the results. Third, we did not evaluate the duration of DM, glucose levels, or HbA1c levels, all of which may have influenced the clinical outcomes. Fourth, we did not evaluate other medical comorbidities.

In conclusion, we found that patients with frozen shoulder treated with MUC showed significantly improved ROM and functional scores 12 months after MUC. The ROM and functional scores were significantly inferior in the refractory group than in the success group 12 months after MUC. Age and the presence of DM were significantly higher in the refractory group. Higher age and the presence of DM are negative prognostic factors for MUC in frozen shoulder. We hope that these results could be applied to the future clinical management of patients with frozen shoulder treated by MUC.

MUC

manipulation under ultrasound-guided cervical nerve root block

ROM

range of motion

external rotation

internal rotation

JOA score

Japanese Orthopedic Association Shoulder Score

CS score

Constant Shoulder score

UCLA score

the University of California, Los Angeles Score

diabetes mellitus

ACR

arthroscopic capsular release

BMI

body mass index

ASES score

American Shoulder and Elbow Surgeons score

NRS

numeric rating scale

VAS

visual analogue scale

ARCR

arthroscopic rotator cuff repair

Acknowledgements

Not applicable

Authors’ contributions

All authors contributed to the study’s conception and design. YK and YH designed the study, drafted the manuscript, and designed the figures. YK collected the clinical data and performed the analysis. YH aided in interpreting the results, supervised the work, and performed corrections of the first draft. All authors have read and approved the final submitted manuscript.

Funding

None.

Availability of data and materials

Not applicable.

Ethics approval and consent to participate

The Institutional Review Board of the Ichinomiya Nishi Hospital approved this study. All methods in this study were performed in accordance with the ethical standards of the Institutional Review Board of the Ichinomiya Nishi Hospital, the 1964 Declaration of Helsinki and its subsequent amendments. Informed consent was obtained from all participants and their parents.

Consent for publication

Not applicable.

Declaration of competing interest

None.

Author details

Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, 1Jihira, Kaimei, Ichinomiya City, Aichi, Japan, 494-0001

TEL: +81-586-48-0077

FAX: +81-586-48-0038

E-mail: [email protected]

Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg. 2011;20(2):322–5.
Cho CH, Kim DH, Lee YK. Serial comparison of clinical outcomes after arthroscopic capsular release for refractory frozen shoulder with and without diabetes. Arthroscopy. 2016;32(8):1515–20.
Mehta SS, Singh HP, Pandey R. Comparative outcome of arthroscopic release for frozen shoulder in patients with and without diabetes. Bone Joint J. 2014;96-B(10):1355–8.
Ando A, Hamada J, Hagiwara Y, Sekiguchi T, Koide M, Itoi E. Short-term clinical results of manipulation under ultrasound-guided brachial plexus block in patients with idiopathic frozen shoulder and diabetic secondary frozen shoulder. Open Orthop J. 2018;12:99–104
Saito T, Sasanuma H, Iijima Y, Takeshita K. Prognostic factors of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder for patient with diabetes mellitus: A retrospective cohort study. Int J Surg Case Rep. 2021;87:106480; doi: 10.1016/j.ijscr.2021.106480].
Takahashi R, Kajita Y, Harada Y, Iwahori Y, Deie M. Clinical results of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder in patients with diabetes. J Orthop. 2020;21:297–301.
Yanlei GL, Keong MW, Tijauw Tjoen DL. Do diabetic patients have different outcomes after arthroscopic capsular release for frozen shoulder? J Orthop. 2019;16(3):211–5.
Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;17;331(7530):1453–6.
Tsvieli O, Atoun E, Consigliere P, Polyzois I, Walecka J, Pradhan R et al. Manipulation under anaesthetic for frozen shoulder using Codman’s paradox: a safe and early return of function. Int Orthop. 2017;11.
Sharma S. Management of frozen shoulder - conservative vs surgical? Ann R Coll Surg Engl. 2011;93(5):343–4; Discussion 5–6.
Maund E, Craig D, Suekarran S, Neilson A, Wright K, Brealey S et al. Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2012;16(11):1–264.
Mun SW, Baek CH. Clinical efficacy of hydrodistention with joint manipulation under interscalene block compared with intra-articular corticosteroid injection for frozen shoulder: a prospective randomized controlled study. J Shoulder Elbow Surg. 2016;25(12):1937–43.
Dodenhoff RM, Levy O, Wilson A, Copeland SA. Manipulation under anesthesia for primary frozen shoulder: effect on early recovery and return to activity. J Shoulder Elbow Surg. 2000 Jan-Feb;9(1):23–6.
Saito T, Sasanuma H, Iijima Y, Kanaya Y, Saito T, Watanabe H et al. Short-term clinical results of frozen shoulder treated with shoulder manipulation under ultrasound-guided cervical nerve root block at outpatient setting: A case series. J Orthop Sci. 2017;22(2):275–80.
Takahashi R, Iwahori Y, Kajita Y, Harada Y, Muramatsu Y, Ikemoto T, Deie M. Clinical results, and complications of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder: A retrospective observational study. Pain Ther. 2019 Jun;8(1):111–20.
Sasanuma H, Sugimoto H, Kanaya Y, Iijima Y, Saito T, Saito T, Takeshita K. Magnetic resonance imaging and short-term clinical results of severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block. J Shoulder Elbow Surg. 2016;25(1):e13-20.
Takahashi R, Kajita Y, Harada Y, Iwahori Y, Miyashita N, Deie M. Does the timing of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder affect the clinical outcome? J Orthop Sci. 2020;23.
Arce G. Primary frozen shoulder syndrome: arthroscopic capsular release. Arthrosc Tech. 2015;4(6):e717-20.
Flannery O, Mullett H, Colville J. Adhesive shoulder capsulitis: does the timing of manipulation influence outcome? Acta Orthop Belg. 2007;73(1):21–5.
Hwang JT. Arthroscopic capsular release versus manipulation under anesthesia for primary frozen shoulder. Clin Shoulder Elb. 2020;23(4):167–8.
Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation. Ann R Coll Surg Engl. 2014;96(1):55–60.
Vastamäki H, Varjonen L, Vastamäki M. Optimal time for manipulation of frozen shoulder may be between 6 and 9 months. Scand J Surg. 2015;104(4):260–6.
Oshiro T, Yagi M, Harada K, Park K. Results of repeat manipulation under ultrasound-guided cervical nerve root block with corticosteroid and local anaesthetic injection for recurrence of frozen shoulder. J Orthop Surg Res. 2020;15(1):586; doi: 10.1186/s13018-020-02120-8.
Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS. Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy. 2008;24(9):983–91.
Rizvi SM, Harisha AJ, Lam PH, Murrell GAC. Factors affecting the outcomes of arthroscopic capsular release for idiopathic adhesive capsulitis. Orthop J Sports Med. 2019;7(9):2325967119867621; doi: 10.1177/2325967119867621.
Jenkins EF, Thomas WJ, Corcoran JP, Kirubanandan R, Beynon CR, Sayers AE, Woods DA. The outcome of manipulation under general anesthesia for the management of frozen shoulder in patients with diabetes mellitus. J Shoulder Elbow Surg. 2012;21(11):1492–8.
Woods DA, Loganathan K. Recurrence of frozen shoulder after manipulation under anaesthetic (MUA): the results of repeating the MUA. Bone Joint J. 2017;99-B(6):812–7.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabet Res Clin Pract. 2010;87(1):4–14.
Laslett LL, Burnet SP, Redmond CL, McNeil JD. Predictors of shoulder pain and shoulder disability after one year in diabetic outpatients. Rheumatology (Oxford). 2008;47(10):1583–6.
Takahashi R, Kajita Y, Iwahori Y, Harada Y. The relationship between clinical outcomes of arthroscopic rotator cuff repair and hemoglobin A1c. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2022;30:21–4.
Monnier VM, Glomb M, Elgawish A, Sell DR. The mechanism of collagen cross-linking in diabetes: a puzzle nearing resolution. Diabetes. 1996;45;Suppl 3:S67-72.
Monnier VM, Sell DR, Abdul-Karim FW, Emancipator SN. Collagen browning and cross-linking are increased in chronic experimental hyperglycemia. Relevance to diabetes and aging. Diabetes. 1988;37(7):867–72.
Miyatake K, Takeda Y, Fujii K, Suzue N, Kawasaki Y, Omichi Y, Yokoyama K. Comparable clinical and structural outcomes after arthroscopic rotator cuff repair in diabetic and non-diabetic patients. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):3810–7.
Takahashi R, Kajita Y, Harada Y, Iwahori Y, Deie M. Clinical results of arthroscopic rotator cuff repair in diabetic and non-diabetic patients. J Orthop Sci. 2021;26(2):213–8.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Factors influencing prognosis of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder: A retrospective cohort study

Status:

Version 1

Abstract

Figures

1. Introduction

2. Materials and methods

2.1. Study participants

2.2. MUC procedure and post-MUC therapy

2.3. Clinical assessment

2.4. Statistical analysis

3. Results

4. Discussion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1