液压扩张疗法治疗冻结肩的临床研究

目的 探讨液压扩张疗法对冻结肩的治疗价值,分析影响治疗效果的相关因素。方法对４３例（４４肩）冻结肩进行了局麻下关节囊内液压扩张治疗,并对其中１９肩进行了扩张造影。结果 随访时间８－１６个月。根据作者拟定的冻结肩的分型及疗效评定标准,４４肩中优３４肩,良１０肩。其中轻型７肩疗效;中型１８肩;优１７肩,良１肩;重型１９肩;优１０肩,良９肩。１９肩扩张造影结果显示：扩张治疗后关节囊内显影有不同程度的改善     

液压扩张疗法结合手法松解治疗冻结肩

我院于 1996年 1月～ 1999年 1月 ,运用液压扩张疗法结合手法松解治疗冻结肩 15 8例 ,取得了满意的效果。报告如下。1　临床资料1.1　一般资料　 15 8例冻结肩病例均属冻结肩慢性病人 ,符合《肩关节外科学》冻结肩诊断要点。随机分为液压扩张疗法组 5 2例 ,手法松解组 5 1例 ,液压扩张疗法结合手法松解组 5 5例。其中男 68例 ,女 90例 ,年龄 3 8～ 72岁 ,平均 5 4.5岁。病程 2～ 3 0月 ,左肩 10 2例 ,右肩 5 6例。1.2　治疗方法1.2 .1　液压扩张疗法　本组全部采用肩关节前方穿刺 ,患者仰卧位 ,患肩稍外展 ,掌心向上 ,常规消毒铺巾 ,于喙突…     

臂丛麻醉下手法松解治疗冻结肩的临床研究

目的 探讨臂丛麻醉下手法松解治疗冻结肩的效果及机制。方法 对９０例（９２肩）冻结肩进行臂丛麻醉下手法松解,２８肩在松解前进行关节造影,５肩于关节功能完全恢复后,再次进行肩关节造影。结果 随访８～４３个月,手法松解９２肩,优８６肩,良６肩,差０肩。３例出现麻醉并发症。造影显示,松解前关节腔容积明显变小,平均７ｍｌ,关节囊粘连挛缩,以腋隐窝及肱二头肌长头腱鞘最严重。康复后关节造影显示,关节囊边缘光滑,     

臂丛麻醉下手法松解治疗冻结肩的床研究

目的探讨臂丛麻醉下手法松解治疗冻结肩的效果及机制.方法对90例(92肩)冻结肩进行臂丛麻醉下手法松解,28肩在松解前进行肩关节造影,5肩于关节功能完全恢复后,再次进行肩关节造影.结果随访8～43个月,手法松解92肩,优86肩,良6肩,差0肩.3例出现麻醉并发症.造影显示,松解前关节腔容积明显变小,平均7ml,关节囊粘连挛缩,以腋隐窝及肱二头肌长头腱鞘最严重.康复后关节造影显示,关节囊边缘光滑,未见造影剂外渗.结论臂丛麻醉下手法松解治疗冻结肩疗效显著.麻醉后运用手法可充分松解关节囊内粘连,松解过程中撕裂的关节囊在患肩主动功能锻炼过程中,可获得重新修复.     

麻醉下手法松解并关节内注射玻璃酸钠治疗冻结肩体会

目的 探讨麻醉下手法松解并关节内注射玻璃酸钠治疗冻结肩的疗效.方法 自2004年6月-2006年8月对100例冻结肩患者采用麻醉下手法松解并关节内注射玻璃酸钠治疗,术后早期的理疗和肩关节功能练习.结果 随访3-26月,平均14个月,优良率为98%.结论 冻结肩僵硬期患者采用麻醉下手法松解配合关节内液压扩张注射玻璃酸钠治疗,术后早期的理疗和功能练习,显著缩短病程,缓解疼痛,恢复患肩的正常功能,是治疗冻结肩僵硬期的较佳方法.     

镇痛泵持续臂丛阻滞联合手法松解治疗冻结肩的临床观察

目的:观察镇痛泵持续臂丛阻滞联合手法松解治疗冻结肩的临床效果。方法:48例患者采用痛点阻滞、臂丛阻滞、手法松解联合治疗冻结肩,术后镇痛泵持续臂丛阻滞,治疗前后进行评估、统计分析。结果:通过分析治疗前后的临床表现,结果显示:优31例,良13例,优良率91.0％,一般4例,未见无效病例。结论:镇痛泵持续臂丛阻滞下行手法松解冻结肩是一种方法简便、并发症少的良好治疗方法。     

麻醉下分次手术松解治疗冻结肩33例报告

麻醉下分次手术松解治疗冻结肩３３例报告陕俊平笔者自１９８７～１９９３年选择肌间沟臂丛神经阻滞下分次手法松解治疗冻结肩３３例，疗效满意，报告如下。临床资料：本组３３例，共３５肩，其中男１４例，女１９例，有两例系双肩患病。左肩１９例，右肩１６例，年龄４４...     

液压疗法配合肌肉力量技术治疗冻结肩疗效分析

目的观察液压疗法配合肌肉力量技术治疗冻结肩的疗效。方法分为二组,治疗组采用液压疗法配合肌肉力量技术,对照组采用局部封闭配合传统的中医按摩手法,临床治疗20d后比较肩关节功能恢复情况。结果治疗组55例,显效率83.63%,对照组42例,显效率73.81%,二组显效率采用x2检验,P0.05,比较有差异,治疗组优于对照组。而且治疗组手法是无痛治疗,对照组手法松解疼痛明显,故治疗组明显优于对照组。结论液压疗法配合肌肉力量技术能充分发挥患者的能动性,增加关节周围组织的延展性并降低其敏感性,内扩张外减压,在微创及微痛中松解挛缩的关节囊及粘连的滑液囊,解旋关节周围扭曲的肌肉,有效地缓解冻结肩的疼痛,恢复关节功能,提高疗效,避免了传统治疗中的痛苦,值得临床借鉴。     

关节镜松解术结合麻醉下手法松解治疗冻结肩

背景：冻结肩是临床常见疾病,治疗方法较多,大部分患者可以通过保守治疗治愈。而对于保守治疗无效的患者,目前有文献报道应用关节镜下松解结合麻醉下手法松解治疗,效果满意。目的：通过术前和术后肩关节活动度及疼痛程度的变化来评估关节镜松解术结合麻醉下手法松解治疗冻结肩的效果。方法：回顾性分析2011年1月至2013年12月接受关节镜松解术结合麻醉下手法松解治疗的21例冻结肩患者的病例资料。年龄48-67岁,平均55.85岁;男6例,女15例;左侧14例,右侧7例;原发性12例,继发性9例。所有患者均经6-18个月,平均11.23个月的保守治疗无效后行关节镜松解术结合麻醉下手法松解。结果：全部获得随访,随访时间为7-32个月,平均15.57个月。被动前屈、外展、外旋活动度由术前平均86.0°±10.8°,47.4°±7.5°,4.3°±7.8°提升至术后平均142.1°±11.8°,92.6°±12.1°,57.6°±19.8°（P〈0.001）。Constant-Murley肩关节功能评分从术前平均（12.9±2.1）分提高至术后平均（26.2±2.4）分。所有患者术后肩关节疼痛均有不同程度减轻。VAS评分由术前平均（7.4±1.1）分降至术后平均（2.5±1.0）分（P〈0.001）。结论：关节镜松解术结合麻醉下手法松解是治疗冻结肩的有效手段。     

治疗性体位预防重型脑卒中患肢早期并发症的探讨

为了预防重型脑卒中患肢并发症,将９４例重型脑卒中患者随机分为实验组和对照组各４７例,在常规脑卒中治疗基础上,实验组彩和治疗性体位;对照组每２ｈ翻身１次,肢体放置按常规,院１个月后进行患肢并发症发生情况的评价。结果：实验组肩关节半脱位、肩手综合征、关节挛缩的发生率显著低于对照组（均Ｐ〈０．０５）。提示治疗性体位能预防偏瘫并发症的发生,为其康复打下基础。     

Open surgical release for frozen shoulder: surgical findings and results of the release

Over a 5-year period, 75 shoulders that met Codman's criteria for primary frozen shoulder were treated. Nine patients improved with nonoperative treatment, and the remaining 66 patients underwent manipulation under anesthesia. The shoulders in 41 patients successfully released with manipulation. Those in 25 failed to release with manipulation, and therefore, these patients underwent open surgical release of the contracted shoulder. We reviewed the cases of all of the surgically treated patients at 19.52 months' average follow-up, using the history and clinical examination technique recommended by the American Shoulder and Elbow Surgeons. The surgical findings in this group of 25 patients showed a consistent alteration in the rotator interval and coracohumeral ligament. The rotator interval was obliterated, and the coracohumeral ligament was transformed into a tough contracted band. The histology of this contracture was examined in 12 patients and consisted of a dense matrix of type III collagen populated with fibroblasts and myofibroblasts. The contracted coracohumeral ligament was excised with immediate release of the external rotation deficit. Pain scores on visual analogue scale improved from 8.28 to 2.0. The average score for function, with a maximum score of 30, improved from 6.08 to 18.9. Twenty patients had excellent or good results, and 3 had fair results. The shoulders of 2 patients failed to improve: 1 was an insulin-dependent patient with diabetes, and 1 had severe bilateral Dupuytren's contractures. The results in the patients without diabetes were very satisfactory, with visual analogue scale scores of pain decreasing from 8.4 to 1.1, function increasing from 6.4 to 20.1, flexion increasing from an average of 96 degrees to an average of 131 degrees, and external rotation increasing from an average of 10.0 degrees to an average of 46.7 degrees. Surgical release of frozen shoulder is a useful option in those few patients with severe disease whose shoulders fail to release with manipulation under anesthesia. Caution should be used in insulin-dependent patients with diabetes.     

Operative management of the frozen shoulder in patients with diabetes

Forty-three patients with diabetes (47 shoulders) who had a manipulation under anesthesia only (24 shoulders), a manipulation under anesthesia followed by an arthroscopy (12 shoulders), or an arthroscopic release (11 shoulders) for a frozen shoulder were followed-up for a mean period of 35 months. The mean Constant score improved from 20.3 to 63.7 points (P <.001). The mean improvement in forward flexion was 71.7 degrees, in abduction 78.5 degrees, in external rotation with the arm at the side 36.3 degrees, and in internal rotation from the buttock to the first lumbar vertebra (P <.001 for all). When gentle manipulation with the patient under anesthesia was possible, the outcome was satisfactory in 13 of 15 shoulders (86.7%) in patients with non-insulin-dependent diabetes and in 17 of 21 shoulders (81%) in patients with insulin-dependent diabetes (P >.5). Insulin-dependent patients with diabetes were more likely to require an arthroscopic release than patients with non-insulin-dependent diabetes (P <.05). Most of our patients obtained their maximum relief of pain and functional recovery within 3 months of surgery. We recommend manipulation under anesthesia for the resistant frozen shoulder in patients with diabetes. Arthroscopic release is required when mobilization under anesthesia is not possible.     

Manipulation under anesthesia for primary frozen shoulder: effect on early recovery and return to activity

Frozen shoulder is still an enigma of shoulder surgery. It is reported that at 2 years from onset, most patients will have recovered whether treated or not. However, the duration of morbidity has major implications for patient function and satisfaction. In view of this fact, we have focused on the early effect of manipulation under anesthesia on shoulder function. We prospectively assessed 39 shoulders in 37 patients who were given the diagnosis of primary frozen shoulder between June 1997 and June 1998 and were treated with manipulation under anesthesia of the affected shoulder. The median preoperative Constant score rose from 24 of 100 to 63 of 100 at 3 to 6 weeks and to 69 of 100 at 3 months. Improvement was maintained at a mean follow-up of 11 months after surgery (range 6 to 18 months). Overall, 94% of patients were satisfied with the procedure. At 3 months 59% (23 shoulders) were rated as having no or mild disability only, 28.2% (11 shoulders) as having a moderate degree of disability, and 12.8% (5 shoulders) as having a severe degree of disability. Of the 5 cases scoring less than 50 of 100 (mean 40) at 3-month follow-up, 1 had unmasked symptoms of a subacromial impingement syndrome that has required further treatment. There was no relationship between the initial Constant score or the initial range of movement after manipulation and the eventual result. We recommend the use of manipulation under anesthetic in primary frozen shoulder to restore early range of movement and to improve early function in this often protracted and frustrating condition.     

Manipulation under anaesthesia for frozen shoulder

Following manipulation of frozen shoulders under general anaesthesia, we reviewed 74 shoulders at an average of 3 weeks and again at an average of 33 months following the manipulation. We used an adjusted Constant score by excluding the abduction strength measurement. The maximum score was therefore 75 points. The average pre-manipulation score was 24.7 points. At 3 weeks after manipulation this score improved to 54.9 points. At the last follow-up (average 33 months) the score was 72.4 points. We have shown that manipulation under general anaesthesia speeds up recovery of frozen shoulders, and the range of movement improves rapidly.     

Manipulation for frozen shoulder: long-term results

Although much has been published regarding shoulder manipulation under anesthesia for the treatment of frozen shoulder, there are no reported long-term results. In 25 patients (26 shoulders) in whom nonoperative treatment for idiopathic frozen shoulder had failed, we performed manipulation under anesthesia. All had had physical therapy for a mean of 6.2 months. Follow-up was by examination until the end of active treatment. Longer-term follow-up was obtained in 18 patients (19 shoulders) by questionnaire and averaged 15 years (range, 8.1 to 20.6 years). There were significant improvements in forward elevation from a mean of 104 degrees before manipulation (range, 70 degrees to 140 degrees ) to 168 degrees (range, 90 degrees to 180 degrees ) and in external rotation from 23 degrees (range, -5 degrees to 70 degrees ) to 67 degrees (range, 0 degrees to 90 degrees ). There were 16 shoulders with no pain or slight pain and 3 with occasional moderate or severe pain. There were no fractures, dislocations, or other complications. Of the 19 shoulders, 18 required no further surgery. At long-term follow-up, the mean Simple Shoulder Test score was 9.5 out of 12 and the mean American Shoulder and Elbow Surgeons score was 80 out of 100. Treatment of idiopathic frozen shoulder by manipulation under anesthesia leads to sustained improvement in shoulder motion and function at a mean of 15 years after the procedure.     

Shoulder manipulation in patients with adhesive capsulitis and diabetes mellitus: A clinical note

Five patients with diabetes mellitus and six affected shoulders underwent 10 manipulations under general anesthesia. During the postmanipulotion course the gains in motion made at the time of manipulation and the relief of pain achieved began to diminish at 2 weeks, gradually returning to premanipulation levels at 4 weeks. The level of pain and the limitation of motion continued during the entire period of follow-up, averaging 8 months. In these patients manipulation had no effect on the course of the adhesive copsulitis.     

Arthroscopic release of the glenohumeral joint in shoulder stiffness: a review of 26 cases. French Society for Arthroscopy.

The purpose of this multicenter retrospective study of arthroscopic release of the glenohumeral joint was to evaluate the technical feasibility, the results, and the potential correlations between results and cause of the stiffness. Twenty-six shoulders in 25 patients (19 women and six men) were re-evaluated 3 to 72 months (mean, 21 months) after arthroscopic release of the glenohumeral joint. Diagnoses were primary frozen shoulder in 13 cases, bipolar stiffness (rotator cuff tear plus capsular contraction) in 3 cases, and postinjury or postsurgery stiffness in 10 cases. Results were evaluated on passive range of motion, Constant's score, and subjective assessment. Anterior or anterior inferior capsular release was done at the anterior rim of the glenoid fossa. Posterior capsule release was not performed in this series. There were no intraoperative complications. Mean range of motion gains were 86 degrees for forward elevation, 72 degrees for abduction, 34 degrees for external rotation, and 6 spinal processes for internal rotation. Constant's range of motion score increased from 12.9 out of 40 to 32 out of 40 points. Thirteen patients were very satisfied, 5 satisfied, 5 improved, and 3 unchanged. Range of motion gains were independent from the cause of shoulder stiffness, but global results were better in the primary frozen shoulder group in terms of pain and strength. Arthroscopic release of the glenohumeral joint is feasible and safe. For primary frozen shoulders, in case of failure of the functional treatment, arthroscopic release is a less traumatic alternative to manipulation under general anesthesia. For bipolar stiffness, arthroscopy provides the opportunity for treating concomitant lesions. For postsurgical stiffness, arthroscopic release improves range of motion, but the shoulder often remains painful.     

Early and long-term results of arthroscopic treatment for shoulder stiffness

We evaluated the efficacy of arthroscopic treatment in 42 patients with shoulder stiffness. Of 44 stiff shoulders, 30 were classified as primary idiopathic, 7 were classified as traumatic, 4 occurred after prolonged immobilization, and 3 occurred in diabetic patients. Similar intraarticular findings were made in all cases. Bursoscopy suggested subacromial impingement in one third of the patients; they underwent not only capsular release but also subacromial decompression. Gains in motion and the Japanese Orthopaedic Association score were statistically significant at 4 weeks after operation and at a mean follow-up of 7.5 years. The results at the latest follow-up were excellent in 37 shoulders (84%), good in 3 (7%), and poor in 4 (9%). Of the 4 poor results, 2 were in patients with traumatic injury, 1 in a diabetic patient, and 1 in a primary idiopathic patient. There were no complications related to the arthroscopic procedure. Our treatment combines fast recovery with long-term efficacy.     

Comparison of idiopathic,post-trauma and post-surgery frozen shoulder after manipulation under anesthesia

Manipulation under anesthesia (MUA) has been used to speed up the recovery of frozen shoulder, which is said to be a self-limiting process. We would like to elucidate the short- and long-term results of the treatment of frozen shoulders by manipulation under anesthesia and compare the results of idiopathic, post-trauma and post-surgery frozen shoulders. We applied an adjusted Constant score (Constant score after excluding the 25 points allocated for the assessment of muscle strength) to assess all patients. In our series, 47 cases with 51 frozen shoulders were collected and evaluated retrospectively. The adjusted Constant score at pre-manipulation was on average 22.8±4.9 (10–31) points. The score from the 3-week follow-up was 52.6±9.2 (31–67) points on average. The score from the averaged 82-month follow-up was on average 70.1±6.2 (54–75) points, with 23 shoulders scored for a maximum point number of 75. The score at the early and late follow-ups was significantly lower for the post-surgery group (63.2±6.7) when compared to the other two groups (P<0.001). Our results revealed that manipulation under anestheia is a very simple and noninvasive procedure for shortening the course of an apparently self-limiting disease and can improve shoulder function and symptoms within a short period of time. However, we found less improvement in post-surgery frozen shoulders, especially in residual pain and limited range of motion (ROM), which may be influenced by the initial injury or initial surgery. Although less improvement in pain and ROM was noted, manipulation is still a good and simple way to treat post-surgery frozen shoulders.

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Résumé La manipulation sous anesthésie est utilisée pour hater la récupération des épaules gelées qui sont considérées comme un processus d’auto-limitation. Nous avons étudié les résultats à court et long terme de ces manipulations en comparant les résultats des épaules gelées idiopathiques, post-traumatiques et post-chirugicales avec un score de Constant modifié (en excluant les 25 points alloués à la force musculaire). Nous avons évalué rétrospectivement 51 épaules gelées chez 47 patients. Le score de Constant modifié était avant la manipulation de 22,8±4,9 (10–31). Le score à 3 semaines était de 52,6±9,2 (31–67). Le score à 82 mois de recul moyen était de 70,1±6,2 (54–75), avec 23 épaules au score maximum de 75 points. Le score au recul précoce et tardif était significativement plus faible dans le proupe post-chirurgie (63,2±6,7) que dans les autres groupes (P<0,001). Nos résultats montrent que la manipulation sous anesthésie est une méthode non invasive éfficace pour améliorer rapidement la fonction de l’épaule. Il y a moins d’amélioration dans les cas post-chirurgicaux notamment au niveau des douleurs résiduelles et de l’amplitude de mobilité mais la manipulation reste quand même un bon traitement dans ces cas.

     

Does the timing of shoulder manipulation under ultrasound-guided cervical nerve root block for frozen shoulder affect the clinical outcome?

BackgroundAlthough the clinical outcomes of manipulation under ultrasound-guided fifth and sixth cervical nerve root block for frozen shoulder have been reported, few studies have focused on the timing of manipulation. This study aimed to determine whether the timing of manipulation impacts the clinical outcomes.MethodsWe retrospectively reviewed the outcomes of 103 frozen shoulder patients (mean age 51.5 years) who underwent manipulation in one shoulder (n = 103 shoulders) between January 2012 and April 2019. Stiff shoulder was defined as limited range of motion in at least three directions, i.e., passive forward flexion of ≤100°, passive external rotation at the side of ≤10°, and internal rotation of ≤L5. The patients were categorized into two groups: those mobilized within 6 months after symptom onset (early group, 44 shoulders) and those mobilized >6 months after symptom onset (late group, 59 shoulders). The range of motion (forward flexion, external rotation, and internal rotation), Japanese Orthopaedic Association shoulder scores, Constant Shoulder Score, and University of California, Los Angeles scores before and 3, 6, and 12 months after manipulation were compared between groups.ResultsThe late group exhibited significant improvement in forward flexion, external rotation, internal rotation, Japanese Orthopaedic Association scores, Constant Shoulder Score, and University of California, Los Angeles scores at 3 months; forward flexion at 6 months; and forward flexion and University of California, Los Angeles scores at 12 months after manipulation compared to the early group.ConclusionsOur results indicate that timing has a significant influence on the outcome of manipulation for frozen shoulders. The optimal time for manipulation may be >6 months after symptom onset. These findings can be applied in counselling for frozen shoulder patients and for improved outcomes after manipulation.