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Translational manipulation under anesthesia for patients with frozen shoulder: a case series study with five-year health care utilization and post-manipulative arthroscopic findings |
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| Authors: | Ben R. Hando Daniel I. Rhon Robert E. Boyles Julie M. Whitman Jenny L. English |
| Affiliation: | 1. Department of Orthopedics and Rehabilitation, Wilford Hall Ambulatory Surgical Center, United States Air Force, San Antonio, TX, USA;2. Center for the Intrepid, United States Army, San Antonio, TX, USA;3. School of Physical Therapy, University of Puget Sound, Takoma, WA, USA;4. Evidence in Motion, Sacramento, CA, USA;5. Budget Integration Office, U.S. Army Medical Command, San Antonio, TX, USA |
| Abstract: | Study Design: Case series study. Objectives: Although there have been no reported complications from translational manipulation under anesthesia (tMUA) for individuals with adhesive capsulitis (AC) there are no cases reporting surgical findings post tMUA. Also, there are no studies evaluating health care utilization following tMUA. The purpose of this study was to: (1) report clinical outcomes following tMUA, (2) describe relevant health care costs and utilization following tMUA, and (3) summarize findings from two cases receiving joint arthroscopy following tMUA. Methods: Fourteen Individuals with AC underwent tMUA. Range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) values were collected at baseline and six weeks follow-up. Shoulder-related health care cost and utilization were analyzed for a five-year period following tMUA. Two additional patients with AC underwent tMUA followed by arthroscopic assessment for evidence of iatrogenic injury. Results: Thirteen patients completed the six-week follow-up. Mean change scores for ROM and SPADI values were flexion; +38.5°, abduction; +71.1°, external rotation (shoulder abducted); +49.8°, internal rotation (shoulder abducted); +26.6°, SPADI scores; +44.4. 13 patient records were analyzed for health care utilization. Ten of the 13 patients utilized no additional shoulder-related health care. Surgical evaluation revealed no evidence of iatrogenic injury. Discussion: Clinical outcomes were similar to previous studies. Utilization data indicated that for the majority of patients, little shoulder-related health care was utilized. Surgical evaluation provided further evidence that tMUA performed by a physical therapist is safe. Future research will be required to establish a causal relationship between tMUA and the results observed in this study. Level of Evidence: Therapy, Level 4. |
| Keywords: | Adhesive capsulitis frozen shoulder glenohumeral manipulation under anesthesia manual therapy health care utilization physical therapy health care cost |