Abstract
BackgroundThis study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC.MethodsA consecutive series of 42 shoulders in 39 patients with idiopathic frozen shoulder underwent MUC. All patients were assessed according to the American Shoulder Elbow Surgeon (ASES) score and shoulder range of motion (ROM) both before MUC and at 1 year thereafter. If patients continued to have pain and limited ROM at 3 months after the procedure, they were offered a repeat MUC. Such patients were also assessed before the procedure and at 3 months and 1 year thereafter.ResultsThe initial MUC was successful in 31 shoulders (single group). Repeat MUC was required in 11 shoulders (repeat group). Patients in the single group showed significant improvement in ROM and ASES score at 1 year after the procedure (p < 0.001); similarly, patients in the repeat group had significant improvement in ROM and ASES score at 3 months and 1 year after the procedure (p < 0.001). Patients in the repeat group had had significantly more severely limited ROM (p < 0.01) and decreased ASES score (p < 0.001) before the procedure compared with those in the single group.ConclusionsA repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. When there is severely limited ROM and decreased ASES score before the MUC, a repeat MUC may be necessary, which would require the patient’s informed consent.Trial registrationRetrospectively registered
Highlights
This study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after Manipulation under ultrasound-guided cervical nerve root block (MUC)
Single group In the single group, there was a statistically significant improvement in range of motion (ROM) of forward flexion, external rotation, American Shoulder Elbow Surgeon (ASES) scores and ASES score for pain from before the procedure to follow-up 1 year after MUC (p < 0.001) (Figs.1, 2, 3 and 4)
Repeat group In the repeat group, there was an initial improvement in ROM of forward flexion, external rotation, ASES score and ASES score for pain, which subsequently deteriorated by the time of the repeat MUC, after which ROM, ASES scores and ASES score for pain improved significantly (p < 0.001) (Figs.1, 2, 3 and 4)
Summary
This study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC. The symptoms of the disease are selflimiting [2, 3], over 50% of patients treated nonoperatively for idiopathic frozen shoulder still have symptoms and impaired range of motion (ROM) as much as 7 years after initial follow-up [4]. The purpose of this study was to evaluate the shortterm clinical outcomes of a repeat MUC with corticosteroid and local anaesthetic injection performed when the initial results were less than satisfactory or when patients developed recurrent symptoms after their initial MUC. We looked at whether there were any differences between the single and repeat MUC groups before the procedure
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