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Half of patients likely to have bone bruising after manipulation for frozen shoulder
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According to results of this study, MRI revealed 29 capsular tears, four labrum tears and 15 bone bruises of the humeral head among 30 patients with severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block.
From September 2013 to January 2015, 34 patients with severe idiopathic frozen shoulders underwent manipulation under ultrasound-guided cervical nerve root blockade. Of these, 30 patients obtained an MRI of the shoulder joint before and after the procedure and were followed up for at least 6 months. Researchers defined severe idiopathic frozen shoulder as a range of motion of 100° or less in forward flexion, 10° or less in external rotation and at or below the fifth lumbar vertebral level in internal rotation.
Results showed significant improvements in range of motion at 1 month after the procedure compared with baseline measures for forward flexion, abduction, external rotation and internal rotation. Numeric Rating Scale scores significantly decreased both at rest and during exercise from before to 1 month after the procedure, according to results. Researchers noted significant improvements in both American Shoulder and Elbow Surgeons scores and Constant-Murley shoulder scores from before to 1 month after the procedure.
MRI detected post-procedural capsular tears in 96.7% of patients, of which 46.7% of tears were classified as midsubstance tears and 50% were classified as humeral avulsion of the glenohumeral ligament-like tears. Results also showed bone bruises of the humeral head in 15 shoulders and anteromedial lesions in three shoulders. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopJay D. Keener, MD
This study utilizes MRI to describe patterns of anatomic injury following closed shoulder manipulation in patients with adhesive capsulitis. The patterns of capsular injury are predictable and beneficial to regain motion. However, the notable injuries to the labrum and the presence of bone bruising in half the shoulders raises concern regarding manipulation. Despite the good clinical outcomes seen in this study, bone bruising highlights the trauma imparted to the shoulder when forceful manipulation is performed. The clinical significance of bone bruising is unknown but raises concern for the potential for fracture or persistent pain as many patients with frozen shoulder also have regional osteopenia. Future studies are needed to determine if bone bruising can be mitigated through arthroscopic capsular release prior to shoulder manipulation.
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