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Use of Codman's Paradox to Perform Safe and Simple Manipulation Under Anesthetic for Frozen Shoulder Release

February 19, 2016

Contributors: George Arealis, MD; IOANNIS POLYZOIS Sr, ChB; Oren Tsvieli, MD; Giorgio Ippolito, MD; RITEN PRADHAN; Ehud Atoun, MD; Ofer Levy, MD; Ofer Levy, MD

Background: Frozen shoulder is an enigma and controversial. Most patients with frozen shoulder eventually recover good function after 2 or more years regardless of management. However, the long duration of frozen shoulder is associated with major consequences with regard to patient function, satisfaction, and overall quality of life. This video focuses on the early effect of a simple technique that involves manipulation under anesthesia (MUA) on shoulder function. This technique uses the Codman paradox to achieve rotational movements in a controlled manner without creating rotational torque on the humerus, which avoids potential complications, such as iatrogenic fracture. The video describes the technique and assessment of shoulder function in the early period after MUA via the Codman paradox. Methods: A total of 210 patients (214 shoulders) with a mean age of 52.3 years and frozen shoulder underwent MUA via the Codman paradox between 2005 and 2013. The patients included 85 males and 125 females. Of the 210 patients, 158 patients had an idiopathic frozen shoulder, 31 patients had a diabetic frozen shoulder, and the remaining patients had a posttraumatic frozen shoulder. All the patients were clinically evaluated for pain, range of motion, Constant assessment score, patient satisfaction, and simple shoulder value preoperatively and postoperatively. Patients were evaluated 3 weeks and 3 months after MUA. Results: No complications were observed. No fractures, dislocations, or nerve injuries were encountered. At 3 weeks after MUA, the mean Constant assessment score improved from 30.6 to 67.7. Mean forward elevation improved from 90.9° to 151.7°, mean abduction improved from 69° to 146.5°, mean internal rotation improved from 11.8° to 62.4°, and mean external rotation improved from 9.4° to 47.6°. The mean pain score improved from 4.5 out of 15 to 9.7 out of 15. The mean patient satisfaction score improved from 1.5 out of 10 to 6.4 out of 10. All improvements were statistically significant (P < 0.001). At 3 months after MUA, the mean constant assessment score was 73.7. Mean forward elevation was 159.5°, mean abduction was 156.1°, mean internal rotation was 66.4°, and mean external rotation was 50.3°. The mean pain score was 10.4 out of 15, and the mean patient satisfaction score was 6.7 out of 10. All improvements were statistically significant (P < 0.001). Conclusion: Use of the Codman paradox is a safe and efficient method to perform MUA for the management of frozen shoulder. The technique is associated with improvements in range of motion, improvements in functional outcomes, and high patient satisfaction as early as 3 weeks postoperatively.

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