(Kiosk 2) Frozen Shoulder Treated with Intra-articular Steroid Injection and Manipulation Under Local Anesthesia

Case Diagnosis: Frozen shoulder successfully treated with intra articular injection and manipulation under local anesthesia

Case Description or Program Description: Patient is a 65 year old male with past medical history of diabetes, HTN, HLD who was admitted for rehabilitation after a prolonged hospitalization from Covid. Patient’s hospital course was complicated by necrotizing fasciitis of the sacrum, diabetic ketoacidosis, sepsis, hospital acquired pneumonia and critical illness myopathy. On admission to rehabilitation, the patient was noted to have trace strength in proximal muscle groups. Patient noted significant pain in the right shoulder and limited passive range of motion to 0 degrees external rotation and 20 degrees abduction. Patient underwent an intra-articular steroid injection with high volume lidocaine (9cc 1% lidocaine and 1cc Kenalog 40mg/mL). After waiting 10 minutes, the patient’s shoulder was passively ranged to over 100 degrees of abduction and 30 degrees of external rotation. During the procedure, audible release of scar tissue was noted and patient endorsed no pain. At re-evaluation in 1 week, patient was able to abduct the shoulder to 80 degrees and at follow up 6 weeks after the procedure he was able to actively obtain 110 degrees of abduction and 30 degrees of external rotation with minimal pain.

Setting: Inpatient Rehabilitation

Assessment/Results: Patient gained significant range of motion in abduction and external rotation with reduction in pain.

Discussion (relevance): Frozen shoulder is a painful condition that has been successfully treated with manipulation under anesthesia and intra-articular injections. Limited data exists for treatment of frozen shoulder with manipulation under local anesthesia. This approach allows for easier access to treatment, less side effects of general anesthesia and potentially less damage to surrounding structures.

Conclusions: Manipulation under local anesthesia may represent an alternative treatment to manipulation under general anesthesia. Additional research is warranted to investigate the safety and efficacy of the treatment.