Last Updated: Monday, February 4, 2013
Examination under anesthesia (EUA) may be helpful in the evaluation and management of a frozen shoulder by enabling the joint to be moved while the muscles are completely relaxed.
Stretching and evaluating shoulder tightness
Under these circumstances the tightness of the capsule of the joint can be evaluated and gently stretched. Before proceeding it is important that the surgeon and patient agree on a plan if good motion is not achieved with manipulation. One option is to return to the exercise program; another is to proceed to a surgical release during the same anesthetic.
The examination is performed under a brachial plexus block or under general anesthesia with total muscle relaxation.
Prolonged analgesia
The brachial plexus block provides prolonged analgesia which greatly facilitates the patient's ability to continue the range of motion program during the critical 12 hours after the procedure.
In the examination gentle forces are applied in forward flexion cross body adduction internal rotation and external rotation. Sometimes a gentle examination may produce lysis of essentially all the restrictions to motion. At other times the examination may reveal firm blocks to motion that do not yield with the application of small forces; if so it is time to go to "plan B." If freedom of motion is achieved by manipulation continuous passive motion (see figure) is instituted in the recovery room.
Benefits of continuous passive motion
The immediate institution of continuous motion has two important benefits:
- it influences the early phases of the healing process in a direction which encourages motion and discourages adhesions and
- it enables the patient to wake up from the anesthetic seeing the shoulder in motion.
As soon as possible after the procedure the patient resumes the stiff shoulder exercises.
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Figure 1 - Continuous passive motion machine
