Thawing the frozen shoulder. A randomised trial comparing manipulation under anaesthesia with hydrodilatation.

This study prospectively evaluated the outcome of manipulation under anaesthesia and hydrodilatation as treatments for adhesive capsulitis. A total of 36 patients (38 shoulders) were randomised to receive either method, with all patients being treated in stage II of the disease process. The mean age of the patients was 55.2 years (44 to 70) and the mean duration of symptoms was 33.7 weeks (12 to 76). Eighteen shoulders (17 patients) underwent manipulation under anaesthesia and 20 (19 patients) had hydrodilatation. There were three insulin-dependent diabetics in each group. The mean visual analogue score in the manipulation under anaesthesia group was 5.7 (3 to 8.5; n = 18) before treatment, 4.7 (0 to 8.5; n = 16) at two months (paired t-test p = 0.02), and 2.7 (0 to 9; n = 16) at six months (paired t-test, p = 0.0006). The mean score in the hydrodilatation group was 6.1 (4 to 10; n = 20) before treatment, 2.4 (0 to 8; n = 18) at two months (paired t-test, p = 0.001), and 1.7 (0 to 7; n = 18) at six months (paired t-test, p = 0.0006). The visual analogue scores in the hydrodilatation group were significantly better than in the manipulation under anaesthesia group over the six-month follow-up period (p < 0.0001). The mean Constant score in those manipulated was 36 (26 to 66) before treatment, 58.5 (24 to 90) at two months (paired t-test, p = 0.001) and 59.5 (23 to 85) at six months (paired t-test, p = 0.0006). In the hydrodilatation group it was 28.8 (18 to 55) before treatment, 57.4 (17 to 80) at two months (paired t-test, p = 0.0004) and 65.9 (28 to 92) at six months (paired t-test, p = 0.0005). The Constant scores in the hydrodilatation group were significantly better than in the manipulated group over the six-month period of follow-up (p = 0.02). The range of movement improved in all patients over the six months, but was not significantly different between the groups. At the final follow-up, 94% of patients (17 of 18) were satisfied or very satisfied after hydrodilatation compared with 81% (13 of 16) of those receiving a manipulation. Most of our patients were treated successfully, but those undergoing hydrodilatation did better than those who were manipulated.

De la Caffinière thumb carpometacarpal replacements. 93 cases at 6 to 16 years follow-up.

The results of 93 de la Caffinière thumb joint replacements in 71 patients were reviewed between 6 and 16 years. The survival rate was 89% at 16 years. Eleven thumb joints had failed requiring revision. The commonest reason for failure was aseptic loosening of the trapezial component. The failure rate was higher in men of working age than any other group, which possibly reflects the increased demands on the prosthesis of these patients. We support the use of this implant for degenerative osteoarthritis, but caution against its use in men under 65 years.

Condensing osteitis of the medial clavicle--an intermediate-term follow-up.

INTRODUCTION: Condensing osteitis of the clavicle is a benign idiopathic condition affecting the medial end of the clavicle, and is characterised by sclerosis and expansion of the clavicular head. MATERIALS AND METHODS: Nine cases of condensing osteitis were reviewed. Their mean age was 37 years (range, 22 to 65 years). All patients presented with pain and swelling localised to the sternoclavicular region. The mean length of follow-up was 38 months (range, 9 to 77 months). RESULTS: At latest follow-up, all patients had subjective improvement in their pain symptoms, but none had any subjective decrease in the swelling around the medial clavicle. Follow-up computerised tomography (CT) scans were available for analysis in 5 patients. CONCLUSION: The results of this study show that in the intermediate term at least, the severity of the pain appears to improve with time, although the clinical swelling over the medial clavicle does not resolve significantly. Longer follow-up will further define the long-term natural history of this rare condition.

De la Caffinière thumb trapeziometacarpal joint arthroplasty: 16-26 year follow-up.

Seventy-one patients (93 implants) had a de la Caffinière prosthesis implanted between 1980 and 1989 and were reviewed and reported in 1997. We reviewed this series 10 years later. Similar outcome measures were used as in the original study, pinch and grip strength measured and validated outcome scores obtained (DASH and EQ-5D). Radiographic outcome was assessed. Twenty-six patients with 39 implants were available for review at a mean of 19 years (range, 16-26 years). Survivorship at 26 years was 73.9% (95% CI, 61.2 to 86.6) for re-operation and 26.0% (95% CI, 0 to 52.7) for all failure. Patients had satisfactory power and thumb mobility and continued to be satisfied without pain. Registries should log such prostheses and add to implant survival data.