Comparison of arthroscopic capsule release and manipulation under anaesthesia for frozen shoulder: a prospective randomized single blinded interventional study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252638Keywords:
Adhesive capsulitis, Arthroscopic capsular release, Frozen shoulder, Functional outcomes, Manipulation under anaesthesia, Orthopaedics, Pain relief, Range of motion, Rehabilitation, Shoulder painAbstract
Background: Adhesive capsulitis (frozen shoulder) is a common cause of shoulder pain, affecting approximately 2% of the population. Despite its prevalence, the exact aetiology remains unclear, leading to varied treatment protocols. Among the available interventions, manipulation under anaesthesia (MUA) and arthroscopic capsular release (ACR) are widely used for refractory cases, though comparative data on their outcomes are limited. Aim: To compare early clinical outcomes, complications and pain relief between MUA and ACR in patients with refractory adhesive capsulitis.
Methods: A prospective, randomized, single-blinded study was conducted from November 2020 to April 2022 at a tertiary care hospital. Forty-four patients with refractory adhesive capsulitis were randomized into two groups: MUA (n=22) and ACR(n=22). Preoperative evaluations included clinical and ultra-sonographic examinations. Postoperative outcomes were assessed at 2, 4 and 12 weeks using the Visual Analogue Scale (VAS), Oxford Shoulder Score (OSS) and range of motion (ROM) measurements.
Results: Both groups demonstrated significant improvements in pain and ROM. However, ACR yielded superior results, with a greater reduction in VAS scores (8 to 1in ACR vs. 8 to 3 in MUA) and better ROM at 12 weeks. Forward flexion improved from80º to 180º in the ACR group, compared to 70º to 170º in the MUA group. External and internal rotation improvements were also significantly greater in the ACR group.
Conclusions: Arthroscopic capsular release, combined with an exercise regimen, provides significantly better pain relief and functional recovery compared to MUA in refractory adhesive capsulitis.
Metrics
References
Green S, Buchbinder R, Hetrick S. Physiotherapy interventions for shoulder pain. Cochrane Database Syst Rev. 2003;2:4258. DOI: https://doi.org/10.1002/14651858.CD004016
Neviaser JS. Adhesive capsulitis of the shoulder: a study of the pathological findings in periarthritis of the shoulder. J Bone Joint Surg Am. 1945;27(2):211-22.
Shaffer B, Tibone JE, Kerlan RK. Frozen shoulder: A long-term follow-up. J Bone Joint Surg Am.1992;74(5):738–46. DOI: https://doi.org/10.2106/00004623-199274050-00013
Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20(3):502–14. DOI: https://doi.org/10.1016/j.jse.2010.08.023
Aydeniz A, Gursoy S, Guney E. Which musculoskeletal complications are most frequently seen in type2 diabetes mellitus. J Int Med Res. 2008;36(3):505–8. DOI: https://doi.org/10.1177/147323000803600315
Panchal DN, Eapen C. Moist heat in treatment of frozen shoulder. Sci J. 2015;7(14):6.
Milgrom C, Novack V, Weil Y, Jaber S, Radeva-Petrova DR, Finestone A. Risk factors for idiopathicfrozen shoulder. Isr Med Assoc J. 2008;10(5):361–4.
Neviaser RJ, Neviaser TJ. The frozen shoulder: Diagnosis and management. Clin Orthop Relat Res.1987;(223):59–64. DOI: https://doi.org/10.1097/00003086-198710000-00008
Dias R, Cutts S, Massoud S. Frozen shoulder. BMJ. 2005;17;331(7530):1453–6. DOI: https://doi.org/10.1136/bmj.331.7530.1453
Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis: A prospective functional outcome study of no operative treatment. J Bone Joint Surg Am. 2000;82(10):1398–407. DOI: https://doi.org/10.2106/00004623-200010000-00005
Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4(4):193–6. DOI: https://doi.org/10.3109/03009747509165255
Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231–6. DOI: https://doi.org/10.1016/j.jse.2007.05.009
Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surg. 2011;19(9):536–42. DOI: https://doi.org/10.5435/00124635-201109000-00004
Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med. 2008;23(4):180–9. DOI: https://doi.org/10.1007/s12178-008-9031-6
Brand RA. 50 years ago in CORR. Clin Orthop Relat Res. 2008;466(3):754–5. DOI: https://doi.org/10.1007/s11999-008-0321-5
D’Orsi GM, Via AG, Frizziero A, Oliva F. Treatment of adhesive capsulitis: A review. Muscles Ligaments Tendons J. 2012;10(2):70–8.
Kivimäki J, Pohjolainen T, Malmivaara A, Kannisto M, Guillaume J, Seitsalo S, et al. Manipulation under anaesthesia with home exercises versus home exercises alone in the treatment of frozen shoulder: A randomized, controlled trial with 125 patients. J Shoulder Elbow Surg. 2007;16(6):722–6. DOI: https://doi.org/10.1016/j.jse.2007.02.125
Dodenhoff RM, Levy O, Wilson A, Copeland SA. Manipulation under anaesthesia for primary frozen shoulder: Effect on early recovery and return to activity. J Shoulder Elbow Surg. 2000;9(1):23–6.
Magnussen RA, Taylor DC. Glenoid fracture during manipulation under anaesthesia for adhesive capsulitis: A case report. J Shoulder Elbow Surg. 2011;20(3):23-6. DOI: https://doi.org/10.1016/j.jse.2010.11.024
Dodenhoff RM, Levy O, Wilson A, Copeland SA. Manipulation under anesthesia for primary frozenshoulder: Effect on early recovery and return to activity. J Shoulder Elbow Surg. 2000;9(1):23–6. DOI: https://doi.org/10.1016/S1058-2746(00)90005-3
Jerosch J, Nasef NM, Peters O, Mansour AMR. Mid-term results following arthroscopic capsularrelease in patients with primary and secondary adhesive shoulder capsulitis. Knee Surg SportsTraumatol Arthrosc. 2013;21(5):1195–202. DOI: https://doi.org/10.1007/s00167-012-2124-1
Smith CD, Hamer P, Bunker TD. Arthroscopic capsular release for idiopathic frozen shoulder withintra-articular injection and a controlled manipulation. Ann R Coll Surg Engl. 2014;96(1):55–60. DOI: https://doi.org/10.1308/003588414X13824511650452
Le Lievre HMJ, Murrell GAC. Long-term outcomes after arthroscopic capsular release for idiopathicadhesive capsulitis. J Bone Joint Surg Am. 2012;94(13):1208–16. DOI: https://doi.org/10.2106/JBJS.J.00952
Mubark IM, Ragab AH, Nagi AA, Motawea BA. Evaluation of the results of management of frozenshoulder using the arthroscopic capsular release. Ortop Traumatol Rehabil. 2015;17(1):21–8. DOI: https://doi.org/10.5604/15093492.1143530
Namdari S, Yagnik G, Ebaugh DD, Nagda S, Ramsey ML, Williams GR, et al. Defining functionalshoulder range of motion for activities of daily living.J Shoulder Elbow Surg. 2012;21(9):1177–83. DOI: https://doi.org/10.1016/j.jse.2011.07.032
Gill H, Gustafsson L, Hawcroft L, McKenna K. Shoulder joint range of motion in healthy adults aged20to 49 years. Br J Occup Ther. 2006;69(12):556–61. DOI: https://doi.org/10.1177/030802260606901204