Medical versus surgical management of frozen shoulder: a prospective observational comparative study at 6 months

Aditya Shankar Jena; Pradeep Kocheeppan; Santosh Raju Kumar; Amal S. Plackiel

doi:10.18203/issn.2455-4510.IntJResOrthop20263266

Authors

Aditya Shankar Jena Department of Orthopaedics, Apollo Hospitals, Bannerghatta Road, Bengaluru, Karnataka, India
Pradeep Kocheeppan Department of Orthopaedics, Apollo Hospitals, Bannerghatta Road, Bengaluru, Karnataka, India
Santosh Raju Kumar Department of Orthopaedics, Apollo Hospitals, Bannerghatta Road, Bengaluru, Karnataka, India
Amal S. Plackiel Department of Orthopaedics, Apollo Hospitals, Bannerghatta Road, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263266

Keywords:

Adhesive capsulitis, Arthroscopic capsular release, Corticosteroid injection, Frozen shoulder, DASH, CMS

Abstract

Background: Frozen shoulder is characterized by pain and progressive restriction of shoulder movement. Conservative treatment is commonly used initially, whereas surgery is considered in selected patients with persistent or severe functional limitation. This study compared outcomes after medical and surgical management at 6 months.

Methods: This prospective observational study included 70 patients with frozen shoulder: 50 received corticosteroid injection with physiotherapy and 20 underwent arthroscopic capsular release followed by physiotherapy. Range of motion (ROM), Constant-Murley score (CMS), DASH score and patient satisfaction were assessed at baseline and 6 months.

Results: Both groups improved significantly at 6 months (p<0.001). CMS improvement was greater in the surgical group than in the medical group (43.05±11.95 vs 25.86±10.05; p<0.001), and DASH reduction was greater after surgery (-38.95±12.57 vs -29.48±13.26; p=0.010). Surgical treatment was associated with greater gains in flexion, abduction and external rotation and higher patient satisfaction (8.45±1.19 vs 6.42±1.16; p<0.001). Similar differences were observed in patients in the freezing and frozen stages.

Conclusions: Both modalities were associated with significant functional improvement at 6 months. In this non-randomized cohort, surgical management was associated with greater improvement in ROM and functional scores, particularly in patients with severe disease.

References

Millar NL, Meakins A, Struyf F, Elaine W, Abigail LC, Paul DK, et al. Frozen shoulder. Nat Rev Dis Primers. 2022;8(1):59.

Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581.

Griesser MJ, Harris JD, Campbell JE, Jones GL. Adhesive capsulitis of the shoulder: a systematic review of the effectiveness of intra-articular corticosteroid injections. J Bone Joint Surg Am. 2011;93(18):1727-33.

Hsu J, Anakwenze O, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20(3):502-14.

Rangan A, Brealey SD, Keding A, Belen C, Matthew N, Lucksy K, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. Lancet. 2020;396(10256):977-89.

Gallacher S, Beazley J, Evans J, Rahul A, David S, Andrew R, et al. A randomized controlled trial of arthroscopic capsular release versus hydrodilatation in the treatment of primary frozen shoulder. J Shoulder Elbow Surg. 2018;27(8):1401-6.

Walther M, Blanke F, von Wehren L, Majewski M. Frozen shoulder-comparison of different surgical treatment options. Acta Orthop Belg. 2014;80(2):172-7.

Le Lievre HMJ, Murrell G. Long-term outcomes after arthroscopic capsular release for idiopathic adhesive capsulitis. J Bone Joint Surg Am. 2012;94(13):1208-16.

Minns Lowe CM, Barrett E, McCreesh K, de Burca N, Lewis JS. Clinical effectiveness of non-surgical interventions for primary frozen shoulder: a systematic review. J Rehabil Med. 2019;51(5):393-401.

Cho C, Kim DH, Lee YK. Serial comparison of clinical outcomes after arthroscopic capsular release for refractory frozen shoulder with and without diabetes. Arthroscopy. 2016;32(8):1515-20.

Grant JA, Schroeder N, Miller BS, Carpenter JE. Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review. J Shoulder Elbow Surg. 2013;22(8):1135-45.

Satora W, Brzóska R, Prill R, Paweł R, Łukasz O, Anna M, et al. Surgical versus nonsurgical multimodality treatment in an idiopathic frozen shoulder: a retrospective study of clinical and functional outcomes. J Clin Med. 2021;10(21):5185.

Salomon M, Pastore C, Maselli F, Mauro DB, Raffaello P, Fabrizio B. Manipulation under anesthesia versus non-surgical treatment for patients with frozen shoulder contracture syndrome: a systematic review. Int J Environ Res Public Health. 2022;19(15):9715.