Background Manipulation under anaesthesia and arthroscopic capsular release are costly and invasive treatments for frozen shoulder, but their effectiveness remains uncertain. We compared these two surgical interventions with early structured physiotherapy plus steroid injection. MethodsIn this multicentre, pragmatic, three-arm, superiority randomised trial, patients referred to secondary care for treatment of primary frozen shoulder were recruited from 35 hospital sites in the UK. Participants were adults (≥18 years) with unilateral frozen shoulder, characterised by restriction of passive external rotation (≥50%) in the affected shoulder. Participants were randomly assigned (2:2:1) to receive manipulation under anaesthesia, arthroscopic capsular release, or early structured physiotherapy. In manipulation under anaesthesia, the surgeon manipulated the affected shoulder to stretch and tear the tight capsule while the participant was under general anaesthesia, supplemented by a steroid injection. Arthroscopic capsular release, also done under general anaesthesia, involved surgically dividing the contracted anterior capsule in the rotator interval, followed by manipulation, with optional steroid injection. Both forms of surgery were followed by postprocedural physiotherapy. Early structured physiotherapy involved mobilisation techniques and a graduated home exercise programme supplemented by a steroid injection. Both early structured physiotherapy and postprocedural physiotherapy involved 12 sessions during up to 12 weeks. The primary outcome was the Oxford Shoulder Score (OSS; 0-48) at 12 months after randomisation, analysed by initial randomisation group. We sought a target difference of 5 OSS points between physiotherapy and either form of surgery, or 4 points between manipulation and capsular release. The trial registration is ISRCTN48804508.

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Su m m ary. The paper deals w ith choice and con strain t in ethnic m in ority housing in Britain . It argu es that the interp retation of pattern s has ch anged from one in which m inorities were view ed as powerless victim s of racist d iscrim inatory con strain t, to one in which they are seen as exercisin g a greater degree of autonom y. In dian and P ak istan i h ousing tenu re is shown to have great sim ilarities in term s of own er-occu pation but to diverge greatly in term s of hou se type and location . Banglad eshis and Carib bean s are shown to share sim ilarities in term s of socioeco nom ic class and housing tenure pattern s, but to differ stron gly in term s of the reason s for their high con centration s in cou n cil housing and also in the location s in which they live an d their tren ds in term s of segregat ion. Banglad eshis and P ak istan is are shown to h ave sim ilar socioeco nom ic pro® les, but to differ in tenure and house typ es. In dians, Pakistan is an d Banglad eshis are shown to have sim ilar fam ily stru ctures but to differ in hou se types. The housing pattern s of In dians, P akistan is, Banglad eshis and Carib b ean s in Britain owe m ore to ethn icity an d culture than to race.

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