Can manipulation under anesthesia alone provide clinical outcomes similar to arthroscopic circumferential capsular release in primary frozen shoulder (FS)?: the necessity of arthroscopic capsular release in primary FS

Abstract

Background: We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). Methods: We assessed patients with refractory primary FS, 54 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Society score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection.Results: Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics.Conclusions: MUA alone can yield similar clinical outcomes to ACR in refractory FS.

Trends in Practice Among Shoulder Specialists in the Management of Frozen Shoulder: A Consensus Survey

“…However, the literature disagrees with this statement, as most studies have confirmed similar treatment outcomes with both options. 36,53…”

“…However, the literature disagrees with this statement, as most studies have confirmed similar treatment outcomes with both options. 36,53 Although the 2 groups strongly agreed that either surgical intervention should be done between 4 and 9 months, the groups remained almost equally divided on whether intervention should occur early (4-6 months) or late (7-9 months). Although most of the literature supports surgical treatment between 6 and 9 months, 52,54 a recent study concluded that the results of surgery before 6 months (mean, 3.8 months) or after 6 months (mean, 11.1 months) are similar.…”

Clinical Guidelines in the Management of Frozen Shoulder: An Update!

“…The authors prefer to inject 40 mg of triamcinolone and 10 ml of 0.25% Bupivacaine to minimise postoperative pain and inflammation. Many other authors too prefer post MUA injection of steroid and local anaesthetic agent [83,84]. However, concrete evidence for the benefit of the same is lacking.…”

“…Post MUA or ACR, authors prefer to inject 40 mg of Triamcinolone along with 10 ml of 0.25% Bupivacaine to minimise post-procedure inflammation and pain. Although many authors prefer injecting steroid post-ACR [83,[104][105][106], only a few report superior outcome after the injection [106]. However, larger consensus regarding utility of steroid injection post-ACR is lacking.…”

“…The PT program should consist of early passive and active-assisted ROM along with scapula stabilisation followed by active ROM combined with strengthening exercises for rotator cuff, scapular muscles, and core rehabilitation. 4 Arthroscopic view (from anterior portal) of inflamed synovium-capsule over the infraspinatus MUA vs. ACR: Despite all said advantages of ACR over MUA, literature has failed to prove clinical superiority of ACR over MUA [28,83,97]. A recently published triple arm pragmatic superiority randomised controlled trial by Rangan et al concluded that PT, MUA and ACR are not superior to each other in treatment of resistant FS [28].…”