Early Clinical Outcomes of Manipulation under Anesthesia for Refractory Adhesive Capsulitis: Comparison with Arthroscopic Capsular Release

Abstract

Traditionally, adhesive capsulitis (AC) of the shoulder has been regarded as a self-limiting condition without significant long-term sequelae, lasting 18 or 30 months. However, several studies have reported long-term residual motion restriction and persisting symptoms in AC. 1,2) Reeves 1) reported that 50% of patients were still experiencing pain or stiffness of the shoulder at a mean of 7 years from the onset of the condition, although only 11% reported functional limitation. To decrease time to recovery and improve the outcomes, a variety of regimens have been used for the treatment of AC, which include nonsteroidal antiinflammatory drugs, local intra-articular steroid injection, physiotherapy, hydrodilation, manipulation under anesthesia (MUA), and arthroscopic capsular release (ACR). [3][4][5][6][7][8] Among these regimens, MUA has been the longstanding treatment for refractory AC. Numerous studies have reported this approach as a safe and effective treatment for reducing the duration of symptoms in patients with AC 3,6,[9][10][11][12][13][14][15] ; however, others have stated that MUA has no advantages compared with conservative treatment. [16][17][18] Also, the potential complications associated with this

Arthroscopic capsular release versus manipulation under anesthesia for primary frozen shoulder

“…Arthroscopic capsular release (ACR) and manipulation under anesthesia (MUA) are treatment options for primary frozen shoulder (FS). Both of these are useful for primary FS [ 1 - 3 ]. In addition, MUA is possible without the surgical equipment needed for an arthroscopic procedure.…”

“…In addition, MUA is possible without the surgical equipment needed for an arthroscopic procedure. The indications for the two procedures are not different, either [ 1 , 2 ].…”

“…Although MUA is an useful option for primary FS, several complications such as proximal humerus fracture, shoulder dislocation, brachial plexus stretching injury, rotator cuff injury, and glenoid fracture may result [ 1 - 3 , 5 ]. Therefore, MUA should be performed with great caution.…”

“…Therefore, the results of this study should be interpreted with caution. Another comparative study reported greater gain in range of motion in a MUA group compared to an ACR group [ 1 ]. According to a systemic review of 22 studies, which included 989 patients, there were minimal differences in shoulder range of motion or Constant score between MUA and ACR groups for treatment of refractory FS, and it concluded the data available demonstrate little benefit for ACR instead of, or in addition to, MUA [ 2 ].…”

“…MUA is more simple and easy than ACR because arthroscopic equipment is not necessary. However, MUA can lead to several serious complications [ 1 - 3 , 5 ]. If experienced surgeons perform ACR, it can be more safe than MUA.…”