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MUA with steroid injection superior to arthroscopic capsular release for frozen shoulder

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Manipulation under anesthesia offered improved outcomes and range of motion compared with arthroscopic capsular release, according to a study presented at the EFORT Congress.

“Manipulation under anesthesia (MUA) with steroid injection should be considered first in the management of frozen shoulder once conservative methods have failed to relieve symptoms,” Ahsan Akhtar, MD, of Leighton Hospital, Crewe, United Kingdom, said.

MUA with steroid injection and arthroscopic capsular release are common treatments for frozen shoulder. However, “there is no clear evidence in the literature as to which treatment method provides the best results for management of frozen shoulder,” Akhtar said. The aim of this prospective study, performed between March 2009 and November 2011, was to determine which procedure yielded superior results.

The researchers included 78 patients with idiopathic frozen shoulder who had failed functional recovery with physiotherapy. To participate, patients had to agree to perform postoperative therapy.

Akhtar and colleagues randomized patients into 2 groups. The 33 patients in group 1 underwent MUA with steroid injection; group 2 included 45 patients who underwent arthroscopic capsular release. A single surgeon performed all of the procedures, and an independent observer evaluated the results. The mean follow-up was 14.6 months.

Results showed that both procedures improved patient outcomes. Preoperatively, the mean Oxford Shoulder Score was 22.8 for group 1 and 24.2 for group 2. The postoperative Oxford scores improved to 44.1 for group 1 and 40.9 for group 2.

The mean preoperative QuickDASH score was 48.9 for both groups; postoperatively, that score improved to 9.8 in group 1 and 18.4 in group 2.

Analysis revealed that for both groups, mean range of motion improved flexion 170° ± 7°, abduction 172° ± 5°, external rotation 77° ± 7° and internal rotation T9 ± 1.

“Results reveal MUA gave a better outcome, regarding pain relief and function, and better improvement in range of motion compared to arthroscopic capsular release,” Akhtar said. “The evidence in the literature does report some good results both MUA and arthroscopic capsular release, but they have never been compared in this way before. As such, it is good to see that one is superior to the other on the basis of these results,” Akhtar said.

Reference:

Akhtar A. Paper #13-4762. Presented at: EFORT Congress. June 5-8, 2013; Istanbul.

Disclosure: Akhtar has no relevant disclosures.