Frozen Shoulder: PT vs. Manipulation Under Anesthesia vs. Arthroscopic Capsular Release

Adhesive capsulitis aka “frozen shoulder” is a relatively common shoulder issue that tends to have poor outcomes in the medical field. The capsule of the shoulder joint becomes inflamed, then scarred and contracted, causing pain, stiffness, and loss of function. The treatments that are typically prescribed are PT, manipulation under anesthesia (MUA) and arthroscopic capsular release.

Aside from PT, the two other common treatments are aggressive and can be costly. Both procedures require sedation via anesthesia. Manipulation under anesthesia is when the surgeon manipulates the shoulder to stretch and tear the capsule, then a steroid injection is administered. Arthroscopic capsular release is surgically cutting/dividing the shoulder capsule, followed by a manipulation of the shoulder, and a possible steroid injection.

A massive article by Rangan et al. in October 2020 compared these 3 interventions to determine which is the most effective and cost efficient. 914 patients were screened, 503 patients were randomly assigned, 90 surgeons, 285 physical therapists, and 35 hospitals were a part of this study.

What were the findings?

“All mean differences on the assessment of shoulder pain and function (OSS) at the primary endpoint of 12 months were less than the target differences. Therefore, none of the three interventions were clinically superior.”

Well...that’s disappointing. If no treatment was better than the others, then what should we recommend?

My opinion is that physical therapy implemented early on with or without steroid injections is the way to go. Statistically, it is just as effective as surgery. However, you do not need to go through unnecessary costs and trauma from the anesthesia and surgery.

Physical therapy should include education on how to manage the condition, education on realistic outcomes and timeframes, manual therapy and exercises to improve mobility, exercises to address imbalances and strengthen the shoulder muscles to improve the ability to perform daily tasks, and addressing any possible complications or conditions (i.e. diabetes, cardiovascular disease, etc.).

Not every frozen shoulder should be treated with the exact same interventions.

Corey Hall, PT, DPT

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