Manipulation under Anesthesia versus Non-Surgical Treatment for Patients with Frozen Shoulder Contracture Syndrome: A Systematic Review

Abstract

Purpose: To investigate the efficacy of manipulation under anesthesia (MUA) compared to other non-surgical therapeutic strategies for patients with frozen shoulder contracture syndrome (FSCS). Methods: A systematic review of literature was conducted. A literature search was performed in MEDLINE, EMBASE, PEDro, Cochrane Central Library and Scopus. Only randomized controlled trials were included and assessed for critical appraisal through the Cochrane Collaborations tools. Results: Five randomized controlled trials were included. The overall risk of bias (RoB) was high in 4 out of 5 of the included studies. MUA was found to be not superior in terms of reduction of pain and improvement of function when compared to cortisone injections with hydrodilatation (mean regression coefficient MUA −2.77 vs. injection −2.75; 95% CI (−1.11 to 1.15)) and home exercise (mean difference 95% CI: 0.2 (−0.64 to 1.02)) in the short term (3 months), and cortisone injections with hydrodilatation (mean regression coefficient MUA 3.13 vs. injection 3.23; 95% CI (−0.90 to 1.11)) in the long term (>6 months). Moreover, if compared to structured physiotherapy, MUA highlighted a higher Oxford Shoulder Score at final 1-year follow up (mean difference 95% CI: 1.05 (−1.28 to 3.39); p = 0.38). Similar results were obtained for disability, with statistically no significant long-term (>12 months) differences between MUA and home exercise (mean difference 95% CI: 0 (−3.2 to 3.2)) or structured physiotherapy (mean difference 95% CI: −0.50 (−5.70 to 4.70); p = 0.85)). Only two trials reported adverse events. Conclusions: This review suggested that limited and inconsistent evidence currently exists on the efficacy of MUA compared to other non-surgical strategies in the management of patients with FSCS. Future research should focus on clinical trials with higher methodological quality.

A high level of scientific evidence is available to guide treatment of primary shoulder stiffness: The SIAGASCOT consensus

“…Manipulation under anaesthesia or nerve block is a low-cost procedure that significantly improves the ROM, pain and clinical scores from short to long term. However, no recommendation in favour of this procedure was produced, since controlled RCTs have not shown the superiority of manipulation under anaesthesia or nerve block over rehabilitative treatment and intra-articular corticosteroid injection [16,44] and clinical studies detected intra-articular injuries after this procedure [45,46].…”

“…An evidence-based conservative treatment period of 3-6 months Three is recommended before considering surgical intervention in cases of treatment failure. 16. Is there a superior surgical technique?…”

“…A broad body of evidence is available to suggest a combination of comprehensive strategies involving mobilisations, stretching and therapeutic exercise, which are indeed rarely provided in isolation in clinical practice, which was reflected in the results of this consensus education of caregivers and patients to a psychosocial approach in physiotherapy appears of utmost importance [13][14][15][16].…”

Physical Therapy in the Treatment of Adhesive Capsulitis of the Shoulder Joint

“…Дослідження ефективності МПА порівняно з іншими нехірургічними терапевтичними стратегіями (терапевтичні вправи, мануальна терапія, ін'єкції) для пацієнтів АКПС проведено у систематичному огляді M. Salomon та співавторів [22]. Дослідники встановили, що МПА не є кращими щодо зменшення болю та покращення функції порівняно з терапевтичними вправами, котрі виконувалися вдома, у короткостроковій перспективі (3 місяці).…”

“…З іншої сторони є висновки, котрі вказують на: відсутність ефективності за показниками болю в плечі або працездатності від додавання МПА до ФТ [21]; однакову ефективність МПА, терапевтичних вправ, структурованої ФТ щодо оцінок болю, інвалідності та функції [22]. Оцінка клінічної та економічної ефективності інвазивних і дорогих хірургічних втручань та ранньої структурованої ФТ (мобілізація та домашні терапевтичні вправи), котра була виконана у великому дослідженні, встановила відсутність переваг жодного підходу через 12 місяців від початку лікування за умови, що усі пацієнти отримували ін'єкцію стероїдів.…”