Featured ArticleManipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial
Section snippets
Patients and methods
The study cohort comprised 53 consecutive patients, aged 40 to 75 years, who presented to the upper limb service at the Royal Oldham Hospital with primary frozen shoulder. A closed envelope method was use to randomize patients to MUA or injection. The MUA group received treatment with a manipulation under general anesthesia, followed by physiotherapy as an outpatient. The injection group was treated by distension with local anaesthetic and a steroid, followed by physiotherapy. Ideally, the
Results
The MUA group contained 28 patients, of which 15 (54%) were women, with a median age of 56.5 years. The injection group contained 25 patients, of which 20 (80%) were women, with a median age of 57.0 years. The median duration of symptoms before presentation in the MUA group was 19 weeks compared with 16 weeks in the injection group, suggesting that most patients were in the “freezing” stage of the disease. The dominant limb was affected in 46% of the MUA group and in 24% of the injection group.
Discussion
In 1980 Thomas et al38 reported a study comparing treatment by MUA and steroid injection with steroid injection alone and showed that those who received MUA had a more rapid improvement in pain and function than those who did not. Gam et al12 had previously reported in their study comparing patients treated with either 6-week injections providing distension and steroid, or steroid alone, that those receiving distension gained a faster improvement in range of motion and reduction in pain. Thus
Conclusions
In view of the potential risks of an MUA and the relative ease and safety of steroid with distension injections, we recommend the use of these injections, rather than MUA and physiotherapy, as a first-line treatment for patients in the “freezing” phase of idiopathic (primary) frozen shoulder. Because the availability of hospital beds is universally becoming increasingly difficult, this outpatient mode of treatment also has obvious advantages in terms of health economics.
Acknowledgment
We would like to thank sincerely all the Specialist Registrars from the North-West Specialist Registrar rotation (United Kingdom) who helped the main author with conducting this study. Without their help this work would never had been completed. The study had Full Local Research and Ethical Committee approval from The Royal Oldham Hospital (ref: 3/96/1(a)). The authors are not aware of any conflicts of interest.
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