Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 6 Issue 2

Arthroscopic Release Versus Manipulation Under Anesthesia for Frozen Shoulder - A Prospective Study

Amirrza Sadeghifar, Farshad Zanderahimi, Alireza Sarhadi Zade, Maryam Aazami and Alireza Saied*

Kerman Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

*Corresponding Author: Alireza Saied, Kerman Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.

Received: November 22, 2022; Published: January 16, 2023


Introduction: Frozen shoulder is a painful condition of the joint for which surgery may be helpful when conservative treatment fails. In this prospective study, we compared two common methods of surgical treatment.

Patients and methods: Between April 2010 and March 2012, 54 patients with frozen shoulder were treated under anesthesia by one of the two methods of arthroscopic release and manipulation. The variables studied in the comparison were postoperative pain, ASES and SST scores, range of motion in different directions, and pain at the last post-surgery follow-up visit.

Results: All of the patients in the two groups had significant improvements in comparison to preoperative scores at a follow-up visit at least one year after surgery. The difference between the two groups was not significant in internal rotation, forward flexion, and pain at the final follow-up visit, but for the other variables, the arthroscopy group showed greater improvement. No statistically significant association was found among any of the variables considered in the comparison and diabetes, age, sex, and dominant limb involvement.

Conclusions: Based upon the findings of the present study it seems that both manipulation under anesthesia and arthroscopic release are effective treatments for frozen shoulder. However, arthroscopy was associated with less postoperative pain and greater improvement some parameters of range of shoulder motion, in comparison with manipulation under anesthesia. The results in diabetic patients were similar to those for nondiabetics in most respects.

Keywords: Anesthesia - Arthroscopy – diabetes - frozen shoulder –Manipulation.


  1. Kelley MJ., et al. “Frozen shoulder: evidence and a proposed model guiding rehabilitation”. Journal of Orthopaedic and Sports Physical Therapy 2 (2009): 135e148.
  2. Walker-Bone K., et al. “Prevalence and impact of musculoskeletal disorders of the upper limb in the general population”. Arthritis and Rheumatology 4 (2004): 642-651.
  3. Tighe CB., et al. “The prevalence of a diabetic condition and adhesive capsulitis of the shoulder”. Southern Medical Journal 6 (2008): 591e595.
  4. Pal B., et al. “Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus”. British Journal of Rheumatology 25 (1986): 147-151.
  5. Tasto JP and Elias DW. “Adhesive capsulitis”. Sports Medicine and Arthroscopy 4 (2007): 216-221.
  6. Hand C., et al. “Long-term outcome of frozen shoulder”. Journal of Shoulder and Elbow Surgery 2 (2008): 231-236.
  7. Tasto JP and Elias DW. “Adhesive capsulitis”. Sports Medicine and Arthroscopy 4 (2007): 216-221.
  8. Arslan S and Çeliker R. “Comparison of the efficacy of local corticosteroid injection and physical therapy for the treatment of adhesive capsulitis”. Rheumatology International 21 (2001): 20-23.
  9. Diercks RL and Stevens M. “Gentle thawing of the frozen shoulder: a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years”. Journal of Shoulder and Elbow Surgery 13 (2004): 499-502.
  10. Park KD., et al. “Treatment effects of ultrasound-guided capsular distension with hyaluronic acid in adhesive capsulitis of the shoulder”. Archives of Physical Medicine and Rehabilitation 2 (2013): 264-270.
  11. Jerosch J., et al. “Mid-term results following arthroscopic capsular release in patients with primary and secondary adhesive shoulder capsulitis”. Knee Surgery, Sports Traumatology, Arthroscopy 5 (2013): 1195-1202.
  12. Vastamäki H and Vastamäki M. “Motion and pain relief remain 23 years after manipulation under anesthesia for frozen shoulder”. Clinical Orthopaedics and Related Research 4 (2013): 1245-1250.
  13. Grant JA., et al. “Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review”. Journal of Shoulder and Elbow Surgery 8 (2013): 1135-1145.
  14. Pomeranz SJ and Modi N. “Adhesive capsulitis”. Journal of Surgical Orthopaedic Advances 2 (2014): 119-121.
  15. Lafosse L., et al. “Arthroscopic arthrolysis for recalcitrant frozen shoulder: a lateral approach”. Arthroscopy7 (2012): 916-923.
  16. Amir-Us-Saqlain H., et al. “Functional outcome of frozen shoulder after manipulation under anaesthesia”. Journal Of Pakistan Medical Association 57 (2007): 181-185.
  17. Birch R., et al. “Brachial plexus palsy after manipulation of the shoulder”. The Journal of Bone and Joint Surgery. British 1 (1991): 172.
  18. Loew M., et al. “Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia”. Journal of Shoulder and Elbow Surgery 14 (2005): 16-21.
  19. Gobezie R., et al. “Dislocation and instability after arthroscopic capsular release for refractory frozen shoulder”. American Journal of Orthopedics 36 (2007): 672-674.
  20. Miller RH., et al. “Shoulder and elbow injuries”. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopedics, 13th Philadelphia, Pennsylvania (2013): 2213 -2247.
  21. Nagy MT., et al. “The frozen shoulder: myths and realities”. The Open Orthopaedics Journal 7 (2013): 352-355.
  22. Lo SF., et al. “Diabetes mellitus and accompanying hyperlipidemia are independent risk factors for adhesive capsulitis: a nationwide population-based cohort study (version 2)”. Rheumatology International 1 (2014): 67-74.
  23. Cinar M., et al. “Comparison of arthroscopic capsular release in diabetic and idiopathic frozen shoulder patients”. Archives of Orthopaedic and Trauma Surgery 3 (2010): 401-406.
  24. Wang JP., et al. “Manipulation under anaesthesia for frozen shoulder in patients with and without non-insulin dependent diabetes mellitus”. International Orthopaedics 8 (2010): 1227-1232.
  25. Baums MH., et al. “Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis”. Knee Surgery, Sports Traumatology, Arthroscopy 15 (2007): 638-644.
  26. Chen J., et al. “Is the extended release of the inferior glenohumeral ligament necessary for frozen shoulder?” Arthroscopy 26 (2010): 529-535.


Citation: Alireza Saied., et al. “Arthroscopic Release Versus Manipulation Under Anesthesia for Frozen Shoulder - A Prospective Study”.Acta Scientific Orthopaedics 6.2 (2023): 41-47.


Copyright: © 2023 Alireza Saied., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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