Manipulation or intra-articular steroids in the management of adhesive capsulitis of the shoulder? A prospective randomized trial

Background: The management of adhesive capsulitis (frozen shoulder) is controversial. The authors present a prospective randomized study comparing the outcome, at a two-year follow-up period, of two groups of patients treated either by manipulation of the shoulder under anaesthetic or by intra-articular shoulder injections using steroid with distension. Methods: Fifty-three patients suffering from Idiopathic "Primary" Frozen Shoulder were prospectively randomized into two treatment groups and followed up for two years from the start of treatment. Patients were assessed using the Constant score, a Visual Analogue Score, and the SF36 questionnaire. Results: No statistical differences were found between the two groups of patients with regards to the outcome measures. Conclusion: Treatment using steroid injections with distension as an out-patient is therefore recommended for the treatment of Idiopathic "Primary" Frozen Shoulder. This has the same clinical outcome as a manipulation under anaesthetic with less attendant risks. Level of evidence: Level 1; Randomized controlled trial, therapeutic study. (C) 2009 Journal of Shoulder and Elbow Surgery Board of Trustees.