A Prospective Study Comparing Arthroscopic Release, Intra-articular Steroid and Physical Therapy for Frozen Shoulder

Abstract

Introduction: Frozen shoulder or Adhesive Capsulitis (AC) is a painful condition with fibrotic and contracted shoulder joint capsule. There is a lack of development of an effective treatment protocol for idiopathic AC. Aim: To evaluate the relative efficacy of Arthroscopic Capsular Release (ACR) and intra-articular steroid injections compared to standard physical therapy in isolation for frozen shoulder. Materials and Methods: This prospective interventional study was conducted at Maulana Azad Medical College, New Delhi, India between October 2012 to October 2015. Patients older than 40 years of age, with symptoms of AC for at least six months, without any related trauma or surgery or uncontrolled diabetes mellitus, and who did not respond to the conservative treatment, were selected. Ten patients were recruited each in the ACR, intra-articular steroids injection, and physical therapy groups. Shoulder Range of Motions (ROM), and the pre and post-treatment Shoulder Rating Questionnaire (SRQ) scores were calculated. Data analysis was performed using a Statistical Package for the Social Sciences (SPSS version 17). Results: The sample consisted of 12 male (40%) and 18 female (60%) patients with an average age of 52.2 years. There was no difference between the groups as far as the demographic characteristics were concerned. The SRQ scores and ROM in all the groups registered significant improvement compared to their pretreatment levels with a p-value of less than 0.005 for all three groups. However, the relative efficacy of different modes of treatment i.e. ACR, intra-articular steroid injection, and physical therapy, were found to be similar (p-value 0.165). Conclusion: The ACR does not provide any significant advantage over less invasive treatment alternatives. Therefore the authors recommend ACR only as a last option where other less invasive treatment modalities have failed.