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

Mattia Salomon (), Chiara Pastore, Filippo Maselli, Mauro Di Bari, Raffaello Pellegrino and Fabrizio Brindisino
Additional contact information
Mattia Salomon: Department of Clinical Science and Translational Medicine, University of Roma “Tor Vergata”, 00133 Rome, Italy
Chiara Pastore: Department of Clinical Science and Translational Medicine, University of Roma “Tor Vergata”, 00133 Rome, Italy
Filippo Maselli: Department of Human Neurosciences, University of Roma “Sapienza”, 00185 Rome, Italy
Mauro Di Bari: Research Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence, 50121 Florence, Italy
Raffaello Pellegrino: Antalgic Mini-Invasive and Rehab-Outpatients Unit, Department of Medicine and Aging Sciences, University “G. D’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
Fabrizio Brindisino: Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, “Cardarelli Hospital”, 86100 Campobasso, Italy

IJERPH, 2022, vol. 19, issue 15, 1-23

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.

Keywords: adhesive capsulitis; frozen shoulder; frozen shoulder contracture syndrome; manipulation under anesthesia; physiotherapy; systematic review (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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