Adhesive shoulder capsulitis: does the timing of manipulation influence outcome?

The purpose of this study was to assess the influence of timing of manipulation under anaesthesia for adhesive capsulitis of the shoulder on the long-term outcome. One hundred and eighty consecutive patients with a diagnosis of adhesive capsulitis according to Codman's criteria were selected from a shoulder surgery database; 145 were available for follow-up after a mean period of 62 months (range: 12 to 125). All patients underwent manipulation under anaesthesia (MUA) with intra-articular steroid injection. A statistically significant improvement in range of movement, function (Oxford Shoulder Score) (OSS) and Visual Analogue pain intensity Score (VAS) was obtained following manipulation. Ninety percent of the 145 patients who successfully completed the study were satisfied with the procedure. Eighty-nine percent indicated that they would choose the same procedure again, if the same problem arose in the opposite shoulder. Eighty-three percent of the patients had manipulation performed less than 9 months from onset of symptoms (early MUA). The remainder had manipulation performed after 9-40 months (late MUA). Patients who had early intervention had a significantly better Oxford Shoulder Score at final follow up; mobility and pain (VAS) were also letter than in the late group, but not significantly.