Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review

It is currently unclear as to whether there is a difference in the clinical effectiveness of an arthroscopic capsular release compared to a manipulation under anaesthesia (MUA) in patients with recalcitrant idiopathic adhesive capsulitis.

A systematic review was performed using computerized keyword searches of MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Two reviewers independently performed searches and article reduction. Studies that reported outcomes data following either a manipulation under regional or general anaesthesia or an arthroscopic capsular release in patients with idiopathic adhesive capsulitis were included. Data on clinical measures of shoulder range of motion and subjective outcome measures were extracted and summarized.

Twenty-two studies (21 studies provided level IV evidence) including 989 patients were included resulting in a comparison of 9 MUA and 17 capsular release groups. Patients were 60% female with a median age of 52 years old (range, 24-91 years). Median duration of symptoms and follow-up were 9 months (range, 3-50) and 35 months (range, 3-189), respectively. There were minimal differences in the median changes in abduction, flexion, and external rotation range of motion (ROM), and final Constant score between the MUA and capsular release groups.

The quality of evidence available is low and the data available demonstrate little benefit for a capsular release instead of, or in addition to, an MUA. A high quality study is required to definitively evaluate the relative benefits of these procedures.