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Updated: Jul 12, 2026

Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder
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Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder

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Manipulation Under Anesthesia With vs Without Intra-Articular Corticosteroid Injection for Frozen Shoulder: A

Marc Boutros1, Guy Awad1, Zina Smadi2

  • 1Faculty of Medicine, Saint Joseph University, Damascus Road, 1107 2180, Beirut, Lebanon.

Orthopaedics & Traumatology, Surgery & Research : OTSR
|July 10, 2026
PubMed
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Adding corticosteroid injections to manipulation under anesthesia (MUA) for adhesive capsulitis significantly improved external rotation (ER) but not pain or other movements. MUA without steroids is a viable option, especially when ER is not the primary goal.

Area of Science:

  • Orthopedics
  • Sports Medicine
  • Physical Therapy

Background:

  • Adhesive capsulitis (frozen shoulder) causes significant shoulder pain and stiffness.
  • Manipulation under anesthesia (MUA) is a common treatment when conservative methods fail.
  • The role of peri-procedural corticosteroid injections with MUA is not well-defined.

Purpose of the Study:

  • To evaluate the effectiveness of adding corticosteroid injections to MUA for adhesive capsulitis.
  • To compare outcomes of MUA with versus without corticosteroid injections.

Main Methods:

  • Systematic literature search of major databases (PubMed, Scopus, Cochrane, Google Scholar).
  • Included 3 randomized trials (RCTs) and 2 observational cohorts.
  • Assessed pain (VAS) and range of motion (ROM) including forward flexion (FF), abduction, external rotation (ER), and internal rotation (IR).
Keywords:
Capsular restriction pattern (rotator interval/anterior-inferior capsule/capsular edema/compliance)Post-MUA clinical outcomes (Visual Analog Scale/forward flexion/abduction/external rotation/internal rotation)Post-MUA rehabilitation (physiotherapy/home exercises/capsular remodeling)Primary stiff shoulder (capsular contracture syndrome/freezing/frozen/thawing phases)Safety profile (shoulder dislocation/post-injection flare/hyperglycemia/cartilage toxicity)Steroid regimen (triamcinolone/methylprednisolone/betamethasone/lidocaine/injection approach)

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Main Results:

  • No significant differences in pain, FF, abduction, or IR between MUA with or without corticosteroids in pooled analysis.
  • Corticosteroids significantly improved ER (MD=6.90; p<0.001) in pooled analysis.
  • RCT sensitivity analysis confirmed ER improvement (MD=7.73; p<0.001) and suggested FF benefit (MD=9.05; p=0.004).

Conclusions:

  • Corticosteroid injections enhance ER recovery following MUA for adhesive capsulitis.
  • No significant benefit for pain relief or most other motion planes was observed.
  • Selective corticosteroid use may be beneficial when ER improvement is a priority; MUA alone is a reasonable alternative.