Related Experiment Video
Updated: Jul 12, 2026
Clinical Efficacy of Small Needle Knife Therapy on Stage I-II Frozen Shoulder
Published on: November 17, 2023
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.
Background:
Adhesive capsulitis is a common cause of shoulder pain and stiffness, and manipulation under anesthesia (MUA) is frequently used when conservative therapy fails. Corticosteroid injections are often added peri-procedurally to reduce inflammation and potentially enhance recovery, but the magnitude and consistency of their benefit remain unclear.
Methods:
A systematic search of PubMed, Scopus, Cochrane Library, and Google Scholar was performed through December 2025. Three randomized trials (RCTs) and two observational cohorts met inclusion criteria. Primary outcomes included VAS for pain and range of motion in forward flexion (FF), abduction, external rotation (ER), and internal rotation (IR). Pooled analyses including all studies were performed, followed by sensitivity analyses restricted to RCTs.
Results:
No significant differences were observed between MUA with versus without corticosteroid injection for pain (p = 0.35), FF (p = 0.12), abduction (p = 0.28), or IR (p = 0.25). However, corticosteroid use was associated with a significant improvement in ER (MD = 6.90; 95% CI 5.05-8.75; p < 0.001). In sensitivity analyses restricted to RCTs, ER remained significantly improved (MD = 7.73; 95% CI 5.26-10.21; p < 0.001), abduction and IR remained non-significant (p > 0.05), and FF became significantly greater in the steroid group (MD = 9.05; 95% CI 2.84-15.25; p = 0.004).
Conclusion:
Adding an intra-articular corticosteroid injection to MUA was associated with improved ER recovery, while offering no significant advantage in pain relief or most other motion planes in the overall pooled analysis. Sensitivity analysis of RCTs supported the robustness of the ER finding and suggested a possible benefit for FF, although this should be interpreted cautiously. These findings support selective corticosteroid use when ER recovery is a primary goal, while MUA without corticosteroid injection remains a reasonable alternative. Further studies should evaluate standardized steroid protocols, phase-specific indications, and long-term functional outcomes.
Level Of Evidence:
II.
