Published online May 18, 2017. doi: 10.5312/wjo.v8.i5.394
Peer-review started: October 15, 2016
First decision: December 15, 2016
Revised: January 26, 2017
Accepted: February 18, 2017
Article in press: February 20, 2017
Published online: May 18, 2017
To compare the results of arthroscopic capsular release with intra-articular steroid injections in patients of frozen shoulder.
Fifty-six patients with frozen shoulder were randomised to one of two treatment groups: Group 1, complete 360 degree arthroscopic capsular release and group 2, intra-articular corticosteroid injection (40 mg methyl prednisolone acetate). Both groups were put on active and passive range of motion exercises following the intervention. The outcome parameters were visual analogue scale (VAS) score for pain, range of motion and Constant score which were measured at baseline, 4, 8, 12, 16 and 20 wk after intervention.
All the parameters improved in both the groups. The mean VAS score improved significantly more in the group 1 as compared to group 2 at 8 wk. This greater improvement was maintained at 20 wk with P value of 0.007 at 8 wk, 0.006 at 12 wk, 0.006 at 16 wk and 0.019 at 20 wk. The Constant score showed a more significant improvement in group 1 compared to group 2 at 4 wk, which was again maintained at 20 wk with P value of 0.01 at 4, 8, 12 and 16 wk. The gain in abduction movement was statistically significantly more in arthroscopy group with P value of 0.001 at 4, 8, 12, 16 wk and 0.005 at 20 wk. The gain in external rotation was statistically significantly more in arthroscopy group with P value of 0.007 at 4 wk, 0.001 at 8, 12, and 16 wk and 0.003 at 20 wk. There was no statistically significant difference in extension and internal rotation between the two groups at any time.
Arthroscopic capsular release provides subjective and objective improvement earlier than intra-articular steroid injection.
Core tip: The treatment of frozen shoulder is selected depending on the preference of the treating physician, since there are no guidelines or protocols. The physicians, physiotherapists, occupational therapists and orthopedicians who are not trained in shoulder arthroscopy often select non-surgical methods. On the other hand, shoulder arthroscopists prefer arthroscopic arthrolysis. We conducted a randomised clinical trial to compare the results of arthroscopic arthrolysis and intra-articular steroid injection in frozen shoulder. Both modalities resulted in significant improvement in pain, range of motion and Constant score. However the improvement in surgery group preceded those in injection group by 4-8 wk.