Comparative Efficacy of Manipulation Under Anaesthesia Versus Arthroscopic Capsular Release in Primary Frozen Shoulder: A Prospective Randomized Study.

Introduction: Adhesive capsulitis, commonly known as frozen shoulder (FS), is a disabling condition marked by progressive restriction in shoulder mobility and pain. It is frequently linked with metabolic disorders such as diabetes and thyroid dysfunction. While many patients respond favorably to conservative therapies, a proportion remains unresponsive and requires surgical intervention. Materials and Methods: This prospective, randomized study was conducted in the Department of Orthopaedics at Jajati Kesari Medical College and Hospital, Jajpur, Odisha, from March 02, 2023, to March 02, 2024. A total of 30 patients (16 females, 14 males; aged 45-65 years) diagnosed with primary refractory FS were enrolled. All patients underwent pre-operative magnetic resonance imaging to validate the diagnosis and rule out any coexisting pathology. Participants were randomly assigned into two groups using a computer-generated sequence: Group 1 underwent Manipulation Under Anesthesia (MUA) (n = 15; 10 diabetic, 5 non-diabetic), and Group 2 underwent Arthroscopic Capsular Release (ACR) (n = 15; 12 diabetic, 3 non-diabetic). Clinical outcomes were assessed using the Visual Analog Scale for pain, the American Shoulder and Elbow Surgeons and Constant scores for shoulder function, and measurements of range of motion (ROM), including abduction, forward flexion, external rotation, and internal rotation. Assessments were performed at baseline, 1 week, 3 months, 6 months, and 1-year post-intervention. Results: Both MUA and ACR produced significant improvements in pain, ROM, and functional scores over the follow-up period. Although the MUA group demonstrated slightly faster early gains, long-term outcomes were comparable between groups. Notably, complications were observed in the MUA group (three cases: mild capsular tear, labral tear, and rotator cuff tendinitis) compared with one minor complication (bone bruising) in the ACR group. Conclusion: Both MUA and ACR are effective in improving pain, ROM, and shoulder function in patients with refractory FS. With similar long-term outcomes, MUA's simplicity and cost-effectiveness support its role as a first-line intervention, while the controlled release offered by ACR may be advantageous in select cases. Further large-scale studies are warranted to optimize treatment protocols.