Manipulation under Anesthesia versus Non-Surgical Treatment for Patients with Frozen Shoulder Contracture Syndrome: A Systematic Review

Purpose: To investigate the efficacy of manipulation under anesthesia (MUA) comparedto other non-surgical therapeutic strategies for patients with frozen shoulder contracture syndrome(FSCS). Methods: A systematic review of literature was conducted. A literature search was performedin MEDLINE, EMBASE, PEDro, Cochrane Central Library and Scopus. Only randomized controlledtrials were included and assessed for critical appraisal through the Cochrane Collaborations tools.Results: Five randomized controlled trials were included. The overall risk of bias (RoB) was high in 4out of 5 of the included studies. MUA was found to be not superior in terms of reduction of painand improvement of function when compared to cortisone injections with hydrodilatation (meanregression coefficient MUA 􀀀2.77 vs. injection 􀀀2.75; 95% CI (􀀀1.11 to 1.15)) and home exercise(mean difference 95% CI: 0.2 (􀀀0.64 to 1.02)) in the short term (3 months), and cortisone injectionswith hydrodilatation (mean regression coefficient MUA 3.13 vs. injection 3.23; 95% CI (􀀀0.90 to 1.11))in the long term (>6 months). Moreover, if compared to structured physiotherapy, MUA highlighteda higher Oxford Shoulder Score at final 1-year follow up (mean difference 95% CI: 1.05 (􀀀1.28 to3.39); p = 0.38). Similar results were obtained for disability, with statistically no significant long-term(>12 months) differences between MUA and home exercise (mean difference 95% CI: 0 (􀀀3.2 to 3.2))or structured physiotherapy (mean difference 95% CI: 􀀀0.50 (􀀀5.70 to 4.70); p = 0.85)). Only twotrials reported adverse events. Conclusions: This review suggested that limited and inconsistentevidence currently exists on the efficacy of MUA compared to other non-surgical strategies in themanagement of patients with FSCS. Future research should focus on clinical trials with higher methodological quality.