Does capsular distension and a short period of countertraction improve outcome following manipulation under anesthesia for the treatment of primary adhesive capsulitis of the glenohumeral joint?

Background: Despite the fact that primary adhesive capsulitis of the glenohumeral joint is often considered a self-limiting condition, not all patients make a full recovery. Manipulation under anesthesia (MUA) is performed to forcibly rupture the contracted capsule in a controlled manner. However, the technique, timing, and use of additional injections are often debated. In this study, we report the outcomes following the addition of capsular distension and countertraction to MUA as a treatment for adhesive capsulitis.
Methods: We performed a retrospective case-cohort study comparing 3 groups: Group 1 underwent MUA alone (n = 54); group 2, MUA with capsular distension (n = 114); and group 3, MUA with capsular distension and countertraction (n = 167). The re-MUA rate, Constant-Murley shoulder (CMS) score, and visual analog scale (VAS) score (for pain) were measured after 6 weeks and 6 months.
Results: The re-MUA rate fell with the addition of both capsular distension and countertraction: 63% in group 1, 39% in group 2, and 18% in group 3. Patients in group 3 recorded the greatest improvement in the CMS score after 6 weeks (+90% vs. +68% in group 2 and +58% in group 1), with all groups showing improvements compared with before treatment. The only independent risk factor identified for re-MUA was smoking. If a second MUA was performed, the CMS (+67%) and VAS (+61%) scores improved, but at 6 months, the CMS score (74.57 ± 7.6 vs. 83.30 ± 5.5) and VAS score (10.57 ± 1.8 vs. 12.96 ± 1.5) remained inferior to those of patients who only needed a single MUA.
Discussion and Conclusion: MUA combined with capsular distension and countertraction reduces the need for a second MUA and results in a faster improvement in functional outcome (CMS score) and reduction of pain (VAS score) compared with MUA alone or MUA with capsular distension. The results of this case-cohort study are of clinical relevance because they show that the efficacy of an MUA can be improved through relatively simple adaptations of the treatment protocol.
(Copyright © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)