# Short-term clinical efficacy of five-step manipulation under anaesthesia combined with arthroscopic shoulder surgery for adhesive capsulitis

## TL;DR

Combining arthroscopic surgery with shoulder manipulation provides better pain relief and function at 6 months compared to manipulation alone, but takes longer and costs more.

## Contribution

Demonstrates that combining arthroscopic capsular release with manipulation under anesthesia improves 6-month outcomes for adhesive capsulitis compared to manipulation alone.

## Key findings

- At 6 months, combined therapy showed significantly lower pain scores (VAS) than manipulation alone.
- Combined therapy resulted in higher ASES functional scores at 6 months compared to manipulation alone.
- Combined therapy increased operative time, hospital stay, and costs compared to manipulation alone.

## Abstract

To compare the short-term efficacy of arthroscopic capsular release combined with five-step manipulation under anaesthesia vs. five-step manipulation under anaesthesia alone for adhesive capsulitis.

This retrospective study included 66 patients assigned to arthroscopic capsular release (ACR) plus five-step manipulation under anaesthesia (MUA) (n = 31) or five-step MUA alone (n = 35); both cohorts received intra-articular “cocktail” irrigation. Outcome assessments comprised American Shoulder and Elbow Surgeons (ASES) scores and Visual Analogue Scale (VAS) pain scores at 1 week, 1 month, and 6 months post-operatively; peri-operative metrics included operative time, length of post-operative hospital stay, and total hospitalisation cost.

One week and one month post-operatively, VAS scores in the two groups were similar (P > 0.05). At 6 months, the treatment group exhibited significantly lower VAS scores than the control group (1.83 ± 0.70 vs. 2.55 ± 0.56, 95% CI: −1.03 to −0.41, P < 0.001). ASES scores did not differ between groups at 1 week or 1 month (P > 0.05), but were significantly higher in the treatment group at 6 months (76.68 ± 6.67 vs. 73.43 ± 2.54, 95% CI: 1.42–5.32, P = 0.009). No complications occurred in either group. Operative time, postoperative hospitalisation days and hospitalisation cost were higher in the treatment group (P < 0.05).

Compared with simple five-step MUA, the combination therapy of five-step MUA and ACR provides superior pain relief and higher ASES functional scores at 6 months after surgery. However, operation time, postoperative hospitalisation days and hospitalisation costs correspondingly increase. Due to the small sample size and short clinical observation time, further follow-up is needed for long-term efficacy.