Shoulder & Elbow. ISSN 1758-5732 S ORIGINAL ARTICLE A prospective randomized trial comparing manipulation under anaesthesia and capsular distension for the treatment of adhesive capsulitis of the shoulder Chye Yew Ng, Anish K. Amin, Liz McMullan, Scott McKie, Ivan J. Brenkel & Robert E. Cook Department of Orthopaedics, Queen Margaret Hospital, Dunfermline KY12 0SU, UK Received Received 15 July 2011; accepted 17 November 2011 Keywords Adhesive capsulitis, frozen shoulder, manipulation under anaesthesia, capsular distension, prospective randomized trial Conflicts of Interest None declared Correspondence Chye Yew Ng, Upper Limb Unit, Wrightington Hospital, Appley Bridge, Wigan WN6 9EP, UK. Tel.: +44 (0)1257 25 6365. Fax: +44 (0)1257 25 6476. E-mail: chyeng@gmail.com DOI:10.1111/j.1758-5740.2011.00171.x ABSTRACT Background We performed a prospective randomised trial recruiting patients with adhesive capsulitis of the shoulder, to undergo either manipulation under anaesthesia (MUA) or capsular distension. Methods Between 2006 and 2010, 28 patients (30 shoulders) were recruited. The mean age was 53 years (44 – 69). Randomisation was done using a sealed envelope. Results Preoperatively, the MUA group had significantly less mean abduction than the distension group (58.2 ± 5.2 ◦ vs. 75.7 ± 5.4 ◦ ; p = 0.03). At 6 months, the MUA group achieved greater mean abduction (163.0 ± 2.4 ◦ vs. 130.7 ± 10.3 ◦ ; p = 0.02). Preoperatively, the MUA group had significantly less external rotation compared to the distension group (11.0 ± 2.8 ◦ vs. 24.0 ± 4.1 ◦ ; p = 0.03). At 6 months, the external rotation was not statistically different between the groups (40.3 ± 4.0 ◦ vs. 40.3 ± 4.6 ◦ ; p = 0.75). Preoperatively, both groups had similar pain visual analogue score (VAS) (5.7 ± 0.6 vs. 4.7 ± 0.6; p = 0.30) and Disabilities of the Arm, Shoulder and Hand (DASH) scores (49.4 ± 4.7 vs. 53.8 ± 1.6; p = 0.26). However there was no statistically significant difference noted between the groups for VAS (1.5 ± 0.4 vs. 2.9 ± 0.8; p = 0.39) or DASH (12.4 ± 4.3 vs. 25.1 ± 6.4; p = 0.21) at 6-month review. Discussion MUA resulted in better shoulder abduction than capsular distension at 6 months following the procedure. However, there was no significant difference between the two groups in external rotation or pain relief achieved. INTRODUCTION Adhesive capsulitis of the shoulder is a disabling condition that is associated with significant morbidity [1]. Traditionally, it has been considered as a benign and self-limiting condition, which typically recovers within 2 years of onset [2–4]. However, this view has been challenged by studies showing the persistence of shoulder pain or stiffness in a significant proportion of patients well beyond 2 years [5,6]. Conservative measures include analgesia, corticosteroids and physiotherapy. Cochrane reviews have concluded that oral or intra-articular steroids provide short- term benefits only [7,8]. In addition, there is no evidence that physiotherapy alone is of benefit for adhesive capsulitis [9]. The traditional second-line treatment has been manipulation under anaesthesia (MUA) [10 – 12], although the procedure is associated with several risks, including partial rupture of glenohumeral ligament and subscapularis, glenohumeral dislocation and humeral fracture [13]. With the advent of shoulder arthroscopy, arthroscopic release [14,15] for adhesive capsulitis is now frequently performed; however, it does require specialized equipment and is technically demanding. Capsular distension, which is performed as an outpatient procedure under local anaesthesia, is thus gaining popularity as an alternative treatment option because it is a relatively risk free and technically straightforward procedure compared to MUA or arthroscopic release [16,17]. The relative effectiveness of the different treatment options for adhesive capsulitis are yet to be established. We aimed to compare the effectiveness of MUA and capsular distension in the management of adhesive capsulitis of the shoulder. We hypothesized that there is no statistically significant difference in terms of pain relief or range of movement (ROM) of the shoulder at 6 months after MUA or capsular distension. PATIENTS AND METHODS This was a prospective randomized trial recruiting patients presenting for the first time to the orthopaedic or physiotherapy clinic with idiopathic adhesive capsulitis of the shoulder. Each patient was assessed by one of the senior authors (IJB or RC) before recruitment into the study. The diagnosis was based on a history of insidious onset of pain and restricted passive glenohumeral movement, specifically restricted external rotation. Plain radiographs of the shoulder were obtained to exclude glenohumeral arthritis or calcific deposits. Patients with a history of inflammatory arthritis, severe osteoporosis, recent (<9 months) trauma or surgery to the ipsilateral limb before the onset of their symptoms were excluded from the study. The study was approved by the Local Research Ethics Committee. Each patient provided their full informed consent before entry into the trial.  2012 British Elbow and Shoulder Society Shoulder and Elbow  2012 British Elbow and Shoulder Society. Shoulder and Elbow 2012 4, pp 95–99 95