Skip to main content

Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections?



The aim of this study was to compare shoulder manipulation and arthroscopic arthrolysis with glenohumeral steroid injections in patients affected by idiopathic adhesive shoulder capsulitis.


In this prospective study we randomly assigned patients to enter group A (23 patients, shoulder manipulation and arthroscopic arthrolysis) and group B (21 patients, glenohumeral steroid injections). Patients were followed-up at three, six and 12 weeks, and at six and 12 months with the Constant and Murley, ASES, UCLA and SST evaluation scales. Moreover, passive forward flexion, abduction, and internal and external rotations were recorded.


Range of motion showed satisfactory results in both groups at final follow-up: in group A the mean ABD increased from 60° to 154°, ER from 20° to 40°, and FF from 75° to 174°; in group B, ABD raised from 76° to 145°, ER from 20° to 35°, and FF from 115° to 164°. All the evaluation scales performed increased significantly at final follow-up in both groups. However, while patients of group A had already reached significant improvement at the six-week follow-up (p <0.03), in group B this happened only at the 12 week follow-up (p <0.03).


Both types of treatment were effective in improving final range of motion; however, while patients of group A accomplished their goal by the six-week follow-up, in group B the same result was obtained at the 12-week follow-up.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Duplay S (1872) De la péri-arthrite scapulo-humérale et des raideurs de L’epaule qui en sont la consequénce. Arch Gen Méd 20:513–42

    Google Scholar 

  2. Codman EA (1984) The shoulder. In: Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Robert E. Kreiger, Florida, USA, pp 216–224

  3. Neviaser RJ, Neviaser TJ (1987) The frozen shoulder. Diagnosis and management. Clin Orthop Relat Res 223:59–64

    Google Scholar 

  4. Lundberg J (1969) The frozen shoulder. Clinical and radiographical observations. The effect of manipulation under general anesthesia. Structure and glycosaminoglycan content of the joint capsule. Local bone metabolism. Acta Orthop Scand 119:1–59

    CAS  Google Scholar 

  5. Bunker TD, Anthony PP (1995) The pathology of frozen shoulder: a Dupuytren like disease. J Bone Joint Surg Br 77:677–83

    PubMed  CAS  Google Scholar 

  6. Reeves B (1975) The natural history of the frozen shoulder syndrome. Scand J Rheumatol 4(4):193–196

    Article  PubMed  CAS  Google Scholar 

  7. Owens-Burkhart H (1991) Management of frozen shoulder. In: Donatelli R (ed) Physical therapy of the shoulder. Churchill Livingstone, New York, pp 91–116

    Google Scholar 

  8. Bal A, Eksioglu E, Gulec B, Aydog E, Gurcay E, Cakci A (2008) Effectiveness of corticosteroid injection in adhesive capsulitis. Clin Rehabil 22(6):503–512

    Article  PubMed  Google Scholar 

  9. Placzek JD, Roubal PJ, Freeman DC, Kulig K, Nasser S, Pagett BT (1998) Long-term effectiveness of translational manipulation for adhesive capsulitis. Clin Orthop Relat Res 356:181–191

    Google Scholar 

  10. Laroche M, Ighilahriz O, Moulinier L, Constantin A, Cantagrel A, Mazieres B (1998) Adhesive capsulitis of the shoulder: an open study of 40 cases treated by joint distention during arthrography followed by an intraarticular corticosteroid injection and immediate physical therapy. Rev Rhum Engl Ed 65(5):313–319

    PubMed  CAS  Google Scholar 

  11. Levine WN, Kashyap CP, Bak SF, Ahmad CS, Blaine TA, Bigliani LU (2007) Nonoperative management of idiopathic adhesive capsulitis. J Shoulder Elbow Surg 16(5):569–573

    Article  PubMed  Google Scholar 

  12. Shaffer B, Tibone JE, Kerlan RK (1992) Frozen shoulder. A long-term follow-up. J Bone Joint Surg Am 74(5):738–46

    PubMed  CAS  Google Scholar 

  13. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    PubMed  Google Scholar 

  14. Ellman H, Hanker G, Bayer M (1986) Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 68(8):1136–1144

    PubMed  CAS  Google Scholar 

  15. Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352

    Article  Google Scholar 

  16. Zuckerman JD, Cuomo F (1993) Frozen shoulder. In: Matsen FA, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. American Academy of Orthopaedic Surgeons, Rosemont

    Google Scholar 

  17. Carbone S, Gumina S, Vestri AR, Postacchini R (2010) Coracoid pain test: a new clinical sign of shoulder adhesive capsulitis. Int Orthop 34(3):385–388

    Google Scholar 

  18. Weber M, Prim J, Bugglin R, Michel BA, Gerber H (1995) Long-term follow-up to patients with frozen-shoulder after mobilization under anesthesia, with special reference to the rotator cuff. Clin Rheumatol 14(6):686–691

    Article  PubMed  CAS  Google Scholar 

  19. Wang JP, Huang TF, Ma HL, Hung SC, Chen TH, Liu CL. (2010) Manipulation under anaesthesia for frozen shoulder in patients with and without non-insulin dependent diabetes mellitus. Int Orthop 34(8):1227–1232

    Google Scholar 

  20. Wang JP, Huang TF, Hung SC, Ma HL, Wu JG, Chen TH (2007) Comparison of idiopathic, post-trauma and post-surgery frozen shoulder after manipulation under anesthesia. Int Orthop 31(3):333–337

    Google Scholar 

  21. Baums MH, Spahn G, Nozaki M, Steckel H, Schultz W, Klinger HM (2007) Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports Traumatol Arthrosc 15(5):638–644

    Article  PubMed  CAS  Google Scholar 

  22. Janda DH, Hawkins RJ (1993) Shoulder manipulation in patients with adhesive capsulitis and diabetes mellitus: a clinical note. J Shoulder Elbow Surg 2:36–38

    Article  Google Scholar 

  23. Green S, Buchbinder R, Glazier R, Forbes A (1998) Systematic review of randomized controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. Br Med J 316(7128):354–360

    Article  CAS  Google Scholar 

  24. Buchbinder R, Green S, Youd JM (2003) Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 1:CD004016, Review

  25. Van der Heijden GJ, Van der Windt DA, Kleijnen J, Koes BW, Bouter LM (1996) Steroid injections for shoulder disorders: a systematic review of randomized clinical trials. Br J Gen Practice 46(406):309–316

    Google Scholar 

  26. Carette S, Moffet H, Tardif J, Bessette L, Morin F, Fremont P, Bykerk V, Thorne C, Bell M, Bensen W, Blanchette C (2003) Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo controlled trial. Arthritis Rheum 48(3):829–838

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Antonio Vadalà.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

De Carli, A., Vadalà, A., Perugia, D. et al. Shoulder adhesive capsulitis: manipulation and arthroscopic arthrolysis or intra-articular steroid injections?. International Orthopaedics (SICOT) 36, 101–106 (2012).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: