This systematic review asked whether arthroscopic capsular release produces better outcomes than manipulation under anesthesia (MUA) for recalcitrant adhesive capsulitis. 22 studies with 989 patients were included, but 21 of 22 provided only Level IV evidence and none directly compared the two treatments prospectively.
When a patient with adhesive capsulitis fails 6 months of conservative management, you face a real clinical decision: MUA or arthroscopic capsular release? This review's honest answer is that the data cannot tell you. Nearly all available evidence is Level IV, and no trial has directly compared the two interventions with prospective allocation.
What the pooled data do show is that the differences are small: roughly 6-8° more ROM improvement with capsular release, and a 3-point Constant score advantage — neither is likely to change a patient's functional life.
The complication profiles differ in character but not in rate (both approximately 0.5%). MUA risks are uncontrolled tearing of capsule, ligament, and rotator cuff. Capsular release risks are axillary nerve injury, post-release instability, and chondrolysis.
For boards and for practice: the 6-month conservative trial threshold before surgical intervention, the three-stage natural history (freezing/frozen/thawing over 2-3 years), the axillary nerve anatomy during inferior capsulotomy, and the ASES MCID of 6.4 points are all high-yield facts this paper directly supports.
This systematic review asked whether arthroscopic capsular release produces better outcomes than manipulation under anesthesia (MUA) for recalcitrant adhesive capsulitis. 22 studies with 989 patients were included, but 21 of 22 provided only Level IV evidence and none directly compared the two treatments prospectively.
When a patient with adhesive capsulitis fails 6 months of conservative management, you face a real clinical decision: MUA or arthroscopic capsular release? This review's honest answer is that the data cannot tell you. Nearly all available evidence is Level IV, and no trial has directly compared the two interventions with prospective allocation.
What the pooled data do show is that the differences are small: roughly 6-8° more ROM improvement with capsular release, and a 3-point Constant score advantage — neither is likely to change a patient's functional life.
The complication profiles differ in character but not in rate (both approximately 0.5%). MUA risks are uncontrolled tearing of capsule, ligament, and rotator cuff. Capsular release risks are axillary nerve injury, post-release instability, and chondrolysis.
For boards and for practice: the 6-month conservative trial threshold before surgical intervention, the three-stage natural history (freezing/frozen/thawing over 2-3 years), the axillary nerve anatomy during inferior capsulotomy, and the ASES MCID of 6.4 points are all high-yield facts this paper directly supports.