Abstract

Background: To compare the effects of conservative steroid injection and arthroscopic capsular release during early intervention of stages I and II of primary frozen shoulder (PFS).

Methods: A randomized controlled clinical trial was conducted. Thirty-six stage I and 32 stage II patients were randomly allotted to a steroid injection and an arthroscopic treatment groups and followed up for 12 months. The outcome was evaluated using visual pain scale (VAS), the American Shoulder and Elbow Surgeon (ASES) score, shoulder active range of motion (ROM) prior to treatment, and 3 weeks and 3 and 12 months post-treatment.

Results: All the subjects in stages I and II PFS groups showed similar shoulder pain and function scoring before treatment. Among stage I patients, conservative treatment showed higher VAS, ASEA and ROM scores 3 weeks post-treatment. Better VAS and ASEA scores were observed in the arthroscopic treatment group with 3 months post-treatment. Patients treated by arthroscopy showed better performance on all the clinical outcomes with 12 months post-treatment, compared with conservative treatment group. In stage II patients, conservative treatment showed better therapeutic effects compared with arthroscopic treatment with 3 weeks post-treatment. Arthroscopic treatment led to better performance on backward extension and forward flexion with 3 months post-treatment. Arthroscopic patients so treated showed better performance on all the clinical outcomes with 12 months posttreatment, compared with conservative treatment group.

Conclusion: In early PFS patients, especially for stage II cases, arthroscopic treatment can better improve shoulder joint ROM, relieve pain, and enhance function, compared with steroid injection treatment.