A Comparative Study of Intra-articular Steroid Injection Alone Versus Steroid Injection Combined with Hydroplasty and Manipulation in the Treatment of Frozen Shoulder

Background Frozen shoulder (adhesive capsulitis) is a common cause of shoulder pain and disability in middle-aged adults, characterized by progressive pain and restriction of both active and passive range of motion. Despite multiple available treatment modalities, the optimal minimally invasive intervention remains controversial. Intra-articular corticosteroid injection and hydroplasty with manipulation are widely practiced techniques, yet comparative evidence remains inconsistent. Methods This randomized comparative study was conducted at a tertiary care hospital over 18 months. Eighty patients aged 40-60 years with unilateral frozen shoulder refractory to conservative treatment were randomly allocated into two groups: Group A received intra-articular methylprednisolone injection, and Group B underwent intra-articular corticosteroid injection combined with capsular distension (hydroplasty) followed by controlled shoulder manipulation. Outcomes were assessed using the Shoulder Pain and Disability Index (SPADI) at baseline and at two weeks, six weeks, three months, 4.5 months, and six months. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States), with p < 0.05 considered statistically significant. Results Both groups demonstrated statistically significant improvement in SPADI scores across all follow-up intervals. Hydroplasty with manipulation showed significantly greater improvement at three months (p = 0.001) and 4.5 months (p = 0.026). At six months, outcomes were comparable between groups (p = 0.457). No major complications were observed. Conclusion Both intra-articular corticosteroid injection alone and corticosteroid injection combined with capsular distension and manipulation resulted in significant improvement in pain and functional disability in patients with frozen shoulder. Hydroplasty with manipulation demonstrated superior mid-term functional improvement; however, no statistically significant difference between the two treatment protocols was observed at six months of follow-up.