Manipulation under anaesthesia versus arthroscopic capsular release in stiff shoulder: A prospective multicentre study

Background: Manipulation under anaesthesia (MUA) and arthroscopic capsular release (ACR) are common modalities of management in shoulder stiffness, yet no robust clinical evidence demonstrates the superiority of one over the other. Objectives: Comparing functional results, complications, and operative time between MUA and ACR. Methods: In this prospective multicentre cohort study, 62 patients with primary shoulder stiffness of at least 6 months’ duration, forward elevation less than 100°, and external rotation limited by more than 50% compared with the contralateral side, despite conservative management, were included. Exclusion criteria were glenohumeral osteoarthritis, periarticular fractures, mechanical block, and skeletal immaturity. Patients treated in centre 1 underwent MUA (group A: n=31) and those in centre 2 underwent ACR (group B: n=31), with standardised anaesthesia, rehabilitation, and follow-up at 4 and 6 months. Results: Baseline demographics were comparable between groups. Both MUA and ACR produced significant improvements in Constant score, VAS, and ROM across all planes at 4 and 6 months, with no significant between-group differences. No major intra‑operative or post‑operative complications were observed in either cohort during the 6‑month follow‑up period. The operative time was significantly lower in the MUA group. Conclusion: MUA and ACR are both effective in improving pain and shoulder function in refractory shoulder stiffness, but MUA offers a shorter operative time. In the management of shoulder stiffness, MUA has comparable functional outcomes with ACR but with shorter operative duration.