Work

MUA with PRP and corticosteroid injection versus arthroscopic capsular release for refractory frozen shoulder: a retrospective cohort study

Year: 2026

Type: article

Abstract: Background Evidence comparing procedural treatment for refractory frozen shoulder is limited. We compared manipulation under anesthesia plus platelet-rich plasma and corticosteroid injection (MUA + PRP + CS) with arthroscopic capsular release (ACR). Materials and methods We reviewed records at two centers, 2019–2024. The 1-month visual analog scale (VAS) contrast was a post hoc exploratory comparison of early postoperative pain. Other outcomes were American Shoulder and Elbow Surgeons (ASES) score, Shoulder Pain and Disability Index (SPADI), passive range of motion, satisfaction, serious complications or reinterventions, and the hospital-recorded aggregate treatment amount. Mixed-effects models handled repeated measures, and inverse probability of treatment weighting (IPTW) assessed the consistency of longitudinal patterns. Results Of 200 screened records, 137 patients were analyzed (MUA + PRP + CS, n = 67; ACR, n = 70). At 1 month, VAS was lower after MUA + PRP + CS (adjusted mean difference [MD], −0.57; 95% confidence interval [CI], −0.75 to −0.38; Holm-adjusted P < 0.001); ASES and forward flexion were higher, while SPADI was lower. ASES also favored the combined strategy at 3 months (MD, 9.09; 95% CI, 7.97–10.22; Holm-adjusted P < 0.001). Early VAS and SPADI differences were small. IPTW was directionally consistent with early findings but did not confirm the small 12-month internal-rotation difference. Satisfaction did not differ significantly (98.5% vs. 90.0%; P = 0.063). No serious procedure-related complication or reintervention was identified. The adjusted recorded aggregate treatment amount was lower (MD, −6,903.88 Chinese yuan; 95% CI, −7,196.76 to −6,611.00; P < 0.001). Conclusions In this cohort, MUA + PRP + CS was associated with favorable early outcome differences and a lower recorded aggregate treatment amount than ACR. The 3-month ASES difference was the clearest potentially meaningful early finding. The clinical importance of the 1-month VAS, ASES, and SPADI differences, as well as the small internal-rotation difference, remains uncertain. Residual confounding precludes causal comparative inferences.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1957034