Physiotherapy ‘as good as surgery’ for fixing frozen shoulder, UK surgeons find

Physiotherapy can be just as effective as invasive surgery for fixing one of the most common shoulder injuries, British surgeons have found.

Frozen shoulder, or adhesive capsulitis, affects about one in ten Britons, mostly those over 40, and is twice as likely in those with type 2 diabetes.

The problem – which occurs when tissue around the shoulder joint gradually stiffens – can become resistant to painkillers, so sometimes an operation is needed to remove the hard, inflamed area to ease excruciating pain and allow sufferers to regain the use of their arm.

But a new study involving 500 sufferers from 35 NHS Trusts has found that surgery may not be necessary for many of these patients.

A programme of physiotherapy, which involved exercises to gradually increase flexibility in the area, reduced pain and increased function as much as the widely used surgical procedure.

The four-year study compared three different treatments – physiotherapy, keyhole surgery and physiotherapy combined with steroid injections to reduce inflammation.

Participants completed lengthy questionnaires throughout the study, reporting their pain and mobility.

Professor Amar Rangan, orthopaedic surgeon and chief investigator of the study, said the findings showed, ‘expensive keyhole surgery is no better’ than exercise.

The surgical procedure most commonly used is known as arthroscopic capsular release, whereby stiff scar tissue around the joint is burned away using a hot probe.

But Prof Rangan says this procedure is ‘invasive and expensive’ as well as riskier due to the possibility of infections and complications with anesthesia. Patients who have this procedure will often need physiotherapy afterwards.

Prof Rangan and colleagues created an alternative treatment especially for the trial – a physiotherapy and steroid combination.

But this proved no more effective than physiotherapy alone.

Prof Rangan says the results show that the keyhole procedure should be reserved for only a small number of the most severe cases of frozen shoulder.

He says: ‘Keyhole is a resource- heavy procedure, taking up a lot of time and money.

‘Our study shows it isn’t always necessarily the best answer – especially for people with diabetes or other health conditions who want to avoid surgery. Now they have other options.’