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Peer-reviewedCC BY 4.0Frontiers in Medicine

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

  • Canming Ye1,2
  • Lunzhu Ciren3
  • Yang Wang4,5
  • Liu Yang1,2
  • Kai Wang6
  • Shaoze Lan1,2
  • Kenan Sun1,2
  • Chen Wang1,2
  • Shenglong Pan1,2
  • Jun Li1,2,3
6 affiliations
  1. 1Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
  2. 2Institute of Orthopedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
  3. 3Department of Orthopedics, Shannan City People’s Hospital, Shannan, China
  4. 4Anhui Medical University, Hefei, China
  5. 5Department of Orthopedics, The Fourth People’s Hospital of Lu'an, Lu'an, China
  6. 6Department of Emergency Medicine, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China
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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.

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Cite

BibTeXRIS
BibTeX
@article{ye2026with,
  title = {{MUA with PRP and corticosteroid injection versus arthroscopic capsular release for refractory frozen shoulder: a retrospective cohort study}},
  author = {Canming Ye and Lunzhu Ciren and Yang Wang and Liu Yang and Kai Wang and Shaoze Lan and Kenan Sun and Chen Wang and Shenglong Pan and Jun Li},
  journal = {Frontiers in Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fmed.2026.1957034},
  url = {https://doi.org/10.3389/fmed.2026.1957034},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - MUA with PRP and corticosteroid injection versus arthroscopic capsular release for refractory frozen shoulder: a retrospective cohort study
AU  - Canming Ye
AU  - Lunzhu Ciren
AU  - Yang Wang
AU  - Liu Yang
AU  - Kai Wang
AU  - Shaoze Lan
AU  - Kenan Sun
AU  - Chen Wang
AU  - Shenglong Pan
AU  - Jun Li
PY  - 2026
DA  - 2026/10/21
JO  - Frontiers in Medicine
DO  - 10.3389/fmed.2026.1957034
UR  - https://doi.org/10.3389/fmed.2026.1957034
AB  - 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.
SN  - 2296-858X
ER  -