Comparative Outcomes of Manipulation under General Anesthesia and Ultrasound-Guided Hydrodistension in Adhesive Capsulitis

Introduction: Adhesive capsulitis (frozen shoulder) is a disabling condition characterized by pain and restricted range of motion (ROM). Among various treatment options, manipulation under general anesthesia (MUGA) and ultrasound-guided hydrodistension (USG-HD) with corticosteroid injection are commonly used. This study compares their short-term efficacy and safety. Materials and Methods: This prospective, comparative, interventional study included 50 patients aged 30-75 years with primary adhesive capsulitis unresponsive to conservative management. Patients were allocated into two groups using alternate assignment (non-randomized). Group A underwent manipulation under anesthesia (MUA) followed by intra-articular steroid injection, while Group B received USG-HD with steroid injection. Outcomes were assessed using the shoulder pain and disability index (SPADI), pain score, disability scale, and ROM at baseline, post-procedure, and at 1-month follow-up. Statistical analysis was performed with P < 0.05 considered significant. Results: Both groups showed significant improvement in pain and functional outcomes. However, Group B demonstrated greater reduction in SPADI, pain, and disability scores at 1-month follow-up compared to Group A, with statistically significant differences (P < 0.05). No major complications were noted, and USG-HD was better tolerated. Discussion: USG-HD provided superior short-term outcomes compared to MUA, likely due to its minimally invasive nature and targeted capsular distension. However, the short follow-up limits assessment of long-term benefits and recurrence. Conclusion: USG-HD is more effective than MUA for short-term improvement in adhesive capsulitis, but longer follow-up is needed before establishing definitive treatment preference.