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Keyhole surgery no more effective at treating ‘frozen shoulder’ than less invasive therapies

Posted on 2 October 2020

Keyhole surgery is no better at treating frozen shoulder than two alternative therapies, an NIHR-funded trial involving researchers at the University of York published in the Lancet today has found.

The study focused on a common surgical treatment called Arthroscopic Capsular Release (ACR) - a keyhole procedure carried out under general anaesthetic where a probe is inserted into the shoulder, along with a camera and the joint capsule is released, stretched and manipulated to regain a range of movement. This is a costly and invasive treatment.

Clinical trial

However, in the largest clinical trial of its kind, researchers led by a team at South Tees Hospitals NHS Foundation Trust and University of York Trials Unit, have found that ACR was no more effective than two other less costly and invasive treatments using a patient-reported questionnaire about shoulder pain and function.

One was Manipulation Under Anaesthesia (MUA) - a minimally invasive procedure where surgeons move the shoulder joint to a full range of motion. The other was early structured physiotherapy (ESP) with a steroid injection - a treatment specially designed for the trial that does not require a general anaesthetic.

Frozen shoulder is a common and painful condition in which movements in the shoulder become restricted. It affects ten per cent of women and eight per cent of men of working age and can last years.

Choice for patients

Chief Investigator Professor Amar Rangan from the University of York who also works as a Consultant Orthopaedic Surgeon at South Tees NHSFT, said: “Our trial has shown that expensive keyhole surgery is no better than two alternative therapies. This could provide more choice for patients - especially those with conditions like diabetes who have to manage a chronic disease and who may not want the additional inconvenience and risk of surgery under anaesthetic.”

The randomised controlled trial was carried out in 35 UK hospitals and recruited over 500 patients. All three treatments led to substantial improvements in patient reported shoulder pain and function over one year, but none of the treatments were superior.

Although ACR resulted in the least number of further treatments: four per cent, compared to seven per cent for MUA and 15 per cent for ESP, it carried relatively higher risks, mostly general risks from having a surgical procedure, and had longer waiting times to access. ESP with a steroid injection could be accessed quickly, had relatively fewer risks than ACR and was cheaper, but more patients required further treatment. Overall MUA was found to be the most cost-effective option to the NHS.

Dr Stephen Brealey, Trial Manager at York, added: “At a time when NHS resources are stretched, encouraging surgeons to use keyhole surgery more selectively when less costly and less invasive interventions fail, could save valuable theatre time and limit the need for people to undergo unnecessary lengthy procedures.”

Find out more about the research in this animation