{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:24:34Z","timestamp":1788211474788,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the clinical efficacy of manipulation under brachial plexus block anesthesia (MUA) compared to standardized conservative treatment in patients with primary adhesive capsulitis of the shoulder (ACS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study analyzed 72 patients with primary ACS, allocated to either the MUA group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936) or the control group receiving conservative treatment (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936). The MUA group underwent a single manipulation procedure under ultrasound-guided interscalene brachial plexus block, followed by a structured 3-month rehabilitation protocol. The control group received a comprehensive conservative regimen. Primary outcomes included shoulder range of motion (ROM) and Constant-Murley scores, assessed preoperatively and at 1, 3, 6, and 12 months post-intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The MUA group demonstrated significantly greater improvement in all ROM parameters compared to the control group at all follow-up intervals (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). At 12 months, forward flexion improved to 152.4\u00b0\u2009\u00b1\u20098.7\u00b0 (vs. 101.2\u00b0\u2009\u00b1\u200913.5\u00b0 in controls), abduction to 150.6\u00b0\u2009\u00b1\u200910.5\u00b0 (vs. 95.8\u00b0\u2009\u00b1\u200912.3\u00b0), and external rotation to 54.6\u00b0\u2009\u00b1\u20095.3\u00b0 (vs. 38.2\u00b0\u2009\u00b1\u20095.9\u00b0). Constant scores were significantly higher in the MUA group (86.7\u2009\u00b1\u20093.9 vs. 73.5\u2009\u00b1\u20095.5,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), exceeding the minimal clinically important difference. Visual Analog Scale (VAS) pain scores decreased more rapidly and substantially in the MUA group (from 7.2\u2009\u00b1\u20091.1 to 1.1\u2009\u00b1\u20090.4 vs. 7.0\u2009\u00b1\u20091.2 to 2.0\u2009\u00b1\u20090.6 in controls). Patient satisfaction was significantly higher in the MUA group (93.3% vs. 75.0%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.038), with a shorter median return-to-work time (6.2 vs. 11.8 weeks,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Transient nerve palsy occurred in 2 MUA patients (5.6%), resolving spontaneously within 4 weeks.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MUA under brachial plexus block anesthesia is significantly more effective than standardized conservative treatment in restoring shoulder function, relieving pain, and accelerating return to normal activities in patients with primary adhesive capsulitis. The procedure demonstrates a favorable safety profile and high patient satisfaction, representing a valuable therapeutic option for conservative treatment failures. This study provides Level III evidence that MUA under brachial plexus block is superior to conservative treatment for primary adhesive capsulitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2025.1670743","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T06:22:35Z","timestamp":1762496555000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical efficacy of manipulation under brachial plexus block anesthesia for primary adhesive capsulitis of shoulder: a retrospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Haiyan","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"B1","first-page":"211","article-title":"Adhesive capsulitis of the shoulder","volume":"27","author":"Neviaser","year":"1945","journal-title":"J Bone Joint Surg Am"},{"key":"B2","first-page":"514","volume-title":"The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or About the Subacromial Bursa","author":"Codman","year":"1934"},{"key":"B3","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1038\/s41572-022-00386-2","article-title":"Frozen shoulder","volume":"8","author":"Millar","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"B4","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.bioactmat.2022.01.016","article-title":"Human bone marrow mesenchymal stem cell-derived extracellular vesicles inhibit shoulder stiffness via let-7a\/Tgfbr1 axis","volume":"17","author":"Luo","year":"2022","journal-title":"Bioact Mater"},{"key":"B5","doi-asserted-by":"publisher","first-page":"101979","DOI":"10.1016\/j.mtbio.2025.101979","article-title":"Antioxidant RuCo nanosheet attenuates capsule fibrosis in adhesive capsulitis of shoulder by p38 MAPK signaling pathway inhibition","volume":"33","author":"Qi","year":"2025","journal-title":"Mater Today Bio"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e2102715118","DOI":"10.1073\/pnas.2102715118","article-title":"Translational targeting of inflammation and fibrosis in frozen shoulder: molecular dissection of the T cell\/IL-17A axis","volume":"118","author":"Akbar","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"key":"B7","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/j.jos.2019.03.011","article-title":"Is frozen shoulder completely resolved at 2 years after the onset of disease?","volume":"25","author":"Kim","year":"2020","journal-title":"J Orthop Sci"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e38388","DOI":"10.1097\/MD.0000000000038388","article-title":"Efficacy of hydrodistension for frozen shoulder: a systematic review and meta-analysis","volume":"103","author":"Chen","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1080\/09593985.2022.2032512","article-title":"Frozen shoulder: living with uncertainty and being in \u201cno-man\u2019s land\u201d","volume":"39","author":"King","year":"2023","journal-title":"Physiother Theory Pract"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.2106\/JBJS.RVW.17.00165","article-title":"Treatment of adhesive capsulitis of the shoulder: a critical analysis review","volume":"6","author":"Yip","year":"2018","journal-title":"JBJS Rev"},{"key":"B11","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1007\/s00264-017-3558-3","article-title":"Manipulation under anaesthetic for frozen shoulder using Codman\u2019s paradox: a safe and early return of function","volume":"42","author":"Tsvieli","year":"2018","journal-title":"Int Orthop"},{"key":"B12","doi-asserted-by":"publisher","first-page":"217","DOI":"10.4055\/cios19027","article-title":"Early clinical outcomes of manipulation under anesthesia for refractory adhesive capsulitis: comparison with arthroscopic capsular release","volume":"12","author":"Kim","year":"2020","journal-title":"Clin Orthop Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1016\/j.jse.2013.01.010","article-title":"Comparison of manipulation and arthroscopic capsular release for adhesive capsulitis: a systematic review","volume":"22","author":"Grant","year":"2013","journal-title":"J Shoulder Elbow Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"23259671211003675","DOI":"10.1177\/23259671211003675","article-title":"Correlation of ultrasound findings with clinical stages and impairment in adhesive capsulitis of the shoulder","volume":"9","author":"Do","year":"2021","journal-title":"Orthop J Sports Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1186\/s13063-023-07810-2","article-title":"A multi-center, single-blinded, randomized, parallel-group, superiority study to compare the efficacy of manipulation under anesthesia vs. intra-articular steroid injection in the treatment of patients with frozen shoulder and a diagnosis of rotator cuff injury or tear by MRI: study protocol for a randomized controlled trial","volume":"24","author":"Song","year":"2023","journal-title":"Trials"},{"key":"B16","doi-asserted-by":"publisher","first-page":"869","DOI":"10.4093\/dmj.2022.0275","article-title":"The risk of shoulder adhesive capsulitis in individuals with prediabetes and type 2 diabetes mellitus: a longitudinal nationwide population-based study","volume":"47","author":"Kim","year":"2023","journal-title":"Diabetes Metab J"},{"key":"B17","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1097\/00003086-198710000-00008","article-title":"The frozen shoulder: diagnosis and management","volume":"223","author":"Neviaser","year":"1987","journal-title":"Clin Orthop Relat Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1186\/s12891-016-1190-9","article-title":"The pathophysiology associated with primary (idiopathic) frozen shoulder: a systematic review","volume":"17","author":"Ryan","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"key":"B19","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1186\/s40634-020-00307-w","article-title":"The puzzling pathophysiology of frozen shoulders\u2014a scoping review","volume":"7","author":"Kraal","year":"2020","journal-title":"J Exp Orthop"},{"key":"B20","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1093\/pm\/pnx227","article-title":"High- vs. low-dose corticosteroid injection in the treatment of adhesive capsulitis with severe pain: a randomized controlled double-blind study","volume":"19","author":"Kim","year":"2018","journal-title":"Pain Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1274790","DOI":"10.1155\/2019\/1274790","article-title":"Intra-articular vs. subacromial corticosteroid injection for the treatment of adhesive capsulitis: a meta-analysis and systematic review","volume":"2019","author":"Shang","year":"2019","journal-title":"Biomed Res Int"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e544","DOI":"10.5435\/JAAOS-D-17-00606","article-title":"Treatment of adhesive capsulitis of the shoulder","volume":"27","author":"Redler","year":"2019","journal-title":"J Am Acad Orthop Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"E661","DOI":"10.36076\/ppj.2023.26.E661","article-title":"Comparison between multisite injection and single rotator interval injection of corticosteroid in primary frozen shoulder (adhesive capsulitis): a randomized controlled trial","volume":"26","author":"Deng","year":"2023","journal-title":"Pain Physician"},{"key":"B24","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1186\/s12891-016-1081-0","article-title":"Adhesive capsulitis of the shoulder, treatment with corticosteroid, corticosteroid with distension or treatment-as-usual; a randomised controlled trial in primary care","volume":"17","author":"Sharma","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"key":"B25","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1097\/CORR.0000000000003252","article-title":"Does integration of graded motor imagery training augment the efficacy of a multimodal physiotherapy program for patients with frozen shoulder? A randomized controlled trial","volume":"483","author":"Yasaci","year":"2025","journal-title":"Clin Orthop Relat Res"},{"key":"B26","first-page":"953","article-title":"Comparison of intra articular NSAID (ketorolac) injection vs. hyaluronic acid injection for the mean decrease of pain score (according to UCLA shoulder rating scale) in the management of adhesive capsulitis","volume":"32","author":"Akhtar","year":"2019","journal-title":"Pak J Pharm Sci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e322","DOI":"10.1016\/j.jse.2020.11.016","article-title":"Rehabilitation variability after rotator cuff repair","volume":"30","author":"Galetta","year":"2021","journal-title":"J Shoulder Elbow Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1007\/s11999-012-2542-x","article-title":"Motion and pain relief remain 23 years after manipulation under anesthesia for frozen shoulder","volume":"471","author":"Vastam\u00e4ki","year":"2013","journal-title":"Clin Orthop Relat Res"},{"key":"B29","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1302\/0301-620X.99B6.BJJ-2016-1133.R1","article-title":"Recurrence of frozen shoulder after manipulation under anaesthetic (MUA): the results of repeating the MUA","author":"Woods","year":"2017","journal-title":"Bone Joint J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1302\/2058-5241.4.180044","article-title":"Manipulation under anaesthesia for frozen shoulders: outdated technique or well-established quick fix?","volume":"4","author":"Tim","year":"2019","journal-title":"EFORT Open Rev"},{"key":"B31","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.jse.2004.04.004","article-title":"Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia","volume":"14","author":"Loew","year":"2005","journal-title":"J Shoulder Elbow Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1016\/j.jse.2015.06.019","article-title":"Magnetic resonance imaging and short-term clinical results of severe frozen shoulder treated with manipulation under ultrasound-guided cervical nerve root block","volume":"25","author":"Sasanuma","year":"2016","journal-title":"J Shoulder Elbow Surg"},{"key":"B33","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s43465-021-00351-3","article-title":"Clinical guidelines in the management of frozen shoulder: an update!","volume":"55","author":"Pandey","year":"2021","journal-title":"Indian J Orthop"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e23","DOI":"10.1016\/j.jse.2010.11.024","article-title":"Glenoid fracture during manipulation under anesthesia for adhesive capsulitis: a case report","volume":"20","author":"Magnussen","year":"2011","journal-title":"J Shoulder Elbow Surg"},{"key":"B35","first-page":"255","article-title":"The effect of shoulder manipulation on rotator cuff integrity","volume":"79","author":"Atoun","year":"2013","journal-title":"Acta Orthop Belg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1111\/os.14077","article-title":"Arthroscopic capsular release vs. manipulation under anesthesia for refractory frozen shoulder: a systematic review with meta-analysis","volume":"16","author":"Zhao","year":"2024","journal-title":"Orthop Surg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"2410","DOI":"10.1016\/j.jseint.2023.07.017","article-title":"Clinical outcomes and cost-effectiveness of manipulation under brachial plexus block vs. physiotherapy for refractory frozen shoulder: a prospective observational study","volume":"7","author":"Saito","year":"2023","journal-title":"JSES Int"},{"key":"B38","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.jor.2023.10.015","article-title":"The efficacy of platelet-rich plasma injections compared to corticosteroids and physiotherapy in adhesive capsulitis: a systematic review and meta-analysis","volume":"47","author":"Pretorius","year":"2023","journal-title":"J Orthop"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e47491","DOI":"10.7759\/cureus.47491","article-title":"Allogenic platelet-rich plasma for the treatment of adhesive capsulitis","volume":"15","author":"Gupta","year":"2023","journal-title":"Cureus"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1016\/j.arthro.2023.01.013","article-title":"Platelet-rich plasma injections for shoulder adhesive capsulitis are at least equivalent to corticosteroid or saline solution injections: a systematic review of prospective cohort studies","volume":"39","author":"Nudelman","year":"2023","journal-title":"Arthroscopy"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1670743\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T06:23:53Z","timestamp":1762496633000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1670743\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":40,"alternative-id":["10.3389\/fsurg.2025.1670743"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1670743","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,7]]},"article-number":"1670743"}}