{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:43:56Z","timestamp":1790419436306,"version":"4.1.0"},"reference-count":78,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,8,7]],"date-time":"2022-08-07T00:00:00Z","timestamp":1659830400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Purpose: To investigate the efficacy of manipulation under anesthesia (MUA) compared to other non-surgical therapeutic strategies for patients with frozen shoulder contracture syndrome (FSCS). Methods: A systematic review of literature was conducted. A literature search was performed in MEDLINE, EMBASE, PEDro, Cochrane Central Library and Scopus. Only randomized controlled trials were included and assessed for critical appraisal through the Cochrane Collaborations tools. Results: Five randomized controlled trials were included. The overall risk of bias (RoB) was high in 4 out of 5 of the included studies. MUA was found to be not superior in terms of reduction of pain and improvement of function when compared to cortisone injections with hydrodilatation (mean regression coefficient MUA \u22122.77 vs. injection \u22122.75; 95% CI (\u22121.11 to 1.15)) and home exercise (mean difference 95% CI: 0.2 (\u22120.64 to 1.02)) in the short term (3 months), and cortisone injections with hydrodilatation (mean regression coefficient MUA 3.13 vs. injection 3.23; 95% CI (\u22120.90 to 1.11)) in the long term (&gt;6 months). Moreover, if compared to structured physiotherapy, MUA highlighted a higher Oxford Shoulder Score at final 1-year follow up (mean difference 95% CI: 1.05 (\u22121.28 to 3.39); p = 0.38). Similar results were obtained for disability, with statistically no significant long-term (&gt;12 months) differences between MUA and home exercise (mean difference 95% CI: 0 (\u22123.2 to 3.2)) or structured physiotherapy (mean difference 95% CI: \u22120.50 (\u22125.70 to 4.70); p = 0.85)). Only two trials reported adverse events. Conclusions: This review suggested that limited and inconsistent evidence currently exists on the efficacy of MUA compared to other non-surgical strategies in the management of patients with FSCS. Future research should focus on clinical trials with higher methodological quality.<\/jats:p>","DOI":"10.3390\/ijerph19159715","type":"journal-article","created":{"date-parts":[[2022,8,7]],"date-time":"2022-08-07T22:51:46Z","timestamp":1659912706000},"page":"9715","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Manipulation under Anesthesia versus Non-Surgical Treatment for Patients with Frozen Shoulder Contracture Syndrome: A Systematic Review"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5315-4236","authenticated-orcid":false,"given":"Mattia","family":"Salomon","sequence":"first","affiliation":[{"name":"Department of Clinical Science and Translational Medicine, University of Roma \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Pastore","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Translational Medicine, University of Roma \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9683-9975","authenticated-orcid":false,"given":"Filippo","family":"Maselli","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, University of Roma \u201cSapienza\u201d, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5514-0524","authenticated-orcid":false,"given":"Mauro","family":"Di Bari","sequence":"additional","affiliation":[{"name":"Research Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence, 50121 Florence, Italy"},{"name":"Unit of Geriatrics\u2014Geriatrics Intensive Care Unit, Department of Medicine and Geriatrics, \u201cCareggi Hospital\u201d, 50134 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5874-0376","authenticated-orcid":false,"given":"Raffaello","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Antalgic Mini-Invasive and Rehab-Outpatients Unit, Department of Medicine and Aging Sciences, University \u201cG. D\u2019Annunzio\u201d Chieti-Pescara, 66100 Chieti, Italy"},{"name":"Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8950-8203","authenticated-orcid":false,"given":"Fabrizio","family":"Brindisino","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cVincenzo Tiberio\u201d, University of Molise, \u201cCardarelli Hospital\u201d, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.math.2014.07.006","article-title":"Frozen shoulder contracture syndrome\u2014Aetiology, diagnosis and management","volume":"20","author":"Lewis","year":"2015","journal-title":"Man. 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