Capsular Distension for Adhesive Capsulitis
A) Stage I: Freezing, painful
B) Stage II: Frozen, stiff
C) Stage III: Global loss of ROM, extreme pain
D) Stage IV: Persistent stiffness, no pain
Capsular Distension (Hydrodilation)
How does capsular distension work? This is debated among orthopedists. Most agree that capsular rupture contributes to a mechanical resolution of shoulder stiffness. What is less clear is whether dilation, slow capsular deformation and/or capsular rupture are the key elements. In a study of manipulation under general anesthesia (MUA), the authors found no correlation between the tactile sensation of tearing the capsule to the patients final outcome (Dodenhoff 2000). Another proposed mechanism is reversal of the myofibroblastic activity that occurs by joint distension.
How effective is capsular distension? A 2008 Cochrane review evaluated capsular distension across 5 trials with 196 patients. They conclude there is “silver” level evidence that arthrographic distension with saline and steroid provides short‐term benefits in pain, range of movement and function in adhesive capsulitis (Buchbinder 2008).
Image 4. Ultrasound image of late capsular distension with needle in plane (courtesy of Dr Troyer and Dr Concepcion)
How does hydrodilation compare to surgical management? Queraishi et al compared 17 patients who received shoulder MUA, to 19 patients who received hydrodilation (Quraishi 2007). They found higher Constant scores but similar range of motion at 6 months, however the hydrodilation group (94%) had a higher patient satisfaction rate compared to MUA (81%). The authors also commented on the added benefit of avoiding general anesthesia and risk of surgical injuries such as fracture or cuff injury. Currently, there are no studies comparing hydrodilation to arthroscopic arthrolysis.
Is there any value to repeating the procedure? Generally, this is unknown. Trehan performed repeat hydrodilation at 6 weeks on patients who had partial but incomplete relief from their primary procedure. They found no difference in the oxford shoulder score between the initial hydrodilation and the repeat procedure (Trehan 2010).
– Read More @ Wiki Sports Medicine: https://wikism.org/Hydrodilation
– Read More @ Wiki Sports Medicine: https://wikism.org/Adhesive_Capsulitis
- Bunker TD, Boyd M, Gallacher S, et al. Association between Propionibacterium acnes and frozen shoulder: a pilot study. Shoulder Elbow 2014;6:257-261.
- Boyle-Walker KL, Gabard DL, Bietsch E, et al. A profile of patients with adhesive capsulitis. J Hand Ther 1997; 10: 222–228.
- Mengiardi B, Pfirrmann CW, Gerber C, et al. Frozen shoulder: MR arthrographic findings. Radiology 2004; 233: 486–492.
- Ryu KN, Lee SW, Rhee YG, et al. Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography. J Ultrasound Med 1993; 12: 445–449.
- Binder AI, Bulgen DY, Hazleman BL, et al. Frozen shoulder: a long-term prospective study. Ann Rheum Dis 1984; 43: 361–364
- Buchbinder, Rachelle, et al. “Arthrographic distension for adhesive capsulitis (frozen shoulder).” Cochrane Database of Systematic Reviews 1 (2008).
- Watson, Lyn, et al. “Hydrodilatation (distension arthrography): a long-term clinical outcome series.” British journal of sports medicine 41.3 (2007): 167-173.
- Clement RG, Ray AG, Davidson C, Robinson CM, Perks FJ. Frozen shoulder : long-term outcome following arthrographic distension. Acta Orthop Belg 2013;79:368-374.
- Quraishi NA, Johnston P, Bayer J, Crowe M, Chakrabarti AJ. Thawing the frozen shoulder: A randomised trial comparing manipulation under anaesthesia with Hydrodilatation. JBJS Br 2007;89:1197-1200
- Trehan RK, Patel S, Hill AM, Curtis MJ, Connell DA. Is it worthwhile to offer repeat hydrodilatation for frozen shoulder after 6 weeks? Int J Clin Pract 2010;64:356-359
- Dodenhoff RM, Levy O, Wilson A, Copeland SA. Manipulation under anesthesia for primary frozen shoulder: effect on early recovery and return to activity. J Shoulder Elbow Surg 2000;9:23-26.