In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study

Basant Elnady,Manal Shawky Hussein,Johannes J Rasker,Elsayed M Rageh,Dalia El-Sayed Desouky,Tohamy Ekhouly,Mohammed Hassan Abu-Zaid

doi:10.1007/s10067-020-05131-2

Basant Elnady, Manal Shawky Hussein + Show 5 more

Open Access

https://doi.org/10.1007/s10067-020-05131-2

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Abstract

Shoulder adhesive capsulitis, also called frozen shoulder, is a musculoskeletal disorder associated with pain and functional disability. This study aimed to compare the effectiveness of shoulder ultrasound-guided hydrodilatation with corticosteroid, via rotator interval (RI) anteriorly, versus posterior approach, in adhesive capsulitis patients. All patients received exercise program following injection.Patients and methodsA prospective randomized controlled study among 60 consecutive adhesive capsulitis patients was randomized into two equal groups. Group I received ultrasound-guided hydrodilatation with corticosteroid, saline, and local anesthetic via posterior intra-articular approach; group II received the same ultrasound-guided hydrodilatation via anterior rotator interval approach. Both groups received guided stretching exercises for 3 months after injection. Baseline and 3 months evaluation of pain by visual analogue scale (VAS), shoulder pain and disability index (SPADI), and range of motion (ROM) had been recorded for all patients.ResultsBoth groups showed significant improvement 3 months after hydrodilatation regarding VAS pain, external rotation, and SPADI. Only in group II (RI anterior approach) improvement was observed regarding flexion and abduction. There was no improvement regarding extension or internal rotation in either group. When comparing the improvement in both groups after hydrodilatation, group II (anterior approach) showed a statistically significant higher level of improvement regarding VAS pain (p = 0.003), SPADI, flexion, abduction, and external rotation, compared to group I (p < 0.001). Extension, internal rotation, and adduction were not different.ConclusionsUltrasound-guided anterior rotator interval hydrodilatation for adhesive capsulitis, followed by guided exercise, is clinically and functionally more effective than the conventional posterior approach.Key Points• Ultrasound-guided hydrodilatation (with prednisolone acetate (40 mg), 1 ml of 2% lidocaine, and 15 ml saline) for adhesive capsulitis followed by guided exercise is clinically and functionally effective.• The ultrasound-guided anterior rotator interval approach is clinically and functionally significantly more effective than the conventional intra-articular posterior approach as it targets mainly the area of pathology.• This is the first prospective study comparing the effect of the anterior rotator interval approach versus the posterior approach in ultrasound-guided hydrodilatation in adhesive capsulitis patients.

Highlights

Adhesive capsulitis and frozen shoulder syndrome are two terms that have been used to describe a painful and stiff shoulder [1]
The definition of adhesive capsulitis according to the American Shoulder and Elbow Surgeons is “a condition of uncertain etiology characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder” [1]
Female participants accounted for 70% and 73.3% of group I and group II, respectively

Summary

Introduction

Adhesive capsulitis and frozen shoulder syndrome are two terms that have been used to describe a painful and stiff shoulder [1]. The definition of adhesive capsulitis according to the American Shoulder and Elbow Surgeons is “a condition of uncertain etiology characterized by significant restriction of both active and passive shoulder motion that occurs in the absence of a known intrinsic shoulder disorder” [1]. Adhesive capsulitis is a common, but poorly understood, musculoskeletal disorder, with a prevalence of 2– 5% in the general population [2, 3]. It is one of the most common disorders presenting to orthopedic surgeons [3]. Frozen shoulder usually is seen in the sixth decade of life, and onset is very uncommon before the age of 40. Capsulitis rarely occurs simultaneously bilaterally [5]

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