Targeted ultrasound-guided hydrodilatation via the rotator interval for adhesive capsulitis

Abstract

To describe and evaluate ultrasound-guided hydrodilatation via the rotator interval for the treatment of adhesive capsulitis. Patients referred to our department with adhesive capsulitis were consented for hydrodilatation. Inclusion criteria included a failure to respond to conservative treatment and the absence of full thickness rotator cuff tear. Twenty-one milliliters of a mixture of local anesthetic and steroid was injected into the rotator interval using a 21-gauge needle. Patients were followed up at 2weeks and 4months, with documented pain scores from 0 to 10 on a visual analogue scale and the Oxford Shoulder Questionnaire. Twenty-two patients were suitable for inclusion in the study. Nineteen were female (86%) and three were male. The mean age was 55years (range, 32-71years). The duration of symptoms ranged from 4weeks to 20months. At 4months, 19/22 (86%) of patients described either complete (7/22) or good (12/22) improvement in their symptoms. The mean pain score was 8.4 prior to the procedure, 3.1 at 48h and 1.9 at 4months, and 20/22 (91%) had a lower pain score after 4months. There was a statistically significant (p < 0.05) improvement in the Oxford shoulder score, from a mean of 13.6 pre-procedure to 36.5 at 4months. The rotator interval and anterior joint capsule are strongly implicated in the symptomatology of adhesive capsulitis. The novel use of targeted ultrasound-guided hydrodilatation via the rotator interval gives good results in reducing shoulder pain and symptoms in adhesive capsulitis.