Hydraulic Distension Research Articles

Intra-articular Glucose Injections for Orthoregeneration of Frozen Shoulder. A Clinical Case.

Frozen shoulder or adhesive capsulitis is a difficult to treat disorder characterized by pain and loss of movement. Novel therapies such as hydraulic distension with orthobiologics may improve outcomes among individuals with this debilitating condition. The clinical case in this article describes the treatment of a patient with frozen shoulder using a series of joint injections using high volumes of sugar water. The positive outcome of this novel injection technique is an invitation to design clinical trials using orthobiologics for frozen shoulder.

A Review on Frozen Shoulder: Pathophysiology and Its Associated Diagnosis

Background: Frozen shoulder is a commonly occurring disease of the population. It is also referred to as shoulder capsulitis. It causes pain and stiffness of the shoulder and dominant in left shoulder. Various things are still unclear regarding the treatment and causes of this disease. It is a painful and n quickly healed disease.
 Patients show recovery but are often unable to regain their full potential movements. Painful stiffness of the shoulder is an ill-described medical entity, this is hard to evaluate and sensitive to treat. The nomenclature sed and consists of phrinclude cluding frozen shoulder, adhesive capsulitis, focal dystrophy, stiff shoulder, shriveled shoulder, and following. Apart from its idiopathic form, the disease can be initiated with the resource of the usage of trauma, infection, tumor, radiation, systemic and neighborhood metabolic concerns. Patho- anatomically, the common place region denominates an inflammatory vascular proliferation found with the resource of the usage thickening, scarring, and retraction of the joint cover.
 Summary: The inflammatory technique frequently begins to evolved on the rotator language and can increase to the subacromial space. Clinical analysis is primarily based totally records and bodily examination. Generally, the onset of ache precedes the belief of a discounted variety of movement with the aid of using weeks or months. In early ranges of ailment, the inflammatory form of ache dominates, the patient's most important criticism is ache at night. In the later stage, variety of movement step by step decreases. Patients no longer frequently whine approximately decreased movement, likely due to its gradual onset.
 Conclusion: Treatment options are a mixture of mobilization carrying sports with intra-articular steroids, hydraulic distension of the joint capsule, manipulation below anaesthesia,arthroscopic and/or open arthrosis.The appropriate preference of protocol is really as critical as its correct timing. In the inflammatory phase, competitive invasive protocols are uncommon, but deleterious and therefore need to be taken into consideration. New anti- angiogenic outlets also can moreover enhance beneficial effects and shorten the rehabilitation phase.

Effectiveness of Frozen Shoulder Treatment Using Hydraulic Distension by Injecting Large Volume of Normal Saline

Effectiveness of Frozen Shoulder Treatment Using Hydraulic Distension by Injecting Large Volume of Normal Saline

Updates on the treatment of adhesive capsulitis with hydraulic distension.

Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at the insertional area of the deltoid muscle and decreased range of motion. The pathophysiological process involves fibrous inflammation of the capsule and intraarticular adhesion of synovial folds leading to capsular thickening and contracture. Regarding the multidirectional limitation of motion, a limitation in external rotation is especially prominent, which is related to not only global fibrosis but also to a localized tightness of the anterior capsule. Ultrasound and magnetic resonance imaging studies can be applied to rule out other structural lesions in the diagnosis of adhesive capsulitis. Hydraulic distension of the shoulder joint capsule provides pain relief and an immediate improvement in range of motion by directly expanding the capsule along with the infusion of steroids. However, the optimal technique for hydraulic distension is still a matter of controversy, with regards to the infusion volume and rupture of the capsule. By monitoring the real-time pressure-volume profile during hydraulic distension, the largest possible fluid volume can be infused without rupturing the capsule. The improvement in clinical outcomes is shown to be greater in capsule-preserved hydraulic distension than in capsule-ruptured distension. Moreover, repeated distension is possible, which provides additional clinical improvement. Capsule-preserved hydraulic distension with maximal volume is suggested to be an efficacious treatment option for persistent adhesive capsulitis.

A prospective study on role of hydraulic distension along with steroid under local anaesthesia in the management of frozen shoulder

Introduction: Frozen shoulder” is a chronic condition characterized by gradually progressive, painful restriction of all shoulder joint movement, with slow spontaneous recovery of either partial or complete movement over a period of time. Although many treatment options have been proposed for the frozen shoulder syndrome, each has limitations. Hydro dilation technique was developed in order to loosen the reported contraction and adhesion. we evaluated the Range of movement and pain relief of shoulder following “Hydraulic distension under local anaesthesia along with a steroid” pre and post distension. Material and methods: A prospective observational study was conducted in the department of orthopaedics at RLJ hospital attached to Sri Devaraj Urs Medical College between June 2018 to November 2019 for a period of 1.5 year. All the Patients with Peri arthritis shoulder and age above 30 years were included in the study. After obtaining the informed consent from the patients, Demographic data, History, Clinical Examination and details of investigations were recorded in study proforma. The pain and functional scoring used as per “The society of American Shoulder and elbow surgeons” and follow-up was done at 3 weeks, 6 weeks and 12 weeks after procedure. IBM SPSS version 22 was used for statistical analysis. Results: Total 50 patients were included in the study. The average age of the study population was 52.68 ± 9.79. There were no patients with complete disability. Marked pain (grade 1) was observed on presentation in 46(92%) of the subjects. Post distension only 9(18%) had pain. Flexion, abduction, internal rotation, external rotation movements of the shoulder have improved post distention and were statistically significant at 3rd, 6th, 12 th week. The mean ASES was 36.04 ± 5.84 at base line, it was 67.6 ± 7.64 at 6th week and 91.04 ± 8.68 at 12th week. The differences in the ASES score at 6th week and 12th week follow up period with baseline value were statistically significant (P value

Hydraulic Distension with Pumping Technique for Treating Frozen Shoulder: A CaseControlled, Retrospective, Comparative Study with 6-Month Follow-Up

Background: We have applied a new method called “the pumping technique” to the capsulepreserving hydraulic distension for frozen shoulder. With this technique, the stretching effect can be directly applied to the joint capsule of the affected shoulder. Objectives: We attempted to evaluate the effect of capsule-preserving hydraulic distension using the pumping technique by comparing capsule-preserving hydraulic distension without it. Study Design: A case-controlled, retrospective, comparative study. Setting: Outpatient clinic of department of rehabilitation medicine in a single university hospital. Methods: Patients (n = 47) with frozen shoulder who were treated with hydraulic distension were assigned into the pumping group (n = 24) and the nonpumping group (n = 23). Range of motion (ROM), Shoulder Pain and Disability Index (SPADI), and Visual Analog Scale (VAS) scores were assessed. Results: Significant improvement of VAS, ROM, and SPADI scores was observed after the second injection in each group (P < 0.05). There were significant differences in total passive ROM, abduction, and flexion after the fifth injection between the 2 groups (P < 0.05). There was a significant difference in the disability domain of SPADI after the second injection between the 2 groups (P < 0.05). However, there was no significant interaction between time and group with respect to VAS scores. There were no serious complications after procedures. Limitations: This was a retrospective study. There might be some limitations in gathering comprehensive records of outcome measurements. In addition, because the objective of this study was to determine the effect of the new pumping technique, included patients range was very narrow. This study only included patients who were treated 5 times with capsule-preserving hydraulic distensions with or without the pumping technique. Conclusions: Although the effect on pain was excellent in both groups, the superiority of the new pumping technique was demonstrated by reduction of SPADI disability subscale score and improvement of ROM of the shoulder compared with the nonpumping technique.

Treatment progress and biomechanical properties of adhesive capsulitis after breast cancer surgery

Background : Adhesive capsulitis occurs frequently in patients after breast cancer surgery (BCS) and makes shoulder pain which decreases the quality of life in survivors. The mechanisms are reported as surgery itself, postoperative shoulder motion limitation, and radiotherapy. Usually patients are recommended by painful range of motion (ROM) exercise. However, this exercise provokes severe pain which makes a failure to proceed the exercise. Recently, hydraulic distension (HD) has been adapted to treatment the adhesive capsulitis in older people and good outcomes are reported. The purpose of this study was to identify the effect of hydraulic expansion on patients who underwent breast cancer surgery and to characterize the biomechanical properties of their glenohumeral joint capsules.

Frozen Shoulder: Ambulatory Treatment with Hydraulic Distension

Frozen Shoulder: Ambulatory Treatment with Hydraulic Distension

A study of clinical evaluation of effectiveness of hydraulic distension of shoulder in the management of frozen shoulder

In this study we aim to evaluate clinical evaluation of outcome of treatment of frozen shoulder by hydraulic distension under local anesthesia with steroid. A rapid, immediate result and cost effectiveness of hydraulic distension technique was also evaluated is this study. There were 22 shoulders with good results after distension and 26 good results at follow up. In total there were 19 shoulders with excellent results at follow up, as compare to 2 shoulders with excellent results after distension. Patients who had detoriated revealed that they had failed to do regular prescribed home exercises. In contrast patients who had gained excellent results had their regular home exercises as prescribed to them. Hydraulic distension is a safe, reliable, cost effective modality in treating the chronically distressing painful condition of frozen shoulder.

A Study of Evaluation of Effectiveness of hydraulic distension of shoulder in the management of frozen shoulder patients

A Study of Evaluation of Effectiveness of hydraulic distension of shoulder in the management of frozen shoulder patients

Effectiveness of hydraulic distension of shoulder in the management of frozen shoulder

Frozen shoulder is a chronic fibrosing condition of capsule of shoulder joint. The purpose of this study was to evaluate the efficacy of hydraulic distension in the treatment of frozen shoulder. 50 Patients with 54 shoulders of frozen shoulder syndrome were treated with hydraulic distension and steroid under local anesthesia from July 2014 to August 2016.Various parameters like pain, range of movements (ROM) and function of shoulder were assessed on predistension, post distension and at 6 weeks follow up. Results were graded as excellent, good, fair, and poor based on above parameters. During post distension period, 4% of the patients had excellent results, 44% good results, 46% fair results and 14% had poor results. At follow up, 38% had excellent results, 52% had good results, 16% had fair results and 2% had poor results. Hydraulic distension is a safe, reliable, cost effective procedure without requiring specialized equipments in the management of frozen shoulder.

The clinical effect of hydraulic distension plus manual therapy on patients with frozen shoulder.

[Purpose] This study aimed to develop a clinical protocol for the treatment of frozen shoulder using applied hydraulic distension plus manual therapy. [Subjects and Methods] Patients were randomly assigned to 2 groups: 60 patients in group A were treated with hydraulic distension plus manual therapy, and 61 in group B were treated with hydraulic distension alone. Treatment effects were assessed using the Visual Analog Scale (VAS) (pain and satisfaction), and active range of motion of the shoulder (forward flexion, internal and external rotation) before treatments and at 2, 6, 12, 24 weeks, and 1 year after the last injections. [Results] Patients in group A achieved faster pain relief and better satisfaction than patients in group B during the 6 weeks after treatment. However, no significant difference in VAS was observed between the groups at final follow-up. AROM of the shoulder was improved at final follow-up in both groups. [Conclusion] Hydraulic distension plus manual therapy provided faster pain relief, a higher level of patient satisfaction, and an earlier improvement in AROM of the shoulder than hydraulic distension alone in patients with frozen shoulder.

Relationships Between Capsular Stiffness and Clinical Features in Adhesive Capsulitis of the Shoulder

BackgroundTightening and contracture of the joint capsule are hallmarks of adhesive capsulitis of the shoulder (ACS). However, quantification of capsular stiffness and its relation to clinical features have not been investigated thoroughly. ObjectivesTo quantify capsular stiffness during intra-articular hydraulic distension (IHD) and to investigate its relationships with pain severity, symptom duration, range of motion (ROM), gender, and diabetes status. DesignCase series. SettingUniversity outpatient clinic of physical medicine and rehabilitation. ParticipantsA total of 107 consecutive patients with ACS who underwent IHD. MethodsPressure-volume monitoring data during IHD, pain severity, symptom duration, shoulder ROM, and diabetes status were obtained by retrospective chart review. Capsular stiffness (Kcap) was measured by calculating the slope of the elastic phase in pressure-volume curves. ROM was evaluated in 3 directions (flexion, abduction, and external rotation) with a goniometer, and the sum of the 3 ROMs was calculated. Main Outcome MeasurementsPearson correlation coefficients and comparisons of averages were used to analyze the relationships between Kcap and clinical features. ResultsThe mean Kcap of the total group of participants was 26.0 ± 14.2 mmHg/mL. Shoulder pain in motion or rest did not correlate with Kcap. Patients with stiffer capsules had smaller sums of ROMs (r = −.298, P = .002), with distinct limitations in external rotation and abduction (r = −.278, P = .004 and r = −.313, P = .001, respectively). Women had significantly stiffer capsules than men (29.5 ± 14.3 versus 20.2 ± 12.1 mmHg/mL, P = .001). Diabetes status had no significant effect on capsular stiffness. ConclusionsCapsular stiffness of the glenohumeral joint significantly correlated with limitation in shoulder ROM, especially in the abduction and external rotation directions, whereas there were no meaningful relationships with shoulder pain during motion or rest. This is the first study to reveal the relationships between in vivo quantified capsular stiffness and shoulder ROM limitations.

Effect of Hypertonic Saline in Intra-Articular Hydraulic Distension for Adhesive Capsulitis

BackgroundMaintaining the integrity of the capsule along with infusing a sufficient amount of fluid is 1 of the therapeutic concepts in intra-articular hydraulic distension (IHD) for adhesive capsulitis. It has been known that hypertonic saline solution decreases tissue edema and increases the fluid volume within the epidural space, causing microdissection, in epidural adhesiolysis. ObjectiveTo investigate the effect of hypertonic saline solution in capsule-preserving intra-articular hydraulic distension (CPIHD) for adhesive capsulitis. DesignProspective randomized controlled trial. SettingUniversity outpatient clinic of physical medicine and rehabilitation. ParticipantsA total of 64 patients who were diagnosed as adhesive capsulitis of shoulder were randomly assigned to 1 of 2 treatment groups. The hypertonic saline group was treated by CPIHD with hypertonic saline (3% NaCl), and the normal saline group with normal saline solution (0.9% NaCl). MethodsBoth groups were treated with CPIHD, a method that preserves the capsule with maximal distension without inducing capsule rupture. The volume of saline solution necessary to adequately distend the capsule was recorded. Injection materials contained 4 mL of 1% lidocaine, 1 mL of triamcinolone (10 mg), and saline solution (hypertonic or normal saline). The intra-articular injection was monitored with ultrasound to maximize the infused volume while preserving the capsule. Main Outcome MeasurementsThe Shoulder Pain and Disability Index (SPADI) and shoulder passive range of motion (PROM) was measured before the procedure and 2 weeks after CPIHD. ResultsThe mean CPIHD volume was 20.2 ± 5.2 mL for the hypertonic saline group and 19.5 ± 5.9 mL for the normal saline group. The hypertonic saline group showed statistically significant improvement in shoulder PROM and SPADI score compared with the normal saline group. Side effects such as soreness or complications related to injection were not reported. ConclusionsOur results suggest that CPIHD with hypertonic saline solution is more effective than that using normal saline solution in patients with adhesive capsulitis.

Sjögren's syndrome complicated by interstitial cystitis: A case series and literature review

ObjectivesTo characterize the interstitial cystitis (IC) associated with Sjögren's syndrome (SS). MethodsReport of three new cases. Only cases fulfilling the American-European consensus criteria for SS and the European Society for the Study of Interstitial Cystitis criteria with positive histological findings for IC were included. ResultsThirteen cases of SS and IC have been reported in women, including the three reported here, with a mean age of 54 years. SS appeared first in 77% (n=10) of cases, a mean of 6.6 years before IC. The symptoms of IC included pollakiuria (n=11), lower abdominal pain (n=8), urinary urgency (n=5), painful micturition (n=6), hematuria (n=3) and dysuria (n=3). Urinary dilatation occurred in three cases, leading to acute renal failure in two patients. The diagnosis of IC was confirmed by anatomical evidence of cystitis inflammation on bladder biopsy in all (n=13) patients. Treatment was reported for nine patients, seven of whom (78%) received corticosteroid treatment, which was partially or completely effective in six cases. Immunosuppressive treatment was added in three cases (cyclosporine, n=2; azathioprine, n=1; cyclophosphamide, n=1). Local bladder treatments were performed, with hydraulic distension in five cases and DMSO instillation in one patient. A urinary catheter was inserted in the two cases of acute obstructive renal failure. ConclusionsUrinary symptoms without infection should lead the physician to consider a diagnosis of IC in SS patients. Urinary dilatation may occur, leading to acute obstructive renal failure. Corticosteroid treatment may be effective and local treatments have been tried.

Comparison Intra Articular Steroid vs. Hydraulic Distention for the Treatment of Frozen Shoulder

Background Frozen shoulder is a chronic fibrosing condition of the capsule of the shoulder joint. OBJECTIVE The objective of the study was to compare the result of treatment of frozen shoulder by Hydraulic Distention under local anesthesia with steroid and intra articular steroid alone. Sample Size: 60 patients were taken in this study and were divided into two groups. Duration and Setting: The study was conducted in 2005-2006 treated in the department of orthopaedic, Janaki medical college Teaching Hospital, Janakpur. Materials and Methods: It was a prospective, observational, comparative and clinical study. Sixty patients were selected from Dhanusha District of Janakpur, Nepal. They were divided into two groups. Since January 2005 to January 2006 periods in the department of orthopedics surgery, Janaki Medical College & Teaching Hospital, Janakpur. The Group I was treated by hydraulic distention of glenohumeral joint with 50ml normal saline with steroid, oral medicines (analgesics and muscle relaxants) and exercises. Patients in group II were treated by intra-articular steroid followed by oral medicines (analgesics and muscle relaxants) and exercises. Results: The average age of patients in group I was 52 ± 2.16 years and 50 ± 2.03 in group II. There were 37 (63%) females and 23 (37%) males in our study. Female to male ratio was 1.7:1. All patients in group noted immediate pain relief with excellent return of range of motion (ROM) and resumption of normal sleep. At the end of 45 days of follow up all patients had returned to their normal daily activities. Most of them got excellent ROM and pain relief. All patients in group II noted immediate pain relief and resumption of almost normal sleep. At the end of 45 days of follow up most of the patient presented with good relief of pain but could not return to most of their normal activities because of less improvement in ROM. Conclusions: Hydraulic distension technique is quick, safe and gives early results, so it should be considered first for the treatment of frozen shoulder. DOI: http://dx.doi.org/10.3126/jucms.v1i1.8415 Journal of Universal College of Medical Sciences Vol.1(1) 2013: 3-9

Intraarticular hydraulic distension with steroids in the management of hemiplegic shoulder

The aim of this study is to compare intraarticular steroid administration and steroid administration with hydraulic distention of the glenohumeral joint in hemiplegic patients who had developed shoulder pain and limitation. Materials and methods: The study consisted of 60 patients attending an inpatient rehabilitation program following a stroke. Each patient had shoulder pain and shoulder limitations . The patients were divided into 3 groups consisting of 20 patients each, according to their order of admission. Conventional physical treatment and rehabilitation (PTR) methods were applied to the patients in Group 1 (control group), conventional PTR and an intraarticular steroid were applied to Group 2, and conventional PTR, hydraulic distention, and the steroid were applied to Group 3. The patients were evaluated according to joint range of motion (ROM), pain (Visual Analogue Scale), and shoulder function before treatment, the first day of treatment, and 1 month after treatment began. Results: ROM in all directions and function showed a statistically significant increase, along with a significant decrease in pain, 1 month after treatment in all groups. The improvement in the steroid + hydraulic distention group (Group 3) was statistically significantly better than in the steroid + PTR and control groups (P < 0.001). Conclusion: We found a marked increase in the ROM in all directions, decreased pain, and better upper extremity function in hemiplegic patients with shoulder pain and ROM limitation 1 month after the steroid administration + hydraulic distention of the shoulder joint. This finding indicated that steroids together with hydraulic distention of the shoulder joint can be used as an inexpensive, easy, and effective method in hemiplegic patients with shoulder pain and ROM limitation.

Changes in Biomechanical Properties of Glenohumeral Joint Capsules With Adhesive Capsulitis by Repeated Capsule-Preserving Hydraulic Distensions With Saline Solution and Corticosteroid

To investigate whether capsule-preserving hydraulic distension with saline solution and corticosteroid for adhesive capsulitis induces biomechanical alterations in glenohumeral joint capsules along with clinical improvements. A case series. University outpatient clinic of physical medicine and rehabilitation. Eighteen patients with unilateral adhesive capsulitis. INTERVENTION AND MAIN OUTCOME MEASUREMENTS: Three hydraulic distensions with saline solution and corticosteroid were performed with 1-month intervals. To avoid rupturing capsules, all distensions were monitored by using real-time pressure-volume curves. Stiffness, maximal volume capacity, and pressure at the maximal volume capacity of the capsule were measured at each intervention. Clinical parameters, such as pain and range of motion, were recorded before, 3 days after, and 1 month after each distension. Stiffness decreased (47.6 ± 27.1 mm Hg/mL to 31.7 ± 18.4 mm Hg/mL to 24.2 ± 14.0 mm Hg/mL, mean SD) and maximal volume capacity increased (18.8 ± 7.3 mL to 20.5 ± 7.5 mL to 24.2 ± 7.0 mL, mean SD) significantly (P = .001 for both) at each repeated hydraulic distension. Pressure at the maximal volume capacity tended to decrease, but the decrements were not statistically significant (P = .662). The clinical parameters were significantly improved throughout and 1 month after the 3 repeat procedures (P < .05 for all). Capsule-preserving hydraulic distension changed the biomechanical properties of the glenohumeral joint capsule, lessening the stiffness and enlarging the volume capacity. These alterations were accompanied by improved range of motion and relief of pain. Repeated capsule-preserving hydraulic distension with saline solution and corticosteroid would be useful to treat adhesive capsulitis and to evaluate the treatment results.

Single puncture for TMJ arthrocentesis: An effective technique for hydraulic distention of the superior joint space

Temporomandibular joint arthrocentesis is a method of flushing out the synovial fluid that is currently performed by providing a double puncture to the upper joint space. The traditional 2-needle technique has some restrictions, such as the difficulty in performing it in the presence of intra-articular adherences and in the female patients, because the space is very small. The adoption of a single-needle for fluid injection might have some advantages with respect to the traditional 2-needle approach in terms of easily, time of execution and tolerability. We describe a single needle technique and we recommend the use.

Capsule preservation improves short‐term outcome of hydraulic distension in painful stiff shoulder

The effect of intraarticular hydraulic distension (IHD) for a painful stiff shoulder (or adhesive capsulitis) has been affirmed, but whether rupturing the joint capsule during this process is beneficial remains controversial. By monitoring real-time pressure-volume (PV) profiles during IHD, we could infuse the largest possible volume without rupturing the capsule. Using the novel technique, we compared the short-term effects of IHD when the capsule was preserved versus when it was ruptured. Fifty-four patients with a painful stiff shoulder underwent IHDs intended to preserve or rupture the capsule and then classified into capsule-ruptured (n = 26) and capsule-preserved (n = 20) groups, based on the obtained PV profiles. Their profiles were triphasic or biphasic; eight with flat profiles were excluded from the comparison. Clinical outcomes were evaluated at 3-day and 1-month follow-ups, in terms of pain and range of motion (ROM). Although both groups showed significant increase in ROM and decrease in pain after IHD, the improvements were greater in the capsule-preserved group than in the ruptured group at both follow-up times, and in triphasic and biphasic cases. In conclusion, the therapeutic effects of IHD in short-term follow-ups were enhanced by preserving the capsule.