Capsule preserving Ultrasound guided hydrodilatation bests capsule rupture technique for shoulder adhesive capsulitis

Adhesive capsulitis (AC) is a common disorder presenting with shoulder pain which gradually progresses to global limitation of both active and passive range of motion (ROM). The rate of complete symptoms’ resolution following conservative treatment has been reported to be as low as 50%. Among all treatment strategies, GHJ hydrodilatation has been shown to be effective in reducing pain and restoring ROM with satisfying short- and long-term outcome.

Madalena Pimenta et al conducted a study to compare the clinical efficacy of capsule-rupturing versus capsule-preserving ultrasound-guided hydrodilatation in patients with shoulder adhesive capsulitis (AC).

Within a 2-year period, 149 consecutive patients with AC were prospectively enrolled and allocated into (i) group-CR, including 39 patients receiving hydrodilatation of the glenohumeral joint (GHJ) with capsular rupture and (ii) group-CP, including 110 patients treated with GHJ hydrodilatation with capsular preservation. Demographics, affected shoulder, and AC grade were recorded. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and visual analog scale (VAS) were used for clinical assessment at baseline/1/3/6 months. Comparisons were performed with Mann-Whitney U test and Kolmogorov-Smirnov test. Linear regression was used to identify predictors of outcome. P value < 0.05 defined significance.

Key findings of the study were:

• DASH and VAS scores in both groups improved significantly compared to baseline (P < 0.001) and were significantly lower in the CP compared to CR group at all time-points following intervention (P < 0.001).

• Capsule rupture was a significant predictor of DASH score at all time-points (P < 0.001).

• DASH scores correlated to initial DASH score at all time-points (P < 0.001).

• DASH/VAS scores at 1 month were correlated to the AC grade (P = 0.025/0.02).

The authors concluded that – “GHJ hydrodilatation results in pain elimination and functional improvement till the mid-term in patients with AC, with improved outcome when adopting the capsule-preserving compared to the capsule-rupturing technique. Higher initial DASH score is predictive of impaired functionality in the mid-term.”

Further reading:

Ultrasound guided hydrodilatation for adhesive capsulitis: capsule preserving versus capsule rupturing technique

Madalena Pimenta, Evangelia E. Vassalou et al

Skeletal Radiology (2024) 53:253–261

https://doi.org/10.1007/s00256-023-04392-7