Adhesive capsulitis (AC) is a chronic, debilitating condition characterized by pain and progressive stiffness of the shoulder joint. Hydrodilatation (HD) is a commonly used method of non-surgical management. However, its effectiveness in patients with rotator cuff pathology remains unclear.
Aishwarya Prakash et al conducted a study to evaluate and compare the clinical effectiveness of HD in patients with AC, with and without rotator cuff tears. A secondary objective was to assess clinical outcomes in patients with concurrent type 2 diabetes mellitus.
The retrospective cohort comprised 78 patients (six excluded due to loss to follow-up and two excluded due to incomplete data) who underwent HD. Patients were stratified by rotator cuff integrity (intact n=60, partial-thickness tear n=10, full-thickness tear n=8). Pain (Visual Analog Scale (VAS)) and range of motion (ROM: abduction, flexion, and external rotation) were recorded at baseline, six weeks, three months, and six months. Change scores were analyzed using the Wilcoxon signed-rank and Kruskal- Wallis tests with Benjamini-Hochberg false discovery rate (FDR) correction. The primary endpoint was the change in abduction at three months.
The key findings of the study were:
• All groups demonstrated significant within-group improvements in pain and ROM (all p-values adjusted for multiple comparisons using the Benjamini-Hochberg FDR (p(FDR < 0.05), except flexion at six months in the full-thickness tear group (p(FDR) = 0.271).
• At three months, median abduction improvement was 80° (60-90) in the intact group vs 40° (20-75) in partial-thickness and 35° (17.5-70) in full-thickness tears (H=13.21, p(FDR)=0.005).
• External rotation gains were also greater in the intact group, most notably at three months (Z=3.91, p(FDR) = 0.002 vs partial-thickness).
• Pain reduction was observed in all groups, but reductions were greater in the intact versus full-thickness subgroup (three months: Z=−3.08, p(FDR)=0.014).
• Patients with diabetes demonstrated attenuated ROM recovery but similar pain improvement compared with nondiabetic patients.
The authors concluded – “HD provided meaningful pain relief across all patient subgroups in this retrospective cohort. However, rotator cuff integrity substantially influenced ROM recovery, with reduced gains in patients with partial and full-thickness tears. Diabetic patients appeared to achieve less ROM improvement, although this subgroup was small, and findings should be interpreted cautiously. Pre-procedure imaging and individualised counselling are recommended.”
Further reading:
Effectiveness of Hydrodilatation for Adhesive Capsulitis in Patients with Pre-existing Rotator Cuff Tears
Aishwarya Prakash et al
Cureus 17(12): e98492.
DOI 10.7759/cureus.98492
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