Shoulder hydrodilatation for primary, post-traumatic and post-operative adhesive capsulitis

2020 ◽  
pp. 175857322097717
Author(s):  
Daoud Makki ◽  
Mustafa Al-Yaseen ◽  
Fayaz Almari ◽  
Puneet Monga ◽  
Lennard Funk ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Outcome Measures ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Capsular Release ◽  
Arthroscopic Capsular Release ◽  
Number Of Patients ◽  
Post Traumatic

Background Adhesive capsulitis (frozen shoulder) is characterised by pain and loss of range of motion of the glenohumeral joint. It can be present as primary (idiopathic) or secondary to surgery, trauma or other conditions that restrict the use of the shoulder joint. Various treatment options have been adopted including physiotherapy, manipulation under anaesthetic, hydrodilatation and arthroscopic or open capsular release but the optimal form of management remains uncertain. Objectives The purpose of the study was to assess the clinical outcome of glenohumeral hydrodilatation in three cohorts of patients with different aetiologies with adhesive capsulitis. Study design & methods We carried out a retrospective study of patient who underwent hydrodilatation for adhesive capsulitis between 2013 and 2015. The procedure was performed by a specialist musculoskeletal radiologist under radiological guidance. The injection consisted of steroids, local anaesthetics and NaCl solution with a target volume around 35 mL. Our outcome measures were range of motion, and pre- and post-operative pain. Patients were divided into three groups based on the presumed cause of their stiffness: idiopathic, post-traumatic and post-surgical. Results Two hundred fifty patients were included, with a mean age of 59 years (range: 20–79). Of these, 180 had idiopathic primary adhesive capsulitis (27 were diabetic), 23 were post-traumatic, and 20 following surgical procedures. Thirty-four required further intervention following initial hydrodilatation with 8 undergoing repeat hydrodilatation, and 26 requiring arthroscopic capsular release. The diabetic group accounted for 16 capsular releases and 4 repeat procedures, while the idiopathic group accounted for 9 and 4, respectively. One patient required capsular release in the surgical group. An improvement was recorded in ROM in all groups with mean abduction improving from 59° to 110°, flexion from 50° to 120° and external rotation from 20° to 50°. With regards to pain, the majority showed an improvement from severe or moderate pain to no or mild pain. Conclusions Results show that hydrodilatation resulted in an improvement in all outcome measures, with only a small number of patients, especially those with diabetes, needing further procedures or showing no improvement in range of motion and pain. There was no difference between the post-traumatic and post-surgical groups.

scholarly journals Factors Affecting the Outcomes of Arthroscopic Capsular Release for Idiopathic Adhesive Capsulitis

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986762 ◽  
Author(s):  
Syed M. Rizvi ◽  
Ahmed J. Harisha ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
External Rotation ◽  
Adhesive Capsulitis ◽  
Linear Regression Analysis ◽  
Frozen Shoulder ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Capsular Release ◽  
Arthroscopic Capsular Release

Background: Arthroscopic capsular release has been shown to provide excellent short- and long-term outcomes in patients with idiopathic frozen shoulder. Some surgeons delay surgery in the belief that operating in the early stages of adhesive capsulitis results in a poorer prognosis. However, it is unclear which factors, particularly the stage of the disorder, affect the surgical outcome of this procedure. Hypothesis: Patients who undergo capsular release during the early symptomatic stage of idiopathic adhesive capsulitis would have less improvement in range of motion compared with those who undergo surgery at a later stage. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 189 shoulders with idiopathic adhesive capsulitis that underwent arthroscopic capsular release were evaluated. All patients completed a L’Insalata questionnaire and had their range of motion and strength tested prior to surgery and at 1, 6, and 12 weeks and 6 months post–capsular release. Post hoc, patients were grouped by whether they had symptoms lasting <10 months (shorter symptoms group; n = 131) or ≥10 months (longer symptoms group; n = 38). Multiple linear regression analysis was performed to determine which preoperative factors were independently associated with a favorable outcome. Results: Patients in the shorter symptoms group were more restricted prior to surgery than were those in the longer symptoms group (mean ± SEM: external rotation, 17° ± 2° vs 27° ± 4° [ P = .04]; abduction, 78° ± 3° vs 92° ± 6° [ P = .04]; internal rotation, S3 ± 1 vs S1 ± 1 [ P = .03]). The shorter symptoms group had greater postoperative improvement in internal rotation (from S3 ± 1 preoperatively to T12 ± 1 vertebral levels) compared with the longer symptoms cohort (from S1 ± 1 to L2 ± 1) ( P = .02). Conclusion: Patients with a frozen shoulder and a duration of symptoms <10 months made greater improvements in internal rotation and had similar final results for flexion, abduction, and external rotation following arthroscopic capsular release when compared with patients who had a longer duration of symptoms, so there is no reason to delay surgery.

scholarly journals A prospective study on causes and functional outcome of frozen shoulder

2016 ◽  
Vol 4 (1) ◽  
pp. 23
Author(s):  
Sanjeev Mahajan ◽  
Daksh Gadi ◽  
Rahul Gupta ◽  
Saurav Singla ◽  
Piyush Setia ◽  
...  
Keyword(s):  
Prospective Study ◽  
Functional Outcome ◽  
Indian Population ◽  
Glenohumeral Joint ◽  
Early Stage ◽  
Adhesive Capsulitis ◽  
Treatment Options ◽  
Frozen Shoulder ◽  
Capsular Release ◽  
Arthroscopic Capsular Release

<p><strong>Backgroud:</strong> Frozen shoulder also called as adhesive capsulitis is a condition characterised by global limitation of humeroscapular motion resulting from contracture and loss of compliance of the glenohumeral joint capsule. Frozen shoulder is a common problem and results in frustrating debilitation for its sufferers. There can be many reasons for pain and stiffness of shoulder joint, so it is very important to differentiate between adhesive capsulitis and the other causes.</p><p><strong>Objective:</strong> The main objective of the study was to evaluate the various modes of treatment for frozen shoulder and to identify various causes and associations of frozen shoulder in Indian population. To the best of our knowledge no prospective study has been done which have compared different treatment options in patients of adhesive capsulitis in Indian population.</p><p><strong>Methods:</strong> The study was done on 75 patients which were divided into three groups, based on the mode of management i.e. conservatively with medication and physiotherapy, physiotherapy and intraarticular injection and arthroscopic capsular release. The range of movement and functional outcome was compared using Constant &amp; Murley score.</p><p><strong>Conclusion:</strong> We found that patients undergoing conservative management showed benefits of various treatment options if the condition is diagnosed at an early stage but the results convincingly prove the advantages of arthroscopic capsular release in patients with chronic painful stiff shoulder or in failed conservative treatment.</p>

Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis

2021 ◽  
pp. 1-8
Author(s):  
Ya-Dong Wang ◽  
Yu-Xiang Ming ◽  
Yong-Hua Pang ◽  
Wei-Nan Chen ◽  
Xu-Hua Zong ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Rotation ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Shoulder Stiffness ◽  
Capsular Release ◽  
Shoulder Range Of Motion ◽  
Arthroscopic Capsular Release ◽  
Shoulder Range

BACKGROUND: Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE: The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD: A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS: Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION: Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.

scholarly journals Arthroscopic capsular release for idiopathic frozen shoulder with intra-articular injection and a controlled manipulation

2014 ◽  
Vol 96 (1) ◽  
pp. 55-60 ◽  
Author(s):  
CD Smith ◽  
P Hamer ◽  
TD Bunker
Keyword(s):  
Pain Relief ◽  
Range Of Motion ◽  
Frozen Shoulder ◽  
Stage Ii ◽  
Capsular Release ◽  
Oxford Shoulder Score ◽  
Arthroscopic Capsular Release ◽  
Good Pain Relief ◽  
The Mean ◽  
Shoulder Score

INTRODUCTION The aim of this prospective study was to assess the immediate and long-term effectiveness of arthroscopic capsular release in a large cohort of patients with a precise and isolated diagnosis of stage II idiopathic frozen shoulder. METHODS All patients underwent a preoperative evaluation. Patients with secondary frozen shoulder and those with concurrent pathology at arthroscopy were excluded. This left 136 patients with a stage II arthroscopically confirmed idiopathic frozen shoulder. At each postoperative attendance, a record was made of pain, function and range of motion. At 12 months, the Oxford shoulder score was calculated, and pain and range of motion were assessed. RESULTS Fifty per cent achieved good pain relief within a week and eighty per cent within six weeks of arthroscopic capsular release. The mean preoperative visual analogue scale pain score was 6.6 and the mean postoperative score was 1.0. The mean time to achieving good pain relief was 16 days following surgery. No patient could sleep through the night prior to surgery while 90% reported having a complete night’s sleep at a mean of 12 days after surgery. The mean postoperative Oxford shoulder score was 38/48 and the mean improvement was 19.2. CONCLUSIONS This large series demonstrates that arthroscopic capsular release is a safe procedure, with rapid improvement in pain and a marked improvement in range of motion.

scholarly journals IDIOPATHIC UNILATERAL FROZEN SHOULDER

2018 ◽  
Vol 25 (02) ◽  
Author(s):  
Kanwal Arshad ◽  
Farooq Islam ◽  
Sunaina Muneer
Keyword(s):  
Range Of Motion ◽  
Glenohumeral Joint ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Systematic Sampling ◽  
Shoulder Abduction ◽  
P Value ◽  
Surgical Interventions ◽  
Group I ◽  
Group Ii

Introduction: Frozen shoulder or adhesive capsulitis is a condition affectingthe glenohumeral joint and leads to restricted painful shoulder. It is very debilitating. This notonly affects the activities of daily living of a person but job related chores too. The inflammationof the capsule of the glenohumeral joint causes pain and restriction of the motion. Adhesivecapsulitis can be characterized as primary or secondary. It can be secondary due to anyunderlying disease such as cervical spondylosis or diabetes mellitus. People affected seekdifferent treatment options for this debilitating condition such as taking non-steroidal antiinflammatorydrugs (NSAIDS), steroid injections, taking physical therapy and some even gofor surgical interventions. Objective: the objective of this research was to find out whetherKaltenborn mobilization technique alone improved the restricted shoulder abduction range ofmotion in better way or a combination of Kaltenborn mobilization and range of motion exerciseswas a better option. Study Design: randomized clinical trial (RCT). Setting: Fatima MemorialHospital (FMH) Shadman Lahore. Period: a period of 6 months. Material and Methods:Group I: Thirty patients participated in this group and were treated with Kaltenborn mobilizationtechnique along with range of motion exercises. Group II: The second group also consisted ofthirty patients and were treated with Kaltenborn mobilization technique without range of motionexercises. Sample Size: Sixty patients were included in the research by taking 30 patients ineach group. Systematic sampling was used in which all the odd ordered patients (1st, 3rd, 5th etc.)were included in group I while all the even ordered patients (2nd, 4th, 6th etc.) in group II. Results:For abduction the mean change was 29.33±10.65 in combination while for kaltenborn alone themean change was 12.30±4.06. The values obtained for shoulder abduction were significantlyhigher in Kaltenborn + ROM group, p-value < 0.05. Conclusion: A combination of Kaltenbornmobilization along with range of motion exercises showed better results in improving shoulderabduction range of motion.

scholarly journals Single intra-articular steroid injection of the glenohumeral joint in management of adhesive capsulitis: a comparison between approaches

2018 ◽  
Vol 4 (3) ◽  
pp. 410
Author(s):  
Surykanth Kalluraya ◽  
Anand Varma ◽  
Jayaram P. H.
Keyword(s):  
Range Of Motion ◽  
Outcome Measures ◽  
Glenohumeral Joint ◽  
Steroid Injection ◽  
Adhesive Capsulitis ◽  
Exercise Program ◽  
Steroid Injections ◽  
Vas Score ◽  
Shoulder Range Of Motion ◽  
Therapeutic Exercises

<p class="abstract"><strong>Background:</strong> Adhesive capsulitis is a common, painful musculoskeletal condition of the shoulder associated with loss of range of motion in the glenohumeral joint resulting from contraction of the glenohumeral joint capsule and adherence to the humeral head. Earlier stages of adhesive capsulitis can be treated by intra-articular steroid injections into the glenohumeral joint. This study was designed to study the role of long acting intra-articular corticosteroid injections in combination with simple therapeutic exercises while comparing the outcome of blinded anterior and posterior injection approaches in the management of adhesive capsulitis.</p><p class="abstract"><strong>Methods:</strong> The study comprised of 60 subjects aged 18 years and above who were diagnosed with primary adhesive capsulitis. They were randomly divided into 2 groups i.e., Group A who received blind intra-articular steroid injections via standard anterior approach and group B who received blind intra-articular steroid injection via standard posterior approach. Both groups followed up with a simple home based exercise program. Outcome measures assessed were visual analog scale (VAS) score, shoulder pain assessment disability index (SPADI) and passive shoulder range of motion (ROM).<strong></strong></p><p class="abstract"><strong>Results:</strong> At last follow up, both groups showed statistically significant improvements in all outcome measures i.e., VAS score, SPADI, shoulder ROM. However, comparison between groups did not reveal any statistically significant differences between the two groups.</p><p class="abstract"><strong>Conclusions:</strong> Intra-articular steroid injections into the glenohumeral joint in conjunction with simple physiotherapy are effective in improving pain, function and shoulder ROM in adhesive capsulitis. Both the anterior and posterior injection approaches provide good results.</p>

scholarly journals MID-LONG TERM RESULTS OF MANIPULATION AND ARTHROSCOPIC RELEASE IN FROZEN SHOULDER

2017 ◽  
Vol 25 (6) ◽  
pp. 270-274 ◽  
Author(s):  
HALUK CELIK ◽  
MUSTAFA FAIK SECKIN ◽  
MEHMET AKIF AKCAL ◽  
ADNAN KARA ◽  
BEKIR ERAY KILINC ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
External Rotation ◽  
Frozen Shoulder ◽  
Case Series ◽  
Long Term Results ◽  
Treatment Level ◽  
Capsular Release ◽  
Arthroscopic Release ◽  
Arthroscopic Capsular Release

ABSTRACT Objective: Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. Methods: A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. Results: Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients’ values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. Conclusion: Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series.

scholarly journals Does Single Blind Anterior Glenohumeral Steroid Injection Performed by Short Experienced Clinicians Could Provide Clinical Efficacy in Patients with Frozen Shoulder?

2014 ◽  
Vol 17 (3) ◽  
pp. 102-106
Author(s):  
Jin Ho Hong ◽  
Ho Young Ryu ◽  
Yong Bok Park ◽  
Sang Jun Jeon ◽  
Won Ha Park ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Glenohumeral Joint ◽  
Steroid Injection ◽  
External Rotation ◽  
Corticosteroid Injection ◽  
Adhesive Capsulitis ◽  
Frozen Shoulder ◽  
Analog Scale ◽  
The Mean ◽  
Frozen State

BACKGROUND: The purpose of this study was to evaluate the effect of single blinded anterior intra-articular corticosteroid injection to the glenohumeral joint performed by short experienced clinicians in frozen state adhesive capsulitis patients.METHODS: From March to June of 2013, among the patients who visited the shoulder outpatient clinic due to shoulder pain for 5-6 months and those patient diagnosed as frozen state adhesive capsulitis was selected. The diagnosis were based on base, first the global limitation of range of motion, defined as forward elevation <100, external rotation at side <10, internal rotation less than buttock, and abduction <70. Second, the patients had additional radiologic evaluations showing no major pathologies for such stiffness. Clinical outcome, were performed with pain visual analog scale (PVAS) and functional visual analog scale (FVAS), American Shoulder and Elbow Surgeons Shoulder score (ASES), preinjection and postinjection after 2-4 weeks. Finally 82-patients were enrolled. Mean age of the patients was 55.1 years and mean follow-up duration was 25.17 days.RESULTS: The mean preinjection PVAS was 6.91 and postinjection was 3.11, there was 3.8 decreases from preinjection status (p < 0.001). The mean FVAS score showed 4.26 at preinjection and 6.63 afterwards (p < 0.001). The ASES score showed 27.89 increases after injection (p < 0.001). There were 64-patients (78.04%) who reported more than 3 points of decrease of PVAS, who could be judged as effective treatment.CONCLUSIONS: Single anterior glenohumeral steroid injection by short experienced clinicians to the patients with frozen state adhesive capsulitis has shown relatively high efficacy in clinical result evaluated by means of PVAS.

scholarly journals Clinical Outcome after Arthroscopic Capsular Release for Adhesive Capsulitis of the Shoulder

2018 ◽  
Vol 21 (3) ◽  
pp. 127-133 ◽  
Author(s):  
Jae Chul Yoo ◽  
Kyoung Hwan Koh ◽  
Min Soo Shon ◽  
Kyu Hwan Bae ◽  
Tae Kang Lim
Keyword(s):  
Glenohumeral Joint ◽  
Constant Score ◽  
Adhesive Capsulitis ◽  
Clinical Results ◽  
Subacromial Space ◽  
Capsular Release ◽  
Clinical Evaluations ◽  
Arthroscopic Capsular Release ◽  
Partial Rotator Cuff Tear

BACKGROUND: This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder.METHODS: This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant's score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up.RESULTS: Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34?74). Mean follow-up duration was 24 months (range, 12?40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up (p≤0.001 for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up.CONCLUSIONS: Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.

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