The effectiveness of ultrasound guided hydrodistension and physiotherapy in the treatment of frozen shoulder/adhesive capsulitis in primary care: a single centre service evaluation

Abstract

This service evaluation demonstrates that management of frozen shoulder stage II to III, as conducted by physiotherapists in a primary care setting utilizing hydrodistension and a guided exercise programme, represents an effective non-operative treatment strategy.

The effectiveness of hydrodistension and physiotherapy following previously failed conservative management of frozen shoulder in a UK primary care centre

“…Importantly, hydrodistension may therefore prove to be a useful clinical tool for reducing the number of referrals for surgical intervention, and therefore give rise to significant financial savings. Bryant et al () quoted a cost of £131 for a primary care hydrodistension procedure, which correlated closely with other published figures (O'Connaire & Lewis, ). Savings per patient, based on published evidence, suggested a saving of £2,073 per patient if undergoing hydrodistension within a primary care clinic compared with surgery (Maund et al, ; O'Connaire & Lewis, ), with evidence suggesting similar, if not improved, outcomes form hydrodistension compared with those post‐surgery (Quraishi et al, ).…”

“…Importantly, hydrodistension may therefore prove to be a useful clinical tool for reducing the number of referrals for surgical intervention, and therefore give rise to significant financial savings. Bryant et al (2017) quoted a cost of £131 for a primary care hydrodistension procedure, with those post-surgery (Quraishi et al, 2007). Furthermore, no significant complications or infections were reported in our study, consistent will other published work (Bell, Coghlan, & Richardson, 2003;Buchbinder et al, 2004 Probability refers to the chances (as a percentage) that the change in outcome measure represents less/trivial/more disability or pain beyond the minimal threshold of 13 units.…”

“…All patients were referred with an initial diagnosis of frozen shoulder; this was subsequently confirmed by a sports and exercise medicine consultant (***Blinded for review purposes***) within the service. The diagnosis of frozen shoulder was made, consistent with the same diagnostic criteria as those used in other studies (Bateman, McClymont, & Hinchliffe, 2014;Bryant, Gough, Selfe, Richards, & Burgess, 2017;Yoong et al, 2015), following a detailed history, a clinical examination showing loss of both passive and active range of movement of at least 50%, in at least two directions out of abduction, internal or external rotation and flexion in a sagittal plane. All patients had a normal anteroposterior and axillary lateral shoulder X-ray (Quraishi et al, 2007).…”

In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study

“…When comparing the two groups 3 months after hydrodilatation, there was statistically significant more improvement after the anterior rotator interval approach regarding VAS pain and SPADI, as well as regarding abduction and external rotation. Bryant et al studied the effectiveness of an ultrasoundguided hydrodistension (with 10 m lidocaine 1%, followed by 40 mg triamcinolone acetonide, and thereafter 20 ml of 0.9% NaCl), via posterior approach, followed by a guided exercise program, in adhesive capsulitis patients, in a primary care setting [26]. They found after 6 weeks and after 3 and 6 months a significant and continuing improvement on the SPADI scores, the Disability Arm Shoulder Hand (Quick DASH) scores, and clinical significant improvements of external rotation, flexion, and abduction movements compared to baseline.…”

“…They found after 6 weeks and after 3 and 6 months a significant and continuing improvement on the SPADI scores, the Disability Arm Shoulder Hand (Quick DASH) scores, and clinical significant improvements of external rotation, flexion, and abduction movements compared to baseline. They did not compare the posterior approach with rotator interval approach [ 26 ]. The current study applied 15 ml saline with 1 ml lidocaine and 1 ml methyl-prednisolone acetate (40 mg) for hydrodilatation and had similar improvements regarding pain, abduction, external rotation of the shoulder joint, and SPADI, with posterior and anterior approach followed by physiotherapy program.…”