Treatment of 'Frozen Shoulder' with Distension and Glucorticoid Compared with Glucorticoid Alone: A Randomised Controlled Trial

Abstract

This study is a comparison of treatments of idiopathic "Frozen Shoulder" (adhesive capsulitis), distension combined with steroid is compared with steroid alone. Evaluation was based on pain scales, analgesic usage, and range of motion outcome scales. Out of one-hundred twenty patients (age, mean 51, range 21-70) that were referred under the diagnosis FS, twenty-six fulfilled the criteria for inclusion in the study, but four patients did not want to participate in the trial, giving a total of 22 patients (age, mean 53, range 40-65) in the study. Patients were randomised by the envelope method. Two patients dropped-out, one in each treatment group thus leaving the study with 20 patients for the final statistical analysis. Eight were treated with steroid alone and 12 with distension combined with steroid. Patients received one treatment per week for a six weeks period with a follow-up at 12 weeks. They were evaluated by pain VAS on function and at rest within the study period, the different ranges of motion (ROM) were measured at inclusion time and subsequent afterwards at 3, 6, and 12 weeks. The VAS outcomes showed no difference between the treatments (VAS-function p=0,1; VAS-rest p=0.1), while in the distension group ROM showed significant improvement in all directions except extension (external p=0.0007, flexion p=0.03, extension p=0,01). The analgesic usage was significantly lower in the group treated with distension at the end of the study (p=0.008). A blinded clinical assessment of ROM also showed significant improvement (p=0.002). It is concluded that distension with steroid can seem to help in management of "Frozen Shoulder". Other studies seems to support the conclusion.

Glenohumeral Corticosteroid Injections in Adhesive Capsulitis: A Systematic Search and Review

“…One study found no statistically significant difference between hydrodilation and injection in SPADI score and ROM improvements 17 . Gam et al showed that at 7 and 12 weeks, dilation with steroid and anesthetic had favorable improvements to injection in extension (p = .03) and external rotation (p = .01) 36 . However, the actual numerical data of these findings were not reported in the study.…”

“…But a combined corticosteroid injection and physical therapy treatment may have greater ROM improvements than either treatment alone 32 . The results of dilation or distension of the glenohumeral joint compared to injection is mixed 36,17 . The results for studies comparing MUA to injection are also mixed 28,34,35 .…”

“…Only eight studies in this review reported an image-guided injection technique that ensured intra-articular placement of all corticosteroid injections - five used fluoroscopy and three used ultrasound 17,18,32,36,38,40,41,44 . Studies have shown low accuracy of glenohumeral injections performed without image guidance.…”

Adhesive Capsulitis of the Shoulder. Is there Consensus Regarding the Treatment? A Comprehensive Review

“…The primary source of pathology in ACS is the rotator interval [9]. Therefore, it is the release of that area in conjunction with the inferior capsule that provides the greatest improvement in ROM [83, 65]. In contrast, several authors have recently utilized the ‘360° total capsular release’ [89-91].…”

“…There was significant improvement of ROM, pain and disability in the distension group compared to placebo group [24]. A RCT conducted by Gam et al showed significant improvement in ROM and lower need for analgesics in the arthrographic group, but no difference in pain or function compared with the steroid injection group [65]. Hsu and Chan reported a prospective study comparing MUA and physiotherapy with arthroscopic distension and physiotherapy, and with physiotherapy alone.…”