Ultrasound‐Guided Hydrodilatation of the Shoulder Capsule at the Rotator Interval: Technical Tips and Tricks

Abstract

Adhesive capsulitis and disorders of the intra‐articular portion of the long head of the biceps brachii tendon are common causes of shoulder pain. Sonographic findings, coupled with clinical evaluation and medical history, are paramount for prompt diagnosis. Herewith, either to precisely confirm the pain generator(s) or to appropriately treat relevant cases, ultrasound‐guided interventions are often required in daily clinical practice. Targeting the anatomical structures involved in the aforementioned pathological conditions, we briefly describe some technical tips and tricks as regards ultrasound‐guided hydrodilatation of the shoulder capsule at the rotator interval.

Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review

“…Of note, concerning US-guided hydrodilatation, the anterior approach through the rotator cuff interval seems to be more effective (than the posterior approach targeting the glenohumeral recess) in reducing pain during shoulder movements [ 40 ]. Accordingly, for dilating the anterior capsule of the glenohumeral joint, the needle’s tip can be advanced within the histological interface between the LHBT and the stabilizing pulley (i.e., coracohumeral and superior glenohumeral ligaments) [ 41 ] or in the gap between the superior edge of subscapularis tendon and the proximal segment of the LHBT [ 42 ].…”

Assessing/Imaging the Subcoracoid Space: From Anatomy to Dynamic Sonography

“…Subcoracoid effusion is a challenging ultrasonographic finding in clinical practice whereby its correct interpretation is paramount to optimize management of the patients and to correctly plan for the more suitable US-guided procedure (Table 2). 3,23 Indeed, technical details of the US-guided intervention (eg, anterior/ posterior approach, in-plane/out-of-plane technique, intraÀ/extra-capsular injection) should be carefully evaluated. Needless to say, distension of the superior subscapular recess and the "triple effusion sign" are commonly indirect findings of a glenohumeral joint disorder that is, not distinct pathological entities.…”

Ultrasound-Guided Infiltrative Treatment Associated with Early Rehabilitation in Adhesive Capsulitis Developed in Post-COVID-19 Syndrome

“…This technique consists of injecting a saline solution or a saline solution combined with corticosteroids and anesthetic which relaxes the capsule because it increases hydrostatic pressure (also called hydrodistension), thus increasing the volume capacity of the shoulder [ 18 , 19 ]. An expert musculoskeletal sonographer, using a 5–14 MHz intraoperative high-frequency linear transducer, performed ultrasound-guided anterior rotator interval hydrodilatation using 1 mL of cortisone (Depo-Medrol 40 mg), 5 mL of 2% lidocaine hydrochloride, and 4 mL of saline ( Figure 3 ) [ 35 , 36 ]. All injections were performed using a 90 mm long 21 G needle, after disinfecting the skin with a solution of povidone iodine or chlorhexidine, depending on any skin allergies or intolerances.…”