Updates on the treatment of adhesive capsulitis with hydraulic distension

Abstract

Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at the insertional area of the deltoid muscle and decreased range of motion. The pathophysiological process involves fibrous inflammation of the capsule and intraarticular adhesion of synovial folds leading to capsular thickening and contracture. Regarding the multidirectional limitation of motion, a limitation in external rotation is especially prominent, which is related to not only global fibrosis but also to a localized tightness of the anterior capsule. Ultrasound and magnetic resonance imaging studies can be applied to rule out other structural lesions in the diagnosis of adhesive capsulitis. Hydraulic distension of the shoulder joint capsule provides pain relief and an immediate improvement in range of motion by directly expanding the capsule along with the infusion of steroids. However, the optimal technique for hydraulic distension is still a matter of controversy, with regards to the infusion volume and rupture of the capsule. By monitoring the real-time pressure-volume profile during hydraulic distension, the largest possible fluid volume can be infused without rupturing the capsule. The improvement in clinical outcomes is shown to be greater in capsule-preserved hydraulic distension than in capsule-ruptured distension. Moreover, repeated distension is possible, which provides additional clinical improvement. Capsule-preserved hydraulic distension with maximal volume is suggested to be an efficacious treatment option for persistent adhesive capsulitis.

Role of Platelet-Rich Plasma in the Treatment of Adhesive Capsulitis: A Prospective Cohort Study

“…The conventional approach in the treatment of frozen shoulders is to provide relief from pain and to reinstate the movement of the joint for its proper functioning [8][9][10]. Multiple techniques like exercise, electrical healing, and massage are used from the very beginning if the patient with a frozen shoulder is being treated through physiotherapy.…”

Updates on Intra-articular Corticosteroid Injection for the Treatment of Adhesive Capsulitis

“…2기 동결진행기는 3-9개월에 해당되고 통증이 더욱 심해지면서 관절가동범위가 감소된다. 3기 동결기는 [2]. 상기 영상의학적 검사 소견들은 관절낭 이나 인대의 전체적인 섬유화(global fibroplasia)를 평가하는 데 유 용하나, 유착성 관절낭염의 일차적인 병태생리인 국소적인 구축 (localized contracture)으로 임상 증상이 나타날 수 있다 [13].…”

“…유착성 관절낭염(adhesive capsulitis)은 통증과 관절 구축을 동반하는 흔한 어깨 질 환이다 [1]. 유착성 관절낭염 환자들은 특징적으로 어깨 통증이 먼저 심해지면서, 어깨 관절 가동범위가 점차 감소된다 [2,3]. 병태생리학적으로 어깨 관절낭의 염증성 변화 에 의해 관절낭의 섬유화와 비후가 진행되어, 임상적으로 어깨 통증과 관절 구축이 나타난다 [4,5].…”

“…병태생리학적으로 어깨 관절낭의 염증성 변화 에 의해 관절낭의 섬유화와 비후가 진행되어, 임상적으로 어깨 통증과 관절 구축이 나타난다 [4,5]. 그러므로 염증 조절을 통한 어깨 통증의 경감과 관절 가동 범위의 회 복이 치료에 중요하다 [2]. 관절강내 스테로이드 주사는 유착성 관절낭염의 가장 효과 적인 치료 방법 중 하나이다 [4,6,7].…”

Impact of capsular preservation on patient-reported outcomes and complication rates in total hip arthroplasty using the direct anterior approach

“…7 In shoulder arthroplasty, preservation of the capsule minimizes the soft-tissue damage and the development of potentially painful periarticular adhesions. 8 Based on these findings, we changed our capsular management in 2015 from resection to preservation and anatomical closure of its anterolateral aspect at the end of the operation.…”