Ann Rehabil Med.  2014 Jun;38(3):360-368. 10.5535/arm.2014.38.3.360.

Randomized Controlled Trial for Efficacy of Capsular Distension for Adhesive Capsulitis: Fluoroscopy-Guided Anterior Versus Ultrasonography-Guided Posterolateral Approach

• Bae JH
• Park YS
• Chang HJ
• Kim MJ
• Park KY
• Jin SH
• Lee EH

• KMID: 2165754
• DOI: http://doi.org/10.5535/arm.2014.38.3.360

Abstract

OBJECTIVE
To find the most effective procedure to treat adhesive capsulitis of the shoulder, we evaluated the clinical effects of an ultrasonographic-guided anterior approach capsular distension and a fluoroscopy-guided posterolateral approach capsular distension. We expected the anterior approach to be better than the posterolateral approach because the rotator interval, a triangular anatomic area in the anterosuperior aspect of the shoulder, which is considered an important component of the pathology of adhesive capsulitis.
METHODS
Participants were randomly assigned to two groups: 27 patients in group A were injected by an anterior approach with 2% lidocaine (5 mL), contrast dye (5 mL), triamcinolone (40 mg), and normal saline (9 mL) under fluoroscopic guidance in the operating room. Twenty-seven patients in group B were injected using a posterolateral approach with 2% lidocaine (5 mL), triamcinolone (40 mg), and normal saline (14 mL) under ultrasonographic guidance. After injection, all patients received physiotherapy four times in the first postoperative week and then two times each week for eight more weeks. Treatment effects were assessed using the shoulder pain and disability index (SPADI), visual numeric scale (VNS), passive range of motion (PROM), hand power (grip and pinch) at baseline and at one week, five and nine weeks after injection.
RESULTS
SPADI, VNS, PROM, and hand power improved in one week, five and nine weeks in both groups. Statistically significant differences were not observed in SPADI, VNS, PROM, or hand power between groups.
CONCLUSION
Ultrasonography-guided capsular distension by a posterolateral approach has similar effects to fluoroscopy-guided capsular distension by an anterior approach.

Keyword

Adhesive capsulitis; Injection

MeSH Terms

Bursitis*
Hand
Humans
Lidocaine
Operating Rooms
Pathology
Range of Motion, Articular
Shoulder
Shoulder Pain
Triamcinolone
Lidocaine
Triamcinolone

Figure

• 

  Fig. 1 Patient flowchart.

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  Fig. 2 Fluoroscopy-guided capsular distension method. (A) The participants were put in a supine position with a C-arm adjusted in the operating room. (B) Needle placement was confirmed in a glenohumeral arthrogram after injection of 1 mL of nonionic radiopaque contrast material. (C) After confirmation, 2% lidocaine (5 mL), contrast dye (5 mL), triamcinolone (40 mg), and normal saline (9 mL), for a total volume of 20 mL, were injected under fluoroscopic imaging.

• 

  Fig. 3 Ultrasonography-guided capsular distension method. (A) The participants were put in a sitting position in a chair, and the affected shoulder was adducted and internally rotated and the elbow flexed to grasp the contralateral shoulder. (B) The joint injection was performed using a posterolateral approach with a 23-gauge needle under sono-guidance. (C) After needle placement confirmation, 2% lidocaine (5 mL), triamcinolone (40 mg), and normal saline (14 mL), for a total volume of 20 mL fluid, were injected under sono-guidance.

• 

  Fig. 4 Comparison of shoulder pain and disability index (SPADI) after capsular distension. SPADI was significantly improved in both groups (*p<0.05). However, no statistically significant difference in the changes of SPADI was found between the two groups.

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  Fig. 5 Comparison of visual numeric scale (VNS) after capsular distension. VNS was significantly improved in groups A and B (*p<0.05). However, no statistically significant difference in the VNS changes was found between the two groups.

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  Fig. 6 Comparison of grip power after capsular distension. Grip power (kg) was significantly improved in the two groups (*p<0.05). However, no statistically significant difference in the changes of grip power was found between the two groups.

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  Fig. 7 Comparison of pinch power after capsular distension. Pinch power (kg) was significantly improved in the two groups (*p<0.05). However, no statistically significant difference in changes of pinch power was found between the two groups.

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