Ann Rehabil Med.  2012 Feb;36(1):88-97. 10.5535/arm.2012.36.1.88.

Comparison of Sono-guided Capsular Distension with Fluoroscopically Capsular Distension in Adhesive Capsulitis of Shoulder

• Park KD
• Nam HS
• Kim TK
• Kang SH
• Lim MH
• Park Y

• KMID: 2266785
• DOI: http://doi.org/10.5535/arm.2012.36.1.88

Abstract

OBJECTIVE
To investigate the short-term effects and advantages of sono-guided capsular distension, compared with fluoroscopically guided capsular distension in adhesive capsulitis of shoulder. METHOD: In this prospective, randomized, and controlled trial, 23 patients (group A) were given an intra-articular injection of a mixture of 0.5% lidocaine (9 ml), contrast dye (10 ml), and triamcinolone (20 mg); they received the injection once every 2 weeks, for a total of 6 weeks, under sono-guidance. Twenty-five patients (group B) were treated similarly, under fluoroscopic guidance. Instructions for the self-exercise program were given to all subjects, without physiotherapy and medication. Effects were then assessed using a visual numeric scale (VNS), and the shoulder pain and disability index (SPADI), as well as a range of shoulder motion examinations which took place at the beginning of the study and 2 and 6 weeks after the last injection. Incremental cost-effective ratio (ICER), effectiveness, preference, and procedure duration were evaluated 6 weeks post-injection.
RESULTS
The VNS, SPADI, and shoulder motion range improved 2 weeks after the last injection and continued to improve until 6 weeks, in both groups. However, no statistical differences in changes of VNS, SPADI, ROM, and effectiveness were found between these groups. Patients preferred sono-guided capsular distension to fluoroscopically guided capsular distension due to differences in radiation hazards and positional convenience. Procedure time was shorter for sono-guided capsular distension than for fluoroscopically guided capsular distension.
CONCLUSION
Sono-guided capsular distension has comparable effects with fluoroscopically guided capsular distension for treatment of adhesive capsulitis of the shoulder. Sono-guided capsular distension can be substituted for fluoroscopic capsular distension and can be advantageous from the viewpoint of radiation hazard mitigation, time, cost-effectiveness and convenience.

Keyword

Sono-guided; Fluoroscopically; Capsular distension; Adhesive capsulitis

MeSH Terms

Adhesives
Bursitis
Humans
Hypogonadism
Injections, Intra-Articular
Lidocaine
Mitochondrial Diseases
Ophthalmoplegia
Prospective Studies
Shoulder
Shoulder Pain
Triamcinolone
Adhesives
Hypogonadism
Lidocaine
Mitochondrial Diseases
Ophthalmoplegia
Triamcinolone

Figure

• 

  Fig. 1 Sono-guided capsular distension. (A) Sono-guided capsular distension by the posterior lateral approach. (B) Before Sono-guided intra-articular injection at glenohumeral joint. (C) After sono-guided injection with capsular distension (arrow). The needle tip (arrowhead). (D) Shoulder posterior-anterior view. After steroid injection with capsular distension.

• 

  Fig. 2 Fluoroscopically guided capsular distension. (A) Fluoroscopically guided capsular distension by the posterior approach. (B) Drawing shows patient in prone position for posterior approach. (C) Shoulder posterior-anterior view. The needle tip (arrow) was inserted above anatomical neck of humerus (D) Shoulder posterior-anterior view. After steroid injection with capsular distension.

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