Yeungnam Univ J Med.  2021 Jan;38(1):19-26. 10.12701/yujm.2020.00535.

Updates on the treatment of adhesive capsulitis with hydraulic distension

• Cho JH

• KMID: 2512062
• DOI: http://doi.org/10.12701/yujm.2020.00535

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.

Keyword

Inflammation; Joint capsule; Pain; Shoulder joint

Figure

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  Fig. 1. Experimental setup for capsule-preserved hydraulic distension (A) with real-time pressure monitoring (B). While the patient is comfortably seated upright on a stool, a 3.5-inch 22-gauge spinal needle is inserted 1 cm lateral to the ultrasound transducer and advanced into the posterior intraarticular space under ultrasound guidance. The pressure sensor is connected to manometric tubes via a 3-way stopcock so that the pressure in the tubes can be measured by the sensor while fluid is infused via the syringe pump. The signal from the sensor is digitalized by a data-acquisition device (DAQ).

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  Fig. 2. Typical pressure-volume curve obtained during intraarticular hydraulic distension. The slope of the phase II (from P1 to P2) is considered the capsular stiffness phase. P1, pressure at the starting point of phase II; P2, pressure at the ending point of phase II.

Reference

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