ARTHROGRAPHIC HYDRODILATATION FOR FROZEN SHOULDER

Christopher ManningPhil WrightLennard Funk

BackgroundArthrographic Hydrodilatation A fine needle is inserted into the frozen shoulder joint and contrast medium is injected to ensure the needle is in the joint.

Hydrodilatation is effective by several modes of action;• Long lasting local anaesthetic offers pain relief• Steroid provides an anti-inflammatory effect • Saline stretches the contracted joint capsule

Normal Arthrogram – normal volume of dye contained within the joint.

Frozen Shoulder – Tight joint with dye

rupturing out through capsule.

Published Data

• Published results for Hydrodilatation are supportive of its effectiveness and use despite differing;

• Hydrodilatation technique

• Physiotherapy regime

• Sample size

• Outcome measures used

• Length of follow-up !!- Buchbinder, R., S. Green, et al. (2008). "Arthrographic distension for adhesive capsulitis (frozen shoulder)." Cochrane Database Syst Rev(1): CD007005.- Bell, S., J. Coghlan, et al. (2003). "Hydrodilatation in the management of shoulder capsulitis." Australas Radiol 47(3): 247-251.- Halverson, L. and R. Maas (2002). "Shoulder joint capsule distension (hydroplasty): a case series of patients with "frozen shoulders" treated in a primary care office.“- Quraishi, N. A., P. Johnston, et al. (2007). "Thawing the frozen shoulder. A randomised trial comparing manipulation under anaesthesia with hydrodilatation." J Bone Joint

Aims

To evaluate the efficacy of arthrographic hydrodilatation for the treatment of frozen shoulder, over a three year period.

MethodsFifty one patients were prospectively followed for a mean period of eight months

post Hydrodilatation for Frozen Shoulder (30 primary, 21 secondary).

Patients were evaluated for:

1- Constant-Murley Score

2- Oxford Shoulder Score

3- Range of Movement

4- Pain (Visual Analogue Scale)

Range of MotionR

ange

of M

ovem

ent (

o)

0

40

80

120

160

Movement

Flexion Abduction Internal Rotation

38

143154

33

128141

0

3453

Outcome Scores

0

23

45

68

90

Scoring Method

Constant-Murley Score Oxford Score

44

83

40

68

2524

Pre Hydrodilatation6 weeks8 months

Pain ScoresVAS

0

2

5

7

9

0 6 36

Results!

• Patient satisfaction at 6 weeks and 8 months was 86%. !

• 7 of the patients went on to have arthroscopic capsular release for ongoing stiffness.

Conclusion

Arthrographic hydrodilatation is a safe and effective intervention for both primary and secondary frozen shoulder, with significant improvements in both pain and stiffness as early as six weeks post-procedure.

For more details on this study, please see the Education section of www.shoulderdoc.co.uk