Ultrasound Guided Hydrodistension in Adhesive Capsulitis Treatment, a Physiatrist’s Therapeutic Weapon: A Prospective Study
DOI:
https://doi.org/10.25759/spmfr.223Keywords:
Bursitis/therapy, Dilatation, Shoulder, Treatment Outcome, Ultrasonography, InterventionalAbstract
Introduction: Presentation of a prospective study of a 14 patients series with adhesive capsulitis of the shoulder, undergoing an ultrasound guided capsular hydrodistension, as part of a multimodal physiatric therapeutic approach.
Material and Methods: This article presents a nine months prospective study. All patients were diagnosed with stage II adhesive capsulitis, and were submitted to an ultrasound guided capsular distension of the shoulder. Subsequently, they underwent a specific adhesive capsulitis conventional rehabilitation protocol. The outcome measures analyzed were pain through the visual numeric scale of pain (VNS), passive range of motion (ROM), and function using the UCLA (University of California and Los Angeles) Shoulder scale. These parameters were evaluated before capsular distension, immediately after the distension, at six months and at nine months of follow-up.
Results: In all 14 patients there was demonstrated pain reduction, with a mean pre-distension VNS of 6.4/10, a six months post-distension VNS of 4.5/10 and a nine months post-distension VNS of 4.3/10. The mean pre-distension lateral elevation was 117.9º, immediately passing to 151.4º right after the intervention, maintaining the articular amplitude of 163.6º at the ninth month of evaluation. The mean pre-distension external rotation was 30.4º, immediately passing to 54.6º after distension, maintaining 54.3º at the end of the follow up period. The adduction/ internal rotation was evaluated in terms of vertebral level gain. Before the intervention, the articular amplitudes in adduction/internal rotation variated between the gluteal region and T12. We observed an immediate gain of 4.1 vertebral levels right after the distension, which increased to 5.6 levels at the end of the nine months follow-up. Concerning the functional scale, the mean score before the distension was 13.8/35 in the UCLA shoulder scale. At the sixth month of follow up it was 25.6/35 and at the ninth month of evaluation it was 25.5/35.
Conclusion: In this study, ultrasound guided capsular hydrodistension associated to a specific rehabilitation program demonstrated clinical and statistical benefit in the treatment of adhesive capsulitis, regarding pain, ROM and function, at a short, medium and long term follow-up. More studies are necessary to evaluate the real valor of the ultrasound guided capsular distension in the therapeutic approach of this pathology.
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