Functional outcome of fluoroscopy-guided hydrodilatation in adhesive capsulitis of the shoulder

Kushal N. Parikh; Kamalkumar H. Ninama

doi:10.18203/issn.2455-4510.IntJResOrthop20263908

Authors

Kushal N. Parikh Department of Orthopedics, Surat Municipal Institute of Medical Education and Research (SMIMER), Opp. Bombay Market, Umarwada, Surat, Gujarat, India
Kamalkumar H. Ninama Department of Orthopedics, Surat Municipal Institute of Medical Education and Research (SMIMER), Opp. Bombay Market, Umarwada, Surat, Gujarat, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263908

Keywords:

Range of motion, Oxford shoulder score, Hydrodilatation, Frozen shoulder, Adhesive capsulitis, Fluoroscopy

Abstract

Background: Adhesive capsulitis is characterized by shoulder pain and globally restricted movement. While conservative treatments are standard, fluoroscopy-guided hydrodilatation aims to directly enlarge the contracted joint capsule. This study was performed to evaluate the functional outcome, pain relief, and range of motion (ROM) following fluoroscopy-guided hydrodilatation in patients with adhesive capsulitis.

Methods: This prospective interventional study included 52 patients (aged 18-60) with adhesive capsulitis presenting at a tertiary care hospital. Patients underwent fluoroscopy-guided hydrodilatation using a mixture of normal saline, local anesthetic, and steroid, followed by a structured physiotherapy regimen. Outcomes were assessed using the visual analog scale (VAS) for pain, the Oxford shoulder score (OSS), the shoulder pain and disability index (SPADI), and ROM measurements at baseline, 1, 3, and 6 months post-intervention.

Results: The mean patient age was 47.6 years, with a female predominance (65.4%). Post-intervention, significant progressive improvements were observed across all parameters (p<0.001). The mean VAS score decreased from 7.5 pre-intervention to 1.9 at 6 months. Shoulder ROM improved substantially, with abduction increasing from 94.1 to 143.3, and flexion from 97.0 to 147.6. Mean OSS increased from 22.5 to 42.5, indicating restored function. The total SPADI score significantly decreased from 64.98 to 31.00 at the 6-month follow-up.

Conclusions: Fluoroscopy-guided hydrodilatation, followed by structured physiotherapy, is a highly effective intervention for adhesive capsulitis, yielding significant mid-term pain relief, restoration of shoulder mobility, and enhanced functional outcomes.

References

Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow. 2017;9(2):75-84.

Zuckerman JD, Rokito A. Frozen shoulder: a consensus definition. J Shoulder Elb Surg. 2011;20:322-5.

Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J. 2016;6:26-34.

Saltychev M, Laimi K, Virolainen P, Fredericson M. Effectiveness of hydrodilatation in adhesive capsulitis of shoulder: a systematic review and meta-analysis. Scand J Surg. 2018;107(4):285-93.

Gam AN, Schydlowsky P, Rossel I, Remvig L, Jensen EM. Treatment of ‘Frozen Shoulder’ with distension and glucorticoid compared with glucorticoid alone: a randomised controlled trial. Scand J Rheumatol. 1998;27:425-30.

Tveitå EK, Tariq R, Sesseng S, Juel NG, Bautz-Holter E. Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial. BMC Musculoskelet Disord. 2008;9:53.

Ahmad M, Khan MJ, Aziz MH, Fatima R, Adnan M, Anwer A, et al. Comparative outcome of ultrasound guided vs. fluoroscopy guided hydrodilatation in adhesive capsulitis: a prospective study. Int J Burns Trauma. 2024;14(4):65.

Paruthikunnan SM, Shastry PN, Kadavigere R, Pandey V, Karegowda LH. Intra-articular steroid for adhesive capsulitis: does hydrodilatation give any additional benefit? A randomized control trial. Skeletal Radiol. 2020;49(5):795-803.

Kumar GR, Kulkarni VS, Nadange A, Pawaskar P, Supare S, Tathe TJ. A study of functional outcome of adhesive capsulitis of shoulder treated by hydrodilatation and intra articular steroid injection. Int J Orthoped Sci. 2022;8(4):82-5.

Clement RG. Frozen shoulder: long-term outcome following arthrographic distension. Acta Orthop Belg. 2013;79:368-74.

Debeer P, Commeyne O, De Cupere I, Tijskens D, Verhaegen F, Dankaerts W, et al. The outcome of hydrodilation in frozen shoulder patients and the relationship with kinesiophobia, depression, and anxiety. J Exp Orthoped. 2021;8(1):85.

Subramanyam K, Sahini SC, Kumar S, Ampajwalam PR. Functional outcome assessment of frozen shoulder treated by distension hydrodilatation and viscosupplementation: a prospective study. Int J Orthop Rheumatol. 2019;5(2):35-41.