To evaluate the efficacy of distention arthrography (DA) alone and in combination with translational mobilization (TM) for treatment of patients with frozen shoulder (FS).
Eighty-five patients diagnosed with unilateral FS (freezing or frozen stage) were included. Forty-one patients were treated with DA and TM (group 1) and 44 patients with DA alone (group 2). Clinical assessments including visual analogue scale (VAS), Cyriax stage, and shoulder passive range of motion (PROM) including forward flexion, abduction, external rotation, and internal rotation were measured at baseline, 1 month, and 3 months following treatment.
There were no significant differences in gender, side affected, symptom duration, presence of diabetes mellitus, VAS score, Cyriax stage, or shoulder PROM between the two patient groups at baseline. Compared with baseline metrics, patients in both groups demonstrated significantly improved outcome parameters at two post-treatment time points. However, mean all shoulder PROMs were significantly greater, and mean VAS score and Cyriax stage were lower in patients treated with DA and TM than in those treated with DA alone group at two post-treatment time points. At these times, mean interval change of all outcome parameters was significantly greater with DA and TM than DA alone. No serious complications were observed following treatment in either patient group.
Compared with DA alone, DA combined with TM more effectively alleviates shoulder pain and increases PROM in patients with freezing or frozen stage FS.
Citations
To investigate whether an audible cracking sound during shoulder manipulation following distention arthrography is clinically significant in patients with adhesive capsulitis of the shoulder.
A total of 48 patients (31 women, 17 men) with primary adhesive capsulitis of the shoulder completed the study. All participants underwent C-arm-guided arthrographic distention of the glenohumeral joint with injections of a corticosteroid and normal saline. After distention, we performed flexion and abduction manipulation of the shoulder. The patients were grouped into sound and non-sound groups based on the presence or absence, respectively, of an audible cracking sound during manipulation. We assessed shoulder pain and disability based on a Numeric Rating Scale (NRS), the Shoulder Pain and Disability Index (SPADI), and passive range of motion (ROM) measurements (flexion, abduction, internal and external rotation) before the procedure and again at 3 weeks and at 6 weeks after the intervention.
The patients were divided into two groups: 21 were included in the sound group and 27 in the non-sound group. In both groups, the results of the NRS, SPADI, and ROM assessments showed statistically significant improvements at both 3 and 6 weeks after the procedure. However, there were no significant differences between the two groups except with respect to external rotation at 6 weeks, at which time the sound group showed a significant improvement in external rotation when compared with the non-sound group (p<0.05).
These findings showed that manipulation following distention arthrography was effective in decreasing pain and increasing shoulder range of motion. In addition, the presence of an audible cracking sound during manipulation, especially on external rotation, was associated with better shoulder range of motion.
Citations
Objective: To define arthrographic findings in patients with frozen shoulder and to evaluate the therapeutic effect of arthrographic capsular distension and rupture.
Method: Thirty patients who were clinically diagnosed as frozen shoulder were enrolled. During a trial of intra-articular injection of 35 mL of fluid which contained 8 mL of 1% lidocaine, 2 mL of prednisolone (80 mg) and 25 mL of radiocontrast material, arthrographic findings and the occurrence of iatrogenic capsular tear were observed. Passive range of shoulder motion (percent of normal, %) at flexion, abduction, internal rotation, and external rotation was measured at pre- and 1 week post-injection. The therapeutic effect of the procedure was statistically analyzed by paired Student's t-test.
Results: Mean age of the subjects was 57-years-old (range: 40∼76 years) and mean duration of the symptom was 6 months (2∼42 months). A decreased joint volume of less than 10 mL (100%), poor or absent filling of the axillary recess or subscapular bursa (75.9%), nonfill of the biceps tendon sheath (37.9%), and irregularity of capsular insertion (31.0%) were typical abnormal arthrographic findings. In one week after arthrographic distension and rupture, the passive range of shoulder motion was significantly (p＜0.05) increased at flexion, abduction and external rotation, of which the range of external rotation was the most remarkably increased (mean, 23.9%).
Conclusion: Distension arthrography was useful for increasing shoulder motion in frozen shoulder, especially at flexion, abduction and external rotation.
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