Date post: | 01-Jul-2015 |
Category: |
Education |
Upload: | lennard-funk |
View: | 379 times |
Download: | 1 times |
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