Comparison of Sono-guided Capsular Distension with Fluoroscopically Capsular Distension in Adhesive Capsulitis of Shoulder

Ki Deok Park, Hee Seung Nam, Tai Kon Kim, Seong Hoon Kang, Min Ho Lim, Yongbum Park, Ki Deok Park, Hee Seung Nam, Tai Kon Kim, Seong Hoon Kang, Min Ho Lim, Yongbum Park

Abstract

Objective: To investigate the short-term effects and advantages of sono-guided capsular distension, compared with fluoroscopically guided capsular distension in adhesive capsulitis of shoulder.

Method: In this prospective, randomized, and controlled trial, 23 patients (group A) were given an intra-articular injection of a mixture of 0.5% lidocaine (9 ml), contrast dye (10 ml), and triamcinolone (20 mg); they received the injection once every 2 weeks, for a total of 6 weeks, under sono-guidance. Twenty-five patients (group B) were treated similarly, under fluoroscopic guidance. Instructions for the self-exercise program were given to all subjects, without physiotherapy and medication. Effects were then assessed using a visual numeric scale (VNS), and the shoulder pain and disability index (SPADI), as well as a range of shoulder motion examinations which took place at the beginning of the study and 2 and 6 weeks after the last injection. Incremental cost-effective ratio (ICER), effectiveness, preference, and procedure duration were evaluated 6 weeks post-injection.

Results: The VNS, SPADI, and shoulder motion range improved 2 weeks after the last injection and continued to improve until 6 weeks, in both groups. However, no statistical differences in changes of VNS, SPADI, ROM, and effectiveness were found between these groups. Patients preferred sono-guided capsular distension to fluoroscopically guided capsular distension due to differences in radiation hazards and positional convenience. Procedure time was shorter for sono-guided capsular distension than for fluoroscopically guided capsular distension.

Conclusion: Sono-guided capsular distension has comparable effects with fluoroscopically guided capsular distension for treatment of adhesive capsulitis of the shoulder. Sono-guided capsular distension can be substituted for fluoroscopic capsular distension and can be advantageous from the viewpoint of radiation hazard mitigation, time, cost-effectiveness and convenience.

Keywords: Adhesive capsulitis; Capsular distension; Fluoroscopically; Sono-guided.

Figures

Fig. 1
Fig. 1
Sono-guided capsular distension. (A) Sono-guided capsular distension by the posterior lateral approach. (B) Before Sono-guided intra-articular injection at glenohumeral joint. (C) After sono-guided injection with capsular distension (arrow). The needle tip (arrowhead). (D) Shoulder posterior-anterior view. After steroid injection with capsular distension.
Fig. 2
Fig. 2
Fluoroscopically guided capsular distension. (A) Fluoroscopically guided capsular distension by the posterior approach. (B) Drawing shows patient in prone position for posterior approach. (C) Shoulder posterior-anterior view. The needle tip (arrow) was inserted above anatomical neck of humerus (D) Shoulder posterior-anterior view. After steroid injection with capsular distension.

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