Fig. 18.1
(a) Patient’s position in ultrasound-guided joint distension (Radiologist Dr. J. Rosales) (b) Ultrasound imaging, the needle trans-infraspinatus
According to our experience, the best moment to perform hydro-dilation would be when recovery of mobility plateaus in physical therapy and in the frozen phase of the disease.
In conclusion, joint distension is a recommended procedure to improve the frozen shoulder during the frozen phase, whether primary or secondary, both in diabetic and non-diabetic patients. The use of steroids is not clear. There is some evidence that it may not be necessary, however, most of the studies do use steroids for the procedure. It is recommended for those patients who no longer have improvement in glenohumeral range of motion while in physical therapy. A maximum of two distension procedures have proven to be more effective than a larger number of them.
Table 18.1
Revision of studies of joint distension for frozen shoulder
Study and date | Type of study | Number of participants | Symptoms duration | Interventions and number of treatments | Measures of results | Follow-up | Findings |
|---|---|---|---|---|---|---|---|
Clement et al. 2013 [7] | Prospective study with a long-term cohort | 51 | >6 weeks | Arthrographic distension as primary intervention Number: not described | Pain Function ROM | 14 months | Study includes 12 diabetic patients who achieved similar improvements as nondiabetics. Comparing pre- and post-distension conditions, improvements in function and pain were observed. Average increments in ROM were of 39.3° for flexion, 55.2° for abduction, and 19.5° in external rotation at first month |
Watson et al. 2007 [8] | Clinical trial | 53 | 6 weeks | Hydrodilation Physical therapy Number: not described | Function ROM | 2 years | In patients with glenohumeral joint contracture, hydrodilation and physical therapy increase functional capacity and ROM in most individuals. These benefits persist in the long term. The greatest changes in external rotation happened 3 days after the procedure for external rotation, between 3 days and 1 week for internal rotation, abduction achieved less improvement, being between the first week and 3 months. It could be observed, however, that mild deficits persist after 2 years |
Ng et al. 2012 [11] | Randomized prospective study | 28 | Not described | Under anesthesia mobilization vs. capsular distension Number: not described | Pain ROM | 6 months | At 6 months follow-up; under anesthesia mobilization achieves better increments in shoulder abduction than capsular distension. No significant differences between the study groups were observed in external rotation and pain relief When analyzing capsular distension by itself 6 weeks after the procedure, significant changes were found in the abduction ranges and external rotation |
Quraishi et al. 2007 [10] | Prospective controlled trial | 36 | 37, 4–39, 8 weeks
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