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The role of capsular distention in adhesive capsulitis
Vijay B Vad1, Durgadas Sakalkale, Russell F Warren
1Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA. vadv@hss.edu
Objective:
To explore the efficacy of capsular distension in the treatment of adhesive capsulitis of the shoulder joint.
Design:
Prospective study.
Setting:
Musculoskeletal clinic.
Participants:
Twenty-two patients (18 women, 4 men; mean age, 41.3y; range, 29-54y) with adhesive capsulitis of shoulder joint. Nineteen patients had Hannafin stage II and 3 patients had Hannafin stage III adhesive capsulitis. All patients had continuous pain and significant range of motion (ROM) limitations of the shoulder joint despite a minimum of 3 months of physical therapy (PT).
Intervention:
Capsular distension with saline under fluoroscopic control, followed by a PT program.
Main Outcome Measures:
L'Insalata Shoulder Rating Questionnaire (LSRQ) score and Hannafin ROM assessment protocol.
Results:
In the 19 patients with stage II adhesive capsulitis, the mean LSRQ score and range of abduction improved from predistention values of 49.8 degrees and 87.2 degrees to postdistension mean values of 88.1 degrees and 117.6 degrees at minimum of 1 year postdistention, respectively (P<.05). However, in the 3 patients with stage III adhesive capsulitis, the mean LSRQ score and range of abduction changed from predistention values of 41.2 degrees and 84.1 degrees to postdistension mean values of 57.8 degrees and 90.4 degrees at minimum of 1 year postdistention, respectively (P>.05).
Conclusions:
The treatment modality should be individualized on the basis of the stage of the adhesive capsulitis, and the distension procedure should be reserved for patients in stage II who do not progress despite participating in a PT program.