Large-volume hydrodiatlation under suprascapular nerve block for the treatment of shoulder adhesive capsulitis

Adhesive capsulitis (AC) and postoperative stiffness are characterized by fibrosis and contracture of the glenohumeral joint capsule, leading to progressive stiffness, pain, and limited range of motion (ROM). Diagnosis is confirmed clinically, with patients demonstrating reduced active and passive motion across multiple planes. While injections and physical therapy are commonly used treatments, no consensus exists regarding the most effective approach. This study aimed to assess patient-reported outcome measures (PROMs) and ROM for patients undergoing a large-volume hydrodilatation protocol under a suprascapular nerve block.

Seventy-one patients diagnosed with AC or postoperative stiffness underwent ultrasound-guided large-volume glenohumeral joint hydrodilatation, which included an ultrasound-guided suprascapular nerve block at the suprascapular notch of the scapula prior to the procedure. The hydrodilatation injectate included 9 cc 1% lidocaine and 1 cc triamcinolone, followed by the injection of up to 110 cc sterile saline. ROM was measured immediately before and after the procedure, then at the final clinic follow-up. PROMs were assessed 6+ months following hydrodilatation using the Numeric Rating Scale for pain, the Shoulder Pain and Disability Index, and the Single Assessment Numeric Evaluation (SANE). Any further treatments that patients required were also recorded.

Of the 71 patients, 47 were female and 24 were male. The mean age was 57 years old. Average pre-procedure forward flexion was 107°, which increased to 156° immediately post-procedure (<0.01) and remained at 153° at final follow-up (P < .01). External rotation pre-procedure ROM was 31°, increasing to 68° (P < .01) immediately post-procedure and 63° at follow-up (P < .01). Abduction demonstrated a pre-procedure ROM of 84°, an immediate post-procedure ROM of 120° (P < .01), and a final follow-up ROM of 101° (P < .01). PROM improvements were near established normal, with average Numeric Rating Scale was 1.9, Shoulder Pain and Disability Index 14.6, and SANE 85.3 compared to the contralateral shoulder SANE of 95.

Large-volume hydrodilatation under suprascapular nerve block for AC resulted in significant improvements in ROM and satisfactory PROMs at a minimum 6 months follow-up.