Hydrodilatation for adhesive capsulitis: a systematic review exploring efficacy and optimal technique

Area of Science:

• Orthopedics
• Physical Medicine & Rehabilitation
• Sports Medicine

Background:

• Adhesive capsulitis (frozen shoulder) management often involves conservative treatments like corticosteroid injections or glenohumeral joint hydrodilatation.
• Evaluating the comparative efficacy of hydrodilatation against other interventions is crucial for guiding clinical practice.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of hydrodilatation for adhesive capsulitis.
• To summarize the various techniques employed in hydrodilatation procedures.

Main Methods:

• Systematic review and meta-analysis of randomized clinical trials (RCTs) and non-RCTs.
• Searched PubMed, Embase, and Web of Science for studies on hydrodilatation in idiopathic adhesive capsulitis.
• Included 103 studies with 9951 patients, focusing on 44 RCTs for meta-analysis.

Main Results:

• Hydrodilatation demonstrated greater external rotation compared to corticosteroid injection alone at 12 weeks (low certainty).
• No significant differences were observed in pain (VAS), SPADI, abduction, or forward flexion between hydrodilatation and corticosteroid injection alone.
• When combined with physical therapy, hydrodilatation showed improved pain (VAS) and SPADI scores at 12 weeks compared to physical therapy alone (low to very low certainty), but no additional range of motion gains.
• The incidence of infection associated with hydrodilatation was low at 0.02%.

Conclusions:

• Significant variability exists in hydrodilatation techniques, making direct comparisons challenging.
• Current evidence does not strongly support meaningful clinical improvements with hydrodilatation compared to corticosteroid injection alone or as an adjunct to physical therapy for adhesive capsulitis.
• Optimal injection volume, capsular status, and number of injections for hydrodilatation remain undetermined.