Adhesive capsulitis of the shoulder: arthrographic diagnosis and treatment

Thirty-one patients (33 shoulders) had clinical adhesive capsulitis confirmed by arthrography and simultaneously treated by intra-articular injection of lidocaine and long-acting corticosteroid introduced with the contrast material during the examination. The routine arthrographic procedure was modified to include gentle passive manipulation of the joint while under the effect of the local anesthetic agent. The patients were instructed to continue exercises at home. The clinical follow-up has averaged eight months. In 31 of the 33 shoulders (94%) excellent relief of symptoms and restoration of function were obtained. There are several advantages to this approach: (1) an accurate diagnosis is made, (2) accurate intra-articular injection of steroid is assured as opposed to blind clinical injections, which often deposit medication in the periarticular soft tissues, (3) the morbidity is much lower than with operative techniques involving general anesthesia, and (4) the therapeutic result has been far better than with the usual program of analgesics and physical therapy.