Frozen shoulder, or adhesive capsulitis, is common and accounts for approximately 2% to 5% of all shoulder pain. Currently, there is limited evidence to support one intervention for frozen shoulder over another.
In 2018, Gallacher et al. performed a randomized controlled trial has compared hydrodilation to surgery with an arthroscopic capsular release. In this study 50 patients were enrolled and randomized to hydrodilation and surgery.
The study found that both treatments are effective interventions for frozen shoulder after physical therapy failed. Both treatments provided a rapid improvement in pain and function within 6 weeks of the treatment. This is in contrast to the prolonged natural history of frozen shoulder.
Over 80% of patients had a significant improvement with the hydrodilation procedure and did not require further treatment. Patients that did not respond to the hydrodilation procedure still showed a significant improvement with surgery, suggesting that in cases that do not respond to hydrodilation a combined procedure can be helpful. Learn more about hydrodilation for adhesive capsulitis here.
Frozen shoulder can develop slowly over a period of time. Typically, patients will experience pain over the outside of the shoulder and shoulder motion will be restricted. The pain can be severe making it difficult to sleep on the shoulder difficult.
Often x-rays are normal. In chronic cases an MRI can show thickening of the joint capsule.
Frozen shoulder was historically thought to be a self-limiting condition that would resolve on its own without intervention.
However, studies have found that one in ten patients will not respond to physical therapy after an average of 22 months (Ju Griggs et al. 2000). Other studies show that 11% of patients will still have symptoms 7 years after being diagnosed (Shaffer et al. 1992).
Treatment for frozen shoulder is typically conservative and involves physical therapy and sometimes cortisone injections. In cases that do not respond, surgery is often discussed. This study by Gallacher et al. suggests that hydrodilation can be an effective treatment. In this study, over 80% of patient with chronic adhesive capsulitis responded to a hydrodilation procedure.
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