Frozen shoulder : long-term outcome following arthrographic distension
Rhys G.E. Clement, Andrew G. Ray, Colin DaviDson, C. Mike Robinson, Fergus J. Perks
Acta Orthopædica Belgica, Vol. 79 - 4 - 2013
Arthrographic distension of the glenohumeral joint was adopted as a mainstream treatment for frozen shoulder before any randomised controlled trials were performed. Interpretation of the effectiveness of this procedure rests mostly on data from cohort studies of which there are few of high quality. Papers reporting long-term results have either excluded diabetic patients or failed to report patient orientated outcomes. The authors present a long-term prospective cohort study of 51 patients (12 diabetics and 39 non-diabetics), with 53 frozen shoulders, who had an arthrographic distension performed by a single radiologist as a primary intervention. Oxford shoulder score (OSS), visual analogue pain score (VAS), and range of movement (ROM) were recorded pre-distension, at 2 days and 1 month post-distension. OSS and VAS were recorded again at a mean of 14 months post distension (range : 8-26 months). OSS improved from a pre-distension mean of 22.3 by 16.9 points at final follow-up (p < 0.001, 2 tailed paired samples t-test) whilst VAS improved from a mean pre-distension value of 7.1 by -3.5 (p < 0.001). ROM improved by a mean of 39.3 degrees in flexion, 55.2 degrees in abduction and 19.5 degrees in external rotation at one month (p < 0.001 for all). The outcome in diabetic patients was the same as in non-diabetic patients.
Arthrographic distension is a safe and effective treatment for frozen shoulder; it is also effective in diabetic patients. It gives long-term improvement. The authors believe that the low number of patients requiring a secondary procedure makes arthrographic distension preferable to manipulation under anaesthesia.
Comments (Len Funk):
As the authors point out, previously the reported studies and Cochrane review on hydrodistension injections only reported short-term outcomes and the conclusion was that it was an excellent procedure for short-term benefit. This is the second study to assess the continued benefit of the procedure. Only two of the 51 patients required additional treatment.
It is good to see that the results are positive for diabetics, as well as non-diabetics, particularly for pain relief.
It is reassuring for us to see these results, as we also undertook a similar study (as yet unpublished) with similar results - see the abstract here.