Ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation in the treatment of frozen shoulder in different clinical stage_West China Medical Journal

Authors：

ZHOU Yulan ¹ , YUAN Dechao ² ,  WU Chao ^2,3 , LIN Xu ² , LI Tao ² , LI Ying ¹ , ZENG Jian ¹ , ZHOU Huan ¹

1. Department of Ultrasound, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;
2. Department of Orthopedics, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;
3. Digital Medical Center, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

WU Chao, Email: flightiness@163.com

Keywords：

Frozen shoulder; Ultrasonography; Intra-articular injection; Joint capsule distension; Clinical stage

DOI：

10.7507/1002-0179.202108056

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Objective To investigate the effect of ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation in the treatment of frozen shoulder in different clinical stage. Methods The clinical data of patients with frozen shoulder diagnosed in Zigong Fourth People’s Hospital from January 2020 to January 2021 were collected retrospectively. The patients were divided into three groups according to the clinical stage of frozen shoulder (stage Ⅰ, stage Ⅱ and stage Ⅲ). All patients volunteered to receive ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation for 3 consecutive times, with a 2-week interval for each treatment, and followed up for 6 months. Before treatment and 2 weeks, 4 weeks, 2 months, 4 months and 6 months after treatment, the patients were scored with Visual Analog Scale (VAS) and Active Range of Shoulder Motion (AROM), and the capsule thickness of shoulder were measured, respectively. Results A total of 150 patients were included, including 61 patients in stage Ⅰ, 74 patients in stage Ⅱ and 15 patients in stage Ⅲ. The thickness of shoulder joint capsule on the affected side was thicker than that on the healthy side (t=24.384, P<0.001). After treatment, the thickness of shoulder joint capsule and VAS score decreased (P<0.05), and the AROM score increased (P<0.05). Before treatment, the thickness of shoulder joint capsule in stageⅡpatients was higher than that in stageⅠand Ⅲ patients [(4.3±1.0) vs. (2.9±0.5) vs. (3.1±0.4) mm; F=57.195, P<0.001]. Four weeks, 2 months, 4 months and 6 months after treatment, the decrease of shoulder joint capsule thickness was the largest in stageⅡpatients (P<0.05). Compared with stageⅡand Ⅲ patients, stageⅠpatients had the highest VAS score before treatment (7.7±0.7 vs. 5.1±0.8 vs. 4.5±0.7; F=233.560, P<0.001). There was no significant difference in VAS scores among the three groups 4 weeks (F=1.679, P=0.190), 4 months (F=1.348, P=0.263) or 6 months (F= 0.940, P=0.393) after treatment, while there were significant differences in VAS scores among the three groups 2 weeks (F=66.924, P<0.001) and 2 months (F=9.598, P<0.001) after treatment. Compared with stageⅠand Ⅲ patients, stageⅡpatients had the lowest AROM score before treatment (15.2±1.8 vs. 23.5±1.9 vs. 26.1±3.5; F=343.718, P<0.001). Four weeks (F=0.034, P=0.967), 2 months (F=0.222, P=0.801), 4 months (F=0.634, P=0.532) or 6 months (F=0.001, P=0.999) after treatment, there was no significant difference in AROM scores among the three groups, while there was significant difference in AROM scores among the three groups 2 weeks after treatment (F=177.135, P<0.001).Conclusions Ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilation has good efficacy in the treatment of frozen shoulder in different clinical stage. Early injection treatment can shorten the course of the disease and relieve the pain of patients during the course of the disease.

Citation： ZHOU Yulan, YUAN Dechao, WU Chao, LIN Xu, LI Tao, LI Ying, ZENG Jian, ZHOU Huan. Ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation in the treatment of frozen shoulder in different clinical stage. West China Medical Journal, 2021, 36(12): 1679-1685. doi: 10.7507/1002-0179.202108056 Copy

1.	Cho CH, Bae KC, Kim DH. Treatment strategy for frozen shoulder. Clin Orthop Surg, 2019, 11(3): 249-257.
2.	Uppal HS, Evans JP, Smith C. Frozen shoulder: a systematic review of therapeutic options. World J Orthop, 2015, 6(2): 263-268.
3.	Fields BKK, Skalski MR, Patel DB, et al. Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options. Skeletal Radiol, 2019, 48(8): 1171-1184.
4.	Celik H, Seckin MF, Akcal MA, et al. Mid-long term results of manipulation and arthroscopic release in frozen shoulder. Acta Ortop Bras, 2017, 25(6): 270-274.
5.	Hand GC, Athanasou NA, Matthews T, et al. The pathology of frozen shoulder. J Bone Joint Surg Br, 2007, 89(7): 928-932.
6.	Tasto JP, Elias DW. Adhesive capsulitis. Sports Med Arthrosc Rev, 2007, 15(4): 216-221.
7.	Itoi E, Arce G, Bain GI, et al. Shoulder stiffness: current concepts and concerns. Arthroscopy, 2016, 32(7): 1402-1414.
8.	Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for pain (VAS pain), Numeric Rating Scale for pain (NRS pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63(11): S240-S252.
9.	Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987(214): 160-164.
10.	Vastamäki H, Kettunen J, Vastamäki M. The natural history of idiopathic frozen shoulder: a 2- to 27-year follow up study. Clin Orthop Relat Res, 2012, 470(4): 1133-1143.
11.	Chan HBY, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore Med J, 2017, 58(12): 685-689.
12.	Elnady B, Rageh EM, Hussein MS, et al. In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study. Clin Rheumatol, 2020, 39(12): 3805-3814.
13.	Pandey V, Madi S. Clinical guidelines in the management of frozen shoulder: an update!. Indian J Orthop, 2021, 55(2): 299-309.
14.	Cao XY, Zhao HY. A pilot study of ultrasound-guided acupotomy for the treatment of frozen shoulder. Medicine (Baltimore), 2019, 98(42): e17632.
15.	Do JG, Hwang JT, Yoon KJ, et al. Correlation of ultrasound findings with clinical stages and impairment in adhesive capsulitis of the shoulder. Orthop J Sports Med, 2021, 9(5): 23259671211003675.
16.	Sernik RA, Vidal Leão R, Luis Bizetto E, et al. Thickening of the axillary recess capsule on ultrasound correlates with magnetic resonance imaging signs of adhesive capsulitis. Ultrasound, 2019, 27(3): 183-190.
17.	郭璇妍, 卢漫, 贺凡丁, 等. 超声引导下关节腔注射联合关节囊扩张治疗冻结肩. 中国医学影像技术, 2018, 34(7): 1081-1084.
18.	Akbar M, McLean M, Garcia-Melchor E, et al. Fibroblast activation and inflammation in frozen shoulder. PLoS One, 2019, 14(4): e0215301.
19.	de la Serna D, Navarro-Ledesma S, Alayón F, et al. A comprehensive view of frozen shoulder: a mystery syndrome. Front Med (Lausanne), 2021, 8: 663703.
20.	Yoon JP, Chung SW, Kim JE, et al. Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial. J Shoulder Elbow Surg, 2016, 25(3): 376-383.
21.	Wu WT, Chang KV, Han DS, et al. Effectiveness of glenohumeral joint dilatation for treatment of frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. Sci Rep, 2017, 7(1): 10507.
22.	Wang JC, Tsai PY, Hsu PC, et al. Ultrasound-guided hydrodilatation with triamcinolone acetonide for adhesive capsulitis: a randomized controlled trial comparing the posterior glenohumeral recess and the rotator cuff interval approaches. Front Pharmacol, 2021, 12: 686139.
23.	Kanbe K. Clinical outcome of arthroscopic capsular release for frozen shoulder: essential technical points in 255 patients. J Orthop Surg Res, 2018, 13(1): 56.
24.	Lee SH, Yoon C, Chung SG, et al. Measurement of shoulder range of motion in patients with adhesive capsulitis using a kinect. PLoS One, 2015, 10(6): e0129398.

1. Cho CH, Bae KC, Kim DH. Treatment strategy for frozen shoulder. Clin Orthop Surg, 2019, 11(3): 249-257.
2. Uppal HS, Evans JP, Smith C. Frozen shoulder: a systematic review of therapeutic options. World J Orthop, 2015, 6(2): 263-268.
3. Fields BKK, Skalski MR, Patel DB, et al. Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options. Skeletal Radiol, 2019, 48(8): 1171-1184.
4. Celik H, Seckin MF, Akcal MA, et al. Mid-long term results of manipulation and arthroscopic release in frozen shoulder. Acta Ortop Bras, 2017, 25(6): 270-274.
5. Hand GC, Athanasou NA, Matthews T, et al. The pathology of frozen shoulder. J Bone Joint Surg Br, 2007, 89(7): 928-932.
6. Tasto JP, Elias DW. Adhesive capsulitis. Sports Med Arthrosc Rev, 2007, 15(4): 216-221.
7. Itoi E, Arce G, Bain GI, et al. Shoulder stiffness: current concepts and concerns. Arthroscopy, 2016, 32(7): 1402-1414.
8. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for pain (VAS pain), Numeric Rating Scale for pain (NRS pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63(11): S240-S252.
9. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res, 1987(214): 160-164.
10. Vastamäki H, Kettunen J, Vastamäki M. The natural history of idiopathic frozen shoulder: a 2- to 27-year follow up study. Clin Orthop Relat Res, 2012, 470(4): 1133-1143.
11. Chan HBY, Pua PY, How CH. Physical therapy in the management of frozen shoulder. Singapore Med J, 2017, 58(12): 685-689.
12. Elnady B, Rageh EM, Hussein MS, et al. In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study. Clin Rheumatol, 2020, 39(12): 3805-3814.
13. Pandey V, Madi S. Clinical guidelines in the management of frozen shoulder: an update!. Indian J Orthop, 2021, 55(2): 299-309.
14. Cao XY, Zhao HY. A pilot study of ultrasound-guided acupotomy for the treatment of frozen shoulder. Medicine (Baltimore), 2019, 98(42): e17632.
15. Do JG, Hwang JT, Yoon KJ, et al. Correlation of ultrasound findings with clinical stages and impairment in adhesive capsulitis of the shoulder. Orthop J Sports Med, 2021, 9(5): 23259671211003675.
16. Sernik RA, Vidal Leão R, Luis Bizetto E, et al. Thickening of the axillary recess capsule on ultrasound correlates with magnetic resonance imaging signs of adhesive capsulitis. Ultrasound, 2019, 27(3): 183-190.
17. 郭璇妍, 卢漫, 贺凡丁, 等. 超声引导下关节腔注射联合关节囊扩张治疗冻结肩. 中国医学影像技术, 2018, 34(7): 1081-1084.
18. Akbar M, McLean M, Garcia-Melchor E, et al. Fibroblast activation and inflammation in frozen shoulder. PLoS One, 2019, 14(4): e0215301.
19. de la Serna D, Navarro-Ledesma S, Alayón F, et al. A comprehensive view of frozen shoulder: a mystery syndrome. Front Med (Lausanne), 2021, 8: 663703.
20. Yoon JP, Chung SW, Kim JE, et al. Intra-articular injection, subacromial injection, and hydrodilatation for primary frozen shoulder: a randomized clinical trial. J Shoulder Elbow Surg, 2016, 25(3): 376-383.
21. Wu WT, Chang KV, Han DS, et al. Effectiveness of glenohumeral joint dilatation for treatment of frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. Sci Rep, 2017, 7(1): 10507.
22. Wang JC, Tsai PY, Hsu PC, et al. Ultrasound-guided hydrodilatation with triamcinolone acetonide for adhesive capsulitis: a randomized controlled trial comparing the posterior glenohumeral recess and the rotator cuff interval approaches. Front Pharmacol, 2021, 12: 686139.
23. Kanbe K. Clinical outcome of arthroscopic capsular release for frozen shoulder: essential technical points in 255 patients. J Orthop Surg Res, 2018, 13(1): 56.
24. Lee SH, Yoon C, Chung SG, et al. Measurement of shoulder range of motion in patients with adhesive capsulitis using a kinect. PLoS One, 2015, 10(6): e0129398.

West China Medical Journal

Ultrasound-guided intra-articular injection of shoulder joint combined with hydraulic dilatation in the treatment of frozen shoulder in different clinical stage

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