Frozen Shoulder Treatment
Adhesive capsulitis of the shoulder is more commonly known as frozen shoulder. In previous posts I have talked about adhesive capsulitis of the shoulder and its causes.
Adhesive Capsulitis of the Shoulder for Frozen Shoulder
In my practice it is seen with some frequency and many different severities. Usually when a patient comes in they have already been tried on a course of NSAIDS and physical therapy. After I get a history, examine the patient, and determine that they have a frozen shoulder, I will try an intra-articular injection of cortisone into the joint. This also will help in verifying the diagnosis in that the capsule is tight and I can feel the resistance of the cortisone as I inject the material. I will have the patient then try and move the shoulder and see them back in one week. If the patient is still having symptoms, one of the newer procedures that I have been doing is distention arthrography. It is also known as hydrodilation of the shoulder.
Distention Arthrogrphy or Hydrodilation of the Shoulder
What this entails is using fluoroscopic guidance to inject 30 cc of a fluid mixture into the shoulder of lidocaine, cortisone, and contrast medium. The procedure is performed with a local anesthetic and takes about 15 minutes. The fluid distends the shoulder capsule and helps to break up the adhesions (scar tissue). Patients may experience some brief pain, but it usually resolves.
Studies have shown that arthrographic shoulder distention has equal to better results then manipulation of the shoulder under anesthesia. There are reports in the literature of success rates up to 70% with this technique. Patients benefit from less pain and improved range of motion and function without having to be under a general anesthesia. Manipulation also has the risk of fracture of the humerus.
In my own practice I have found distention arthrographic dilation to be a safe and effective alternative for treating frozen shoulder. My patients receive quick feedback and can start physical therapy right away. They often have increased range of motion and less pain at their first office visit after the procedure.