The effectiveness of ultrasound guided hydrodistension and physiotherapy in the treatment of frozen shoulder/adhesive capsulitis in primary care: a single centre service evaluation

Abstract

Background

Evidence for optimal non-operative treatment of frozen shoulder is lacking. The present study aimed to evaluate a treatment strategy for stage II to III frozen shoulder provided by the current primary care musculoskeletal service.

Methods

General practioner referrals of shoulder pain to the musculoskeletal service diagnosed with stage II to III frozen shoulder and who opted for a treatment strategy of hydrodistension and guided physiotherapy exercise programme over a 12-month period were evaluated for 6 months. Thirty-three patients were diagnosed with stage II to III frozen shoulder by specialist physiotherapists and opted for the treatment strategy. Outcome measures included Shoulder Pain Disability Index (SPADI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH), pain score and range of movement. Data were collected at baseline, as well as at 6 weeks, 12 weeks and 6 months.

Results

All patients significantly improved in shoulder symptoms on the SPADI and QuickDASH scores (p < 0.001). Pain scores and range of shoulder movement flexion, abduction, external rotation showed significant improvement at all time points (p < 0.001).

Conclusions

This service evaluation demonstrates that management of frozen shoulder stage II to III, as conducted by physiotherapists in a primary care setting utilizing hydrodistension and a guided exercise programme, represents an effective non-operative treatment strategy.

Keywords

adhesive capsulitis cost frozen shoulder hydrodistension physiotherapy primary care QuickDASH SPADI

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References

Walker-Bone

Palmer

Reading

Coggon

Cooper

. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Care Res 2004; 51: 642–651.

Zuckerman

Rokito

. Frozen shoulder: a consensus definition. J Shoulder Elbow Surg 2011; 20: 322–325.

Robinson

Seah

Chee

Hindle

Murray

. Frozen shoulder. J Bone Joint Surg 2012; 94B: 1–9.

Reeves

. The natural history of the frozen shoulder syndrome. Scand J Rheum 1975; 4: 193–196.

Lewis

. Frozen shoulder contracture syndrome – aetiology, diagnosis and management. Man Ther 2015; 20: 2–9.

Bunker

. The pathology of frozen shoulder. A Dupuytren-like condition. J Bone Joint Surg 1995; 77B: 677–783.

Rizk

Gavant

Pinals

. Treatment of adhesive capsulitis (frozen shoulder) with arthrogaphic capsular distension and rupture. Arch Phys Med Rehab 1994; 75: 803–807.

Rookmoneea

Dennis

Brealey

. The effectiveness of interventions in the management of patients with primary frozen shoulder. J Bone Joint Surg 2010; 92B: 1267–1272.

Dawson

Sheppard

Carr

. An overview of factors relevant to undertaking research and reviews on the effectiveness of treatment for frozen shoulder. Shoulder Elbow 2010; 2: 232–237.

10.

Andren

Lundberg

. Treatment of rigid shoulders by joint distension during arthrography. Acta Orthop Scand 1965; 36: 45–53.

11.

Buchbinder

Green

Youd

Johnston

Cumpston

. Arthrographic distension of adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev 2008; 1. CD007005.

12.

Buchbinder

Green

Forbes

Hall

Lawler

. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind placebo controlled trial. Ann Rheum Dis 2004; 63: 302–309.

13.

Maund

Criag

Suekarran

et al.

Management of frozen shoulder: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012; 16: 11–11.

14.

Ó Conaire E, Lewis J. Arthrographic hydrodistension for frozen shoulder: a physiotherapy-led initiative in primary care, 2012. http://www.health.org.uk/sites/health/files/Shine2011_TreatmentOfFrozenShoulderInAPrimaryCareSetting_poster.pdf (accessed 24 April 2017).

15.

Manske

Prohaska

. Clinical commentary and literature review: diagnosis, conservative and surgical management of adhesive capsulitis. Shoulder Elbow 2010; 2: 238–254.

16.

Bateman

McClymont

Hinchliffe

. The effectiveness and cost of corticosteroid injection and physiotherapy in the treatment of frozen shoulder – a single centre service evaluation. Clin Rheum 2014; 33: 1005–1008.

17.

Yoong

Duffy

McKean

Hujairi

Mansour

Teh

. Targeted ultrasound-guided hydrodilatation via the rotator interval for adhesive capsulitis. Skeletal Radiol 2015; 44: 703–708.

18.

Hill

Lester

Taylor

Shanahan

Gill

. Factor structure and validity of the shoulder pain and disability index in a population-based study of people with shoulder symptoms. Musculoskelet Disord 2011; 12: 8–8.

19.

Paul

Lewis

Shadforth

Croft

van der Windt

Hay

. A comparison of four shoulder-specific questionnaires in primary care. Ann Rheum Dis 2004; 63: 1293–1299.

20.

Breckenridge

McAuley

. Shoulder Pain and Disability Index. Aust J Physiol 2011; 57: 197–197.

21.

Gummesson

Ward

Atroshi

. The Shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. Musculoskeletal Disorders 2006; 7: 44–44.

22.

Sorenson

Howard

Wen Hui Tan Ketchersid

Calfee

. Minimal clinically important differences of three patient rated outcome instruments. J Hand Surg Am 2013; 38: 641–649.

23.

Roy

MacDermid

Woodhouses

. Measuring shoulder function: a systematic review of four questionnaires. Arth Rheum 2009; 61: 623–632.

24.

Zawar

Read

Noakes

. Sonographically guided glenohumeral joint injection. AJR Am Roentgenl 2004; 183: 48–50.

25.

Sidarthan

Mbako

Wootton

. Needle guide in shoulder arthroscopy – a technique. Sports Med Arthrosc Rehabil Ther Technol 2007; 1: 7–7.

26.

McNally

. Practical musculoskeletal ultrasound, 2nd edition. Edinburgh: Churchill Livingstone, 2014.

27.

Jones

Hanchard

Hamilton

Rangan

. A qualitative study of patients’ perceptions and priorities when living with primary frozen shoulder. BMJ 2013; 3: e003452–e003452.

28.

Juel

Oland

Kvalheim

Love

Ekeberg

. Adhesive capsulitis: one sonographic-guided injection of 20mg triamcinolone into the rotator interval. Rheum Int 2013; 33: 1547–1553.

29.

Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003; 1:CD004016.

30.

van der Windt

Koes

Deville

Boeke

de Jong

Bouter

. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial. BMJ 1998; 317: 1292–1296.

31.

Carette

Moffet

Tardif

et al.

Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder. Arth Rheum 2003; 48: 829–838.

32.

Ryans

Montgomery

Galway

Kernohan

McKane

. A randomised controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology 2005; 44: 529–535.