Hydrodilatation is an Effective Treatment for Both Diabetics and Non Diabetics With Adhesive Capsulitis


Jegathesan T, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)
SINGAPORE

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Hydrodilatation is an Effective Treatment for Both Diabetics and Non Diabetics With Adhesive Capsulitis

Jegathesan T, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), SINGAPORE Jason Derry Onggo, MBBS, SINGAPORE Mehek Gupta, MBBS, SINGAPORE Teong Jin Lester Tan, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), SINGAPORE Keng Thiam Lee, MBBS(SPORE), MMED(ORTHO)(SPORE), FRCSEd(ORTHO), SINGAPORE Sean W.L. Ho, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), SINGAPORE

Tan Tock Seng Hospital, Singapore, Singapore, SINGAPORE

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Anatomic Location

Shoulder Glenohumeral

Diagnosis / Condition

Stiff Joints

Patient Populations

Elderly

Anatomic Structure

Bones Synovial

Diagnosis Method

X-ray

Sports Medicine

Practice Management Epidemiology Evidence Based Medicine Outcome Studies

Summary: Hydrodilatation is an effective treatment option in the short and medium term in both diabetics and non-diabetics with adhesive capsulitis, with good relief of pain and improvement in shoulder range of motion, but diabetic patients have significantly less improvement in range of motion and pain compared to non-diabetics at the 6-months post hydrodilatation.

Introduction

Adhesive capsulitis (AC), also known as frozen shoulder, is a common gradual inflammatory condition that affects the glenohumeral joint. The natural history of the disease is long but often self-limiting, and can be a debilitating condition for patients to suffer from. Diabetics tend to have a higher prevalence of AC of ranging from 10% to up to 29%. In addition to an increased prevalence, diabetics have a more severe presentation of frozen shoulder, and treatment outcomes tend to be inferior compared to the non-diabetic population Hydrodilatation is a relatively new treatment modality used to manage AC along with physical therapy as a part of conservative management.

Background

The primary aim of this retrospective study is to evaluate the short and medium-term outcomes for shoulder hydrodilatation for treatment of shoulder AC in diabetic and non-diabetic patients.

Methods

Patients with clinical or radiological diagnosis of AC and who underwent ultrasound guided shoulder hydrodilatation in our local institution from January 2021 to June 2022 were included in this study. Clinical outcomes were measured with visual analog scale (VAS) for pain and passive range of motion consisting of forward flexion (FF) and external rotation (ER) at pre-hydrodilatation, 1-month and 6-months post hydrodilatation.

Results

A total of 163 shoulders were included, corresponding to 156 patients consisting of 47 diabetics, 109 non-diabetics and 7 bilateral shoulders (3 diabetics and 4 non-diabetics). At the time of presentation, there was no significant difference in VAS, FF or ER between diabetics and non-diabetics. From pre-hydrodilatation to 1-month post-hydrodilatation and 1-month to 6-months post-hydrodilatation, there was significant improvement in VAS, FF and ER for both groups. Comparing diabetics vs non-diabetics, non-diabetic group had significantly better FF (p<0.01) at 1 month post hydrodilatation. At 6 months post-hydrodilatation, non-diabetic group also had significantly better outcomes including VAS score (p=0.02), FF (p<0.01) and ER (p=0.02).

Conclusion

Hydrodilatation is an effective treatment option in the short and medium term in both diabetics and non-diabetics with adhesive capsulitis, with good relief of pain and improvement in shoulder range of motion. Diabetic patients have significantly less improvement in range of motion and pain compared to non-diabetics at the 6-months post hydrodilatation.

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