Treatment effects of ultrasound-guided capsular distension with hyaluronic acid in adhesive capsulitis of the shoulder

Ki Deok Park, Hee-Seung Nam, Ju Kang Lee, Young Joo Kim, Yongbum Park
Archives of Physical Medicine and Rehabilitation 2013, 94 (2): 264-70

OBJECTIVE: To investigate the efficacy of ultrasound-guided intra-articular (IA) hyaluronic acid injection with capsular distension compared with steroid injection alone in patients with adhesive capsulitis of the shoulder by assessing pain relief, functional improvements, and range of motion at 2 and 6 weeks after final injections.

DESIGN: Prospective randomized controlled trial.

SETTING: University hospital.

PARTICIPANTS: Patients (N=100) with adhesive capsulitis of shoulder.

INTERVENTIONS: Subjects were randomly assigned to 2 groups: 45 patients in group A were treated with 0.5% lidocaine plus triamcinolone 40mg IA injection and 45 patients in group B were treated with 0.5% lidocaine plus hyaluronic acid 20mg and capsular distension. All injections were performed every 2 weeks for a total of 3 times.

MAIN OUTCOME MEASURES: Treatment effects were assessed using the Shoulder Pain and Disability Index (SPADI), Verbal Numeric Scale (VNS), and passive range of motion (ROM) of the shoulder (flexion, abduction, external rotation) before injections and at 2 and 6 weeks after the last injections.

RESULTS: SPADI, VNS, and passive ROM were improved at 2 and 6 weeks in both groups. The statistical differences were not observed in SPADI and VNS between groups (P<.05), and shoulder passive external rotation was more improved in group B than in group A (P<.05).

CONCLUSIONS: Capsular distension with IA hyaluronic acid injection was shown to be a treatment method as effective as the steroid injection alone in pain relief and functional improvement; additionally, it was more effective in passive external rotation improvement than steroid injection alone.

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