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Upper Limb: N. A. Quraishi, P. Johnston, J. Bayer, M. Crowe, and A. J. Chakrabarti Thawing the frozen shoulder: A RANDOMISED TRIAL COMPARING MANIPULATION UNDER ANAESTHESIA WITH HYDRODILATATION J Bone Joint Surg Br 2007; 89-B: 1197-1200 [Abstract] [Full text] [PDF]

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Thawing the frozen shoulder

Ravi K Trehan, M Curtis, Consultant Orthopaedic Surgeon, Kingston Hospital   (10 January 2008)

Thawing the frozen shoulder 10 January 2008
Ravi K Trehan, Specialist Registrar, Trauma & Orthopaedics Kingston Hospital, Kingston upon Thames, Surrey, M Curtis, Consultant Orthopaedic Surgeon, Kingston Hospital Send letter to journal: Re: Thawing the frozen shoulder trehanravi{at}hotmail.com Ravi K Trehan, et al.	Sir, I read this article with interest and I want to congratulate the authors for carrying out a randomised controlled trial comparing manipulation under anaesthesia with hydrodilatation. I would like to raise a few points regarding hydrodilatation as a treatment for adhesive capsulitis of shoulder. I want to draw the authors' attention to their statement that “there is a lack of evidence on how to treat frozen shoulder.” There have been few randomised controlled trials in the past comparing different ways to treat frozen shoulder. Buchbinder et al1 reported the results of their work. The authors demonstrated the efficacy of arthrographic distension with normal saline and corticosteroid over placebo in patients with a painful stiff shoulder. Three other trials2-4 have compared distension with or without steroid with corticosteroid alone. Two of these studies2,3 failed to show any benefit for distension and corticosteroid over corticosteroid injection alone. Gam et al4 reported a significant improvement in range of motion and analgesic use in the group treated with distension and steroid compared with steroid alone. We are currently evaluating the results of repeat distension in adhesive capsulitis patients. Early results are quite promising and seem to extend the benefit. Buchbinder and Green5 stated that the timing of joint distension in treating patients with frozen shoulder may also influence outcome. Due to pain in the early stages of the disorder patients may be unable to tolerate distension, resulting in the injection of insufficient volume. The authors suggested that distension may be more effective in the later phases. R.K. Trehan, Specialist Registrar, Trauma & Orthopaedics, M. Curtis, Consultant Orthopaedic Surgeon, Kingston Hospital, Kingston upon Thames, Surrey, UK. 1. Buchbinder R, Green S, Forbes A, Hall S, Lawler G. 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. 2. Corbeil V, Dussault RG, Leduc BE, Fleury J. Adhesive capsulitis of the shoulder: a comparative study of arthrography with intra-articular corticotherapy and with or without capsular distension (Article in French). Can Assoc Radiol J 1992;43:127-30. 3. Jacobs LG, Barton MA, Wallace WA, et al. Intra-articular distension and steroids in the management of capsulitis of the shoulder. BMJ 1991;302:1498-501. 4. Gam AN, Schydlowsky P, Rossel I, Remvig L, Jensen EM. Treatment of "frozen shoulder" with distension and glucorticoid compared with glucorticoid alone. A randomised controlled trial. Scand J Rheumatol 1998;27:425-30. 5. Buchbinder R, Green S. Effect of arthrographic shoulder joint distension with saline and corticosteroid for adhesive capsulitis. Br J Sports Med 2004;38:384-5.