Title: Effectiveness of Frozen Shoulder Treatment Using Hydraulic Distension by Injecting Large Volume of Normal Saline
Author: Prabhav Majagaiyan Pokhrel
DOI: https://dx.doi.org/10.18535/jmscr/v9i8.04
Abstract
Introduction: Frozen shoulder is an insidious, painful condition that results in gradual restriction of movement in the shoulder. It is a clinical diagnosis frequently made for patients with shoulder pain and limited motion. Though self-limiting, various modalities of treatment like physiotherapy, hot fomentation, oral analgesics are recommended. These can include intra- articular injections, capsular distension, manipulation under anaesthesia, and surgery. However, manipulation after anaesthesia and surgery are limited by poor accessibility; thus, the intra- articular injection of drugs, such as corticosteroids, and capsular distension after intra-articular injection are more commonly used. But none of them are gold standard treatment. This study is being done to determine the effectiveness and safety of capsular distension as a modality of treatment in terms of its functional outcome.
Method: 61 patients complaining of pain and stiffness in one shoulder for at least 6 weeks with restricted movement in two or more planes and undergoing physiotherapy were studied from the Out Patient Department (OPD) of National Medical College & Teaching Hospital. A Large volume (approx. 60-80 ml) of Normal saline along with 2.5 ml of 1% lidocaine was injected intraarticularly and the outcome was recorded at different intervals up to 6 months. The Outcome was computed in SS Pro 16.
Result: The study documented 54.10% of the patient had pain in the right shoulder and 45.90% of them had a complaint on their left side with male predominance (55.74%). We reported after the injection of saline abduction improved up to 56.57ᴼ and adduction up to 44.26ᴼ.
Conclusion: Outcome of large volume Normal Saline injection in case of Frozen Shoulder under local anaesthesia was found to be effective. Further study with large sample is recommended. It can be performed in areas with limited resources.
Keywords: Abduction, Adduction, Frozen Shoulder, Injection, Normal Saline, Pain.
References
- Tallia AF, Cardone DA. Diagnostic and therapeutic injection of the shoulder region. American family physician. 2003;67(6):1271-8.
- Zuckerman JD, F C. The shoulder: a balance of mobility and stability. American Academy of Orthopaedic Surgery. 1993:p 19-109.
- Canale ST, Beaty JH. Campbell's Operative Orthopaedics: Elsevier/Mosby; 2012.
- Pearsall AW, Speer KP. Frozen shoulder syndrome: diagnostic and treatment strategies in the primary care setting. Medicine and science in sports and exercise. 1998;30(4 Suppl):S33-9.
- Muller LP, Muller LA, Happ J, Kerschbaumer F. Frozen shoulder: a sympathetic dystrophy? Archives of orthopedic and trauma surgery. 2000;120(1-2):84-7.
- Wybier M, Parlier-Cuau C, Baque MC, Champsaur P, Haddad A, Laredo JD. Distension Arthrography in Frozen Shoulder Syndrome. Seminars in musculoskeletal radiology. 1997;1(2):251-6.
- van Royen BJ, Pavlov PW. Treatment of frozen shoulder by distension and manipulation under local anesthesia. International orthopedics. 1996;20(4):207-10.
- Kuptniratsaikul S, Kuptniratsaikul V, Tejapongvorachai T, Itiravivong P. A capsular dilatation facilitated shoulder manipulation for treating patients with frozen shoulder. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2002;85 Suppl 1:S163-9.
- Callinan N, McPherson S, Cleaveland S, Voss DG, Rainville D, Tokar N. Effectiveness of hydroplasty and therapeutic exercise for treatment of frozen shoulder. Journal of hand therapy : official journal of the American Society of Hand Therapists. 2003;16(3):219-24.
- Gam AN, Schydlowsky P, Rossel I, Remvig L, Jensen EM. Treatment of "frozen shoulder" with distension and glucocorticoid compared with glucocorticoid alone. A randomized controlled trial. Scandinavian journal of rheumatology. 1998;27(6):425-30.