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Intra-articular steroid for adhesive capsulitis: does hydrodilatation give any additional benefit? A randomized control trial

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Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the benefit offered by capsular hydrodilatation in addition to intra-articular steroid injections in cases of adhesive capsulitis, assess outcomes in diabetic patients with capsular hydrodilatation as compared to non-diabetics and correlate duration of symptoms with outcome based on the type of intervention given.

Materials and methods

This prospective double-blinded randomized control trial included patients presenting with clinical features of adhesive capsulitis with no evidence of rotator cuff pathology and randomized them into two groups—intra-articular steroid with hydrodilatation (distension group) and only intra-articular steroid (non-distension group) with intervention being performed as per the group allotted. Primary outcome measure was Shoulder Pain and Disability Index (SPADI) scores which were taken pre-intervention, at 1.5, 3 and 6 months post-intervention, which were assessed by generalized linear model statistics and Pearson correlation.

Results

Although there was statistically significant drop in SPADI in both groups over time [F(1.9, 137.6) = 112.2; p < 0.001], mean difference in SPADI between the 2 groups was not statistically significant (1.53; CI:-3.7 to 6.8; p = 0.56). There was no significant difference between both groups among diabetics [F(1,38) = 0.04; p = 0.95] and no significant difference between diabetic and non-diabetic patients who received hydrodilatation [F(1.8, 60) = 2.26; p = 0.12]. There was no significant correlation between the reduction in SPADI scores and duration of symptoms in any subset of the study population.

Conclusion

Shoulder joint hydrodilatation offered no additional benefit compared to intra-articular steroid injections for shoulder adhesive capsulitis. Outcome for diabetics and non-diabetics were similar and there was no correlation between duration of symptoms and outcome.

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Abbreviations

ANOVA:

Analysis of variance

CI:

Confidence interval

CONSORT:

Consolidated Standards of Reporting Trials

ITT:

Intention to treat

RCT:

Randomized control trial

SD:

Standard deviation

SPADI:

Shoulder Pain and Disability Index

VAS:

Visual analog scale

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Acknowledgements

We would like to acknowledge the Department of Statistics for providing statistical advice for this trial.

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Authors and Affiliations

  1. Department of Radio-diagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India

    Samir M. Paruthikunnan, Praveen N. Shastry, Rajagopal Kadavigere & Lakshmikanth Halegubbi Karegowda

  2. Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India

    Vivek Pandey

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  1. Samir M. Paruthikunnan
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Correspondence to Rajagopal Kadavigere.

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Paruthikunnan, S.M., Shastry, P.N., Kadavigere, R. et al. Intra-articular steroid for adhesive capsulitis: does hydrodilatation give any additional benefit? A randomized control trial. Skeletal Radiol 49, 795–803 (2020). https://doi.org/10.1007/s00256-019-03316-8

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