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Mechanism of Action Rupture effect Stretching Rupture
Stretching = No Rupture Andren and Lundberg 1965 Capsular stretching Early rupture = no stretching therefore failure to restore motion BUT..Early rupture in very stiff patients with less pliable capsule
Rupture = less stretching Gavant 1994 Reduced capsular tension Interruption of pain receptors As per MUA / RI release No adhesions to stretch in frozen shoulder, no abolition of synovial serrations or filling of recesses….BUT…all pts ruptured.
Background Evidence• Andren and Lundberg 1965 Moderate stiffness 2/3 improve at 2 months, Severe stiffness: 1/5 recovered. Gavant et al 1994 13/16 pain free at 6 months, 69 – 90 % of normal ROM Cochrane review 2009 5 RCT Minimal harm May shorten duration of symptoms and disability Ng et al 2012 Better AB for MUA, but equal pain relief and ER
Aim Outcome of hydrodilatation Does capsular rupture matter?
Method Retrospectivereview Consecutive patients August 2009 and August 2010
Inclusion Allfrozen shoulder patients who had undergone Hydrodilatation Diagnosis Clinical Normal XR
Exclusion Surgerywithin the follow-up period Trauma within the follow-up period
Procedure Standard Radiologistlead Standard post operative physio regime
Outliers Rupture group NIDDM No Rupture Group On going pain, required further injection at follow up. Bothat lower end of Constant scoring. No specific complications in these patients.
Subgroup: post intervention:paired analysis No Rupture Rupture DifferencePost pain score 2.78 1.33 1.444Post Flex 150.83 161.43 -10.595Post Abd 139.17 154.29 -15.119Post ER 44.17 35.00 9.167postCS 71.00 80.29 -9.286postOS 39.00 43.29 -4.286
Conclusion Mean significant improvement in Pain, ROM, CS, and OS No significant difference in baseline data between subgroups All subgroup patients improved in all areas No Significant difference in magnitude of improvement between rupture and no-rupture groups
Discussion Outpatient procedure Local Anaesthetic No Adverse events Generally well tolerated Few Outliers Further research