HS-43 Treatment of Shoulder Adhesive Capsulitis with Large Volume Hydrodilatation

INTRODUCTION/OBJECTIVE: Adhesive capsulitis (AC) commonly known as “frozen shoulder”, is characterized by fibrosis and contracture of the glenohumeral joint capsule, leading to progressive stiffness, pain, and limited range of motion (ROM) in multiple planes which is used to confirm diagnosis. Injections, physical therapy, and hydrodilatation are commonly used treatments, but no consensus exists regarding the most effective approach. This study aimed to assess patient-reported outcome measures (PROMs) and ROM for patients undergoing our novel large-volume hydrodilatation protocol. METHODS: Seventy-one patients diagnosed with AC or postoperative stiffness underwent a novel ultrasound-guided large-volume glenohumeral joint hydrodilatation protocol, which included an ultrasound-guided suprascapular nerve block at the suprascapular notch of the scapula prior to the procedure. The hydrodilatation included 9cc 1% lidocaine and 1cc triamcinolone, followed by the injection of up to 110cc sterile saline. Immediately post-procedure, patients performed two sets of 10 forward wall crawls and held a 1-minute external rotation doorway stretch for two repetitions in the clinic, with outpatient physical therapy was prescribed as well. ROM was measured immediately pre-procedure, post-procedure, and at the final clinic follow-up. PROMs were assessed 6+ months following hydrodilatation using the Numeric Rating Scale (NRS) for pain, the Shoulder Pain and Disability Index (SPADI), and the Single Assessment Numeric Evaluation (SANE). Any further treatments that patients required were also recorded. RESULTS: Of the 71 patients, 47 were female and 24 were male. Average pre-procedure forward flexion was 107°, which increased to 156° immediately post-procedure (p CONCLUSION: Our novel ultrasound-guided hydrodilatation procedure for AC and post-operative stiffness resulted in significant improvements in ROM and satisfactory 6+ month PROMs. These findings suggest that it could be an effective lasting alternative or adjunct to traditional treatments.