Background & Aims
Adhesive Capsulitis (AC), commonly denoted as frozen shoulder is characterized by shoulder pain and a gradual onset of significantly diminished active and passive range of motion (ROM) of the glenohumeral joint. Although multiple management options have been described in the literature, there is disagreement on the most effective management at different stages of the disease. Recent studies have demonstrated ultrasound-guided (USG) interventions as an effective modality for managing pain and improving ROM associated with AC. Of all the mentioned options, two minimally invasive ultrasound-guided procedures i.e., Pulsed radiofrequency (PRF) ablation of Suprascapular Neve (SSN) interventions and hydro dilatation have been preferred choices for various interventional pain physicians for managing AC patients. Thus, this study aimed to compare and evaluate the effects of USG-guided hydro dilatation in rotator interval and PRF of the suprascapular nerve in patients of shoulder AC.
Methods
After the approval of The Institutional Ethics Committee (IEC) Sixty patients with AC were randomized into the following 2 groups: AH-Group (Patients who underwent USG-guided hydro dilatation in rotator interval) and PRF-Group (Patients who underwent PRF Ablation of SSN). Additionally, all the patients in both groups received 12 weeks of physical therapy. The primary outcome measure was the reduction of pain intensity as quantified by the Numerical Rating Scale (NRS). Secondary clinical outcome measures were the score of shoulder pain and disability index (SPADI), ROM improvement as assessed by Goniometry, Emotional functioning as assessed by Hospital anxiety and depression scale (HADS) score, and adverse and long-term complications following interventions. All outcome measurements including NRS, SPADI, and ROM were performed at Baseline, immediately post-procedure, at 1 month & 3 months following treatment. The statistical significance level was maintained at a P-value <0.05.
Results
In Group AH, the mean NRS improved from 6.60 at the baseline to 2.53 at the first-month time point, then worsened to 2.83 in the third month, whereas in Group PRF, the mean NRS improved from 6.80 at the baseline to 2.30 at the First-month time point, then worsened to 4.50 in the third month. This change was also statistically significant in both groups. However, at three months post-procedure, NRS was significantly (p-value: <0.001) improved in individuals of the AH group (2.83±0.59) as opposed to the PRF group (4.50±0.51). SPADI was also considerably lesser in the patients of the AH group as opposed to the PRF group at the baseline, 1st, and 3rd month follow-up (p-value: <0.001). While comparing ROM we found that the percentage improvements between AH and PRF groups were significant in Abduction and External Rotation movements at specific time points i.e., at 3rd Month postinjection. Also, there were no serious adverse effects or complications in either group.
Conclusions
Both of the procedures help in reducing pain and disability, improving ROM, and improving the emotional status of AC patients. However, USG-guided hydro dilatation in rotator cuff interval achieved better results in terms of pain relief and ROM abnormality than PRF of the SSN. Thus, we can conclude that hydro dilatation through the anterior approach i.e., rotator cuff interval might be a better management option for patients with AC, considering its superior outcome on improving pain and disability, improving ROM, and feasibility of equipment when compared with the PRF of SSN.
References
1.Wang JC, Tsai PY, Hsu PC, Huang JR, Wang KA, Chou CL, Chang KV. Ultrasound-Guided Hydro dilatation With Triamcinolone Acetonide for Adhesive Capsulitis: A Randomized Controlled Trial Comparing the Posterior Glenohumeral Recess and the Rotator Cuff Interval Approaches. Frontiers in Pharmacology. 2021 May 7; 12:1104.
2.Yan J, Zhang XM. A randomized controlled trial of ultrasound-guided pulsed radiofrequency for patients with frozen shoulder. Medicine (Baltimore). 2019 Jan;98(1):e13917.
3.Yoong P, Duffy S, McKean D, Hujairi NP, Mansour R, Teh JL. Targeted ultrasound-guided hydro dilatation via the rotator interval for adhesive capsulitis. Skeletall Radiol. 2015 May;44(5):703-8.
4.Luleci N, Ozdemir U, Dere K, Toman H, Luleci E, Irban A. Evaluation of patients’ response to pulsed radiofrequency treatment applied to the suprascapular nerve in patients with chronic shoulder pain. J Back Musculoskelet Rehabil 2011; 24:189-194
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Presenting Author
Ravi Shankar Sharma
Poster Authors
Ravi Sharma
M.D., D.M.(Pain Medicine)
AIIMS, Gorakhpur
Lead Author
Topics
- Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science