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Skeletal Radiology

, Volume 48, Issue 8, pp 1269–1274 | Cite as

Shoulder manipulation under targeted ultrasound-guided rotator interval block for adhesive capsulitis

  • David McKeanEmail author
  • Philip Yoong
  • Rebecca Brooks
  • Joseph Papanikitas
  • Richard Hughes
  • Aniruddha Pendse
  • Bernard John McElroy
Technical Report

Abstract

Objective

To describe and evaluate the outcome following shoulder manipulation under rotator interval block for the treatment of adhesive capsulitis.

Materials and methods

Patients with adhesive capsulitis referred by our local orthopaedic shoulder surgeons consented to targeted ultrasound-guided injection of the glenohumeral joint via the rotator interval. Inclusion criteria included a failure to respond to conservative treatment and the absence of a full-thickness rotator cuff tear. Twelve millilitres of a mixture of local anaesthetic and steroid was injected into the rotator interval using a 21-gauge needle, with a small volume of the same solution instilled into the subacromial bursa. Following injection, under local anaesthetic block, patients were gently manipulated into abduction, external rotation and internal rotation as far as they could comfortably tolerate. Patients were assessed pre-injection with documented pain scores from 0 to 10 on a visual analogue scale (VAS) and the Oxford Shoulder Score (OSS) questionnaire. Initial follow-up comprised a VAS pain score at 1 h, 24 h and 2 weeks. Clinical review by the referring orthopaedic surgeon was performed at 2 months post-injection. Long-term follow-up involved a VAS pain score and the OSS questionnaire at 5 months.

Results

Forty patients were suitable for inclusion in the study. Twenty-three were female (57.5%) and 17 were male. The mean age was 52 years (range, 31–73 years). Twelve patients were post-operative. The duration of symptoms ranged from 3 months to 18 months. Mean pre-procedure OSS was recorded as 23.3 (range, 4–36). The mean VAS pain score was 7.7 before the procedure (range, 4 – 10), 3.4 at 1 h (range, 0–8), 2.9 at 24 h (range, 0–8), and 1.8 at 2 weeks (range 1–4). Orthopaedic follow-up at an average of 66 days post-injection was recorded in 18 patients. All patients reported initial improvement of their shoulder pain and return to near full range of movement; however, recurrence of adhesive capsulitis symptoms was recorded in 5 patients. One case of rupture of the long head of the biceps tendon was reported, but the patient remained asymptomatic. Long-term follow-up at 5 months was obtained in 31 patients, with a mean OSS of 42 (range, 21–60) and VAS of 2.3 (range, 0–7).

Conclusion

Manipulation under general anaesthesia is a well-recognised treatment for adhesive capsulitis. We report that targeted ultrasound-guided injection of the rotator interval and manipulation of the shoulder under local anaesthetic blockade result in good outcomes in reducing shoulder pain and symptoms of adhesive capsulitis with low recurrence and complication rates.

Keywords

Ultrasound Shoulder Rotator interval Adhesive capsulitis Frozen shoulder Interventional techniques Guided injection 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. Am J Sports Med. 2010;38(11):2346–56.CrossRefGoogle Scholar
  2. 2.
    Binder AI, Bulgen DY, Hazleman BL, Roberts S. Frozen shoulder: a long-term prospective study. Ann Rheum Dis. 1984;43(3):361–4.CrossRefGoogle Scholar
  3. 3.
    Hand C, Clipsham K, Rees JL, Carr AJ. Long-term outcome of frozen shoulder. J Shoulder Elbow Surg. 2008;17(2):231–6.CrossRefGoogle Scholar
  4. 4.
    Wang K, Ho V, Hunter-Smith DJ, Beh PS, Smith KM, Weber AB. Risk factors in idiopathic adhesive capsulitis: a case control study. J Shoulder Elbow Surg. 2013;22:e24–9.CrossRefGoogle Scholar
  5. 5.
    Lequesne M, Dang N, Bensasson M, et al. Increased association of diabetes mellitus with capsulitis of the shoulder and shoulder-hand syndrome. Scand J Rheumatol. 1977;6:53–6.PubMedGoogle Scholar
  6. 6.
    Grey RG. The natural history of “idiopathic” frozen shoulder. J Bone Joint Surg Am. 1978;60(4):564.PubMedGoogle Scholar
  7. 7.
    Brue S, Valentin A, Forssblad M, Werner S, Mikkelsen C, Cerulli G. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthrosc. 2007;15(8):1048–54.CrossRefGoogle Scholar
  8. 8.
    Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011;20(3):502–14.CrossRefGoogle Scholar
  9. 9.
    Neer CS 2nd, Satterlee CC, Dalsey RM, Flatow EL. The anatomy and potential effects of contracture of the coracohumeral ligament. Clin Orthop Relat Res. 1992;280:182–5.Google Scholar
  10. 10.
    Gagey OJ, Boisrenoult P. Shoulder capsule shrinkage and consequences on shoulder movements. Clin Orthop Relat Res. 2004;419:218–22.CrossRefGoogle Scholar
  11. 11.
    Eid A. Miniopen coracohumeral ligament release and manipulation for idiopathic frozen shoulder. Int J Shoulder Surg. 2012;6(3):90–6.CrossRefGoogle Scholar
  12. 12.
    Ozaki J, Nakagawa Y, Sakurai G, Tamai S. Recalcitrant chronic adhesive capsulitis of the shoulder: role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment. J Bone Joint Surg Am. 1989;71(10):1511–5.CrossRefGoogle Scholar
  13. 13.
    Li JQ, Tang KL, Wang J, et al. MRI findings for frozen shoulder evaluation: is the thickness of the coracohumeral ligament a valuable diagnostic tool? PLoS One. 2011;6(12):e28704.CrossRefGoogle Scholar
  14. 14.
    Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology. 2004;233(2):486–92.CrossRefGoogle Scholar
  15. 15.
    Zhao W, Zheng X, Liu Y, et al. An MRI study of symptomatic adhesive capsulitis. PLoS One. 2012;7(10):e47277.CrossRefGoogle Scholar
  16. 16.
    Lee SY, Park J, Song SW. Correlation of MR arthrographic findings and range of shoulder motions in patients with frozen shoulder. AJR Am J Roentgenol. 2012;198(1):173–9.CrossRefGoogle Scholar
  17. 17.
    Jung JY, Jee WH, Chun HJ, Kim YS, Chung YG, Kim JM. Adhesive capsulitis of the shoulder: evaluation with MR arthrography. Eur Radiol. 2006;16(4):791–6.CrossRefGoogle Scholar
  18. 18.
    Lee MH, Ahn JM, Muhle C, et al. Adhesive capsulitis of the shoulder: diagnosis using magnetic resonance arthrography, with arthroscopic findings as the standard. J Comput Assist Tomogr. 2003;27(6):901–6.CrossRefGoogle Scholar
  19. 19.
    Connell D, Padmanabhan R, Buchbinder R. Adhesive capsulitis: role of MR imaging in differential diagnosis. Eur Radiol. 2002;12(8):2100–6.CrossRefGoogle Scholar
  20. 20.
    Carbone S, Napoli A, Gumina S. MRI of adhesive capsulitis of the shoulder: distension of the bursa in the superior subscapularis recess is a suggestive sign of the pathology. Eur J Radiol. 2014;83(2):345–8.CrossRefGoogle Scholar
  21. 21.
    Homsi C, Bordalo-Rodrigues M, da Silva JJ, Stump XM. Ultrasound in adhesive capsulitis of the shoulder: is assessment of the coracohumeral ligament a valuable diagnostic tool? Skeletal Radiol. 2006;35(9):673–8.CrossRefGoogle Scholar
  22. 22.
    Wu CH, Chen WS, Wang TG. Elasticity of the coracohumeral ligament in patients with adhesive capsulitis of the shoulder. Radiology. 2016;278(2):458–64.  https://doi.org/10.1148/radiol.2015150888. CrossRefPubMedGoogle Scholar
  23. 23.
    Yoong P, Duffy S, McKean D, et al. Targeted ultrasound-guided hydrodilatation via the rotator cuff interval for adhesive capsulitis. Skeletal Radiol. 2015;44:703–8.CrossRefGoogle Scholar
  24. 24.
    Sun Y, Liu S, Chen S, Chen J. The effect of corticosteroid injection into rotator interval for early frozen shoulder: a randomized controlled trial. Am J Sports Med. 2018;46(3):663–70.CrossRefGoogle Scholar
  25. 25.
    Granville-Chapman J, Torrance E, Funk L. Long-term results of hydrodistension for frozen shoulder. Shoulder Elbow. 2015;7:309–32.CrossRefGoogle Scholar
  26. 26.
    Gavant M, Rizk T, Gold R, et al. Distension arthrography in the treatment of adhesive capsulitis of the shoulder. J Vasc Intervent Radiol. 1994;5:305–8.CrossRefGoogle Scholar
  27. 27.
    Hagiwara Y, Ando A, Kanazawa K, Koide M, Sekiguchi T, Hamada J, et al. Arthroscopic coracohumeral ligament release for patients with frozen shoulder. Arthrosc Tech. 2018;7(1):e1–5.CrossRefGoogle Scholar
  28. 28.
    Dawson J, Fitzpatrick R, Carr A. Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br. 1996;78(4):593–600.CrossRefGoogle Scholar
  29. 29.
    Robinson CM, Seah KT, Chee YH, Hindle P, Murray IR. Frozen shoulder. J Bone Joint Surg Br. 2012;94(1):1–9.CrossRefGoogle Scholar
  30. 30.
    Lee JC, Sykes C, Saifuddin A, Connell D. Adhesive capsulitis: sonographic changes in the rotator cuff interval with arthroscopic correlation. Skeletal Radiol. 2005;34(9):522–7.CrossRefGoogle Scholar
  31. 31.
    Amir-Us-Saqlain H, Zubairi A, Taufiq I. Functional outcome of frozen shoulder after manipulation under anaesthesia. J Pak Med Assoc. 2007;57(4):181–5.PubMedGoogle Scholar
  32. 32.
    Anil Kumar PG, Jacob MB, Newton JSM. Transient brachial plexus palsy following manipulation and local anaesthetic infiltration of a “primary frozen shoulder”. Orthopaedics. 2003;3(3):83–4.Google Scholar
  33. 33.
    Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg. 2005;14(1):16–21.  https://doi.org/10.1016/j.jse.2004.04.004.CrossRefPubMedGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • David McKean
    • 1
    Email author
  • Philip Yoong
    • 2
  • Rebecca Brooks
    • 1
  • Joseph Papanikitas
    • 1
  • Richard Hughes
    • 1
  • Aniruddha Pendse
    • 3
  • Bernard John McElroy
    • 4
  1. 1.Radiology DepartmentStoke Mandeville Hospital, Buckinghamshire Healthcare NHS TrustAylesburyUK
  2. 2.Radiology DepartmentRoyal Berkshire Hospital, Royal Berkshire NHS Foundation TrustReadingUK
  3. 3.Orthopaedic DepartmentStoke Mandeville Hospital, Buckinghamshire Healthcare NHS TrustAylesburyUK
  4. 4.Orthopaedic DepartmentChiltern HospitalGreat MissendenUK

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