title: Capsule-Preserving Hydrodilatation With Corticosteroid Versus Corticosteroid Injection Alone in Refractory Adhesive Capsulitis of Shoulder: A Randomized Controlled Trial.
abstract: To determine whether capsule-preserved hydrodilatation with corticosteroid improves pain and function in patients with refractory adhesive capsulitis (AC) better than intra-articular corticosteroid injection (IACI) alone.
  
  
  
  Prospective randomized controlled study.
  
  
  
  University-affiliated tertiary care hospital.
  
  
  
  Subjects with primary AC (N=64) with shoulder pain level of visual analog scale (VAS) score ≥5, even after the initial administration of IACI alone.
  
  
  
  Participants randomly received ultrasound-guided IACI alone with 1mL of 40mg/mL triamcinolone acetonide and 3mL of 1% lidocaine (n=32) or ultrasound-guided capsule-preserved hydrodilatation with corticosteroid with a mixture of 1mL of 40mg/mL triamcinolone acetonide, 6mL of 1% lidocaine, and normative saline (n=32).
  
  
  
  The primary outcome measure was the Shoulder Pain and Disability Index score. Secondary outcomes were the VAS of shoulder pain level and angles of shoulder passive range of motion, including flexion, abduction, extension, external rotation, and internal rotation at pretreatment and weeks 3, 6, and 12 of posttreatment.
  
  
  
  There were no significant differences between the 2 groups in terms of demographic characteristics (age, sex, duration of symptoms, shoulder affected, and body mass index) at baseline. Repeated-measures analysis of variance showed significant effect of time in all outcome measurements in both groups. However, group-by-time interactions were not significantly different for any of the outcomes between groups.
  
  
  
  This study shows that compared with pretreatment, all outcome measures improved significantly in both groups by time; however, there was no significant difference between the 2 groups. Therefore, we recommend IACI alone over capsule-preserved hydrodilatation with corticosteroid when considering the corticosteroid injection as a secondary option after the initial IACI fails to improve symptoms for patients with refractory AC.
authors.affiliation: Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Doo-Hyung
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea. Electronic address: yoonsh@ajou.ac.kr.
authors.forename: Seung-Hyun
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Lee
authors.affiliation: Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Kyu-Sung
authors.initials: KS
authors.lastname: Kwack
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Ueon Woo
authors.initials: UW
authors.lastname: Rah
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002062:Bursitis / Q000188:drug therapy / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020069:Shoulder Pain / Q000188:drug therapy / Q000628:therapy*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D008012:Lidocaine; D014222:Triamcinolone Acetonide
keywords: Injections; Rehabilitation; Shoulder pain; Ultrasonography