Ultrasound guided glenohumeral joint hydrodistention for (adhesive capsulitis) frozen shoulder Poster No.: C-2271 Congress: ECR 2010 Type: Educational Exhibit Topic: Musculoskeletal Authors: D. A. Deeab, M. Walker; London/UK Keywords: Adhesive capsulitis, hydrodistension, GH joint DOI: 10.1594/ecr2010/C-2271 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 10
Learning objectives 1.To outline the advantages and limitations of ultrasound (US) guided glenohumeral joint hydrodistention in treatment of frozen shoulder. 2.To describe the technique and the results of the method based on a series of 30 patients. Background Frozen Shoulder is characterised by reduced range of movement and pain. Although, it is a self limiting disorder, patients can suffer severe discomfort and debility during the course of the disorder, which lasts for 12-36 months. Treatment aims to reduce pain and increase motion. In this exhibit, we will describe US guided glenohumeral joint hydrodistention, a minimally invasive outpatient treatment. We will describe the technique's advantages and limitations compared to other established treatments.. Between January 2008 and April 2009, 30 patients with frozen shoulder were treated in our department with ultrasound guided glenohumeral joint hydrodistention and we report the results of this technique. Imaging findings OR Procedure details The posterior glenohumeral joint and posterior glenoid labrum were identified using a 17mhz linear array ultrasound probe. Under ultrasound guidance and aseptic technique, local anaesthesia was infiltrated into the subcutaneous tissues and soft tissues, via a posterolateral approach, to the posterior aspect of the glenohumeral joint. A 22G spinal needle was placed between humeral head and posterior labrum. An injection of 40mg of Triamcinolone, 5mls of Levobupivicaine and 14mls of Normal Saline (approx 20mls) were injected. 50% of patients underwent multiple injections (2-3) at weekly intervals. Proformas were filled out at the time of patient attendance to assess perceived pain, analgesic use and range of motion. Follow up was performed by telephone after 6 weeks. Images for this section: Page 2 of 10
Fig. 1: identification of posterior glenoid labrum Page 3 of 10
Fig. 2: B. US image showing the posterior glenoid labrum Page 4 of 10
Fig. 3: skin marker Page 5 of 10
Fig. 4: US-guided 22 G spinal needle insertion. Page 6 of 10
Fig. 5: 22G spinal needle inserted under US guidance into the glenohumeral joint. Page 7 of 10
Fig. 6: US image shos The glenohumeral capsule distension. Page 8 of 10
Conclusion Glenohumeral joint hydrodistention under US guidance resulted in reduction in pain, analgesic use and improved range of motion in 72% of patients. The results were better for patients undergoing multiple hydrodistentions. This technique is an effective treatment for frozen shoulder. Personal Information Dr Dhafer Deeab FRCR, Radiology Registrar, dhafer_ahmed@yahoo.com Dr Miny Walker BA MBBS MRCP FRCR Consultant Musculoskeletal Radiologist, minyw@hotmail.com Imperial College Healthcare NHS Trust Radiology Department rd St Mary's Hospital/Praed Street, QEQM Block, 3 Floor. London, The U.K. References Slide 29 1.Reeves B. The natural history of the frozen shoulder syndrome. Scandinavian Journal of Rheumatology 1975;4:193-6. 2.Binder AI, Bulgen DY, Hazleman BL, Roberts S. Frozen shoulder: a long-term prospective study. Annals of Rheumatic Disease 1984;43:361-4 3.Hazleman BL. The painful stiff shoulder. Rheumatology and Physical Medicine 1972;11(8):413-21. 4.Neviaser TJ. Adhesive capsulitis. Orthopedic Clinics of North America 1987;18:439-43. 5.Buchbinder R, Green S, Forbes A, Hall S, Lawler G. Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised doubleblind placebo-controlled trial. Annals of Rheumatic Disease 2004;63:302-9. 6.Corbeil V, Dussault R, Leduc B, Fleury J. Adhesive capsulitis of the shoulder: a comparative study of arthrography with intra-articular corticotherapy and with or without capsular Page 9 of 10
distension [Capsulite retractile de l'epaule: etude comparitive de l'arthrographie avec corticotherapie intra-articulaire avec ou sans distension capsulaire]. Canadian Association of Radiologists Journal 1992;43:127-30. 7.Gam AN, Schydlowsky P, Rossel I, Remvig L, Jensen EM. Treatment of "frozen shoulder" with distension and glucocorticoid compared with glucocorticoid alone. Scandinavian Journal of Rheumatology 1998;27:425-30. 8.Jacobs L, Barton M, Wallace W, Ferrousis J, Dunn W, Bossingham D. Intra-articular distension and steroids in the management of capsulitis of the shoulder. BMJ 1991;302:1498-501. 9.Khan AA, Mowla A, Shakoor MA, Rahman MR. Arthrographic distension of the shoulder joint in the management of frozen shoulder. Mymensingh Medical Journal 2005;14:67-70. 10.Buchbinder R et al Arthrographic distension for adhesive capsulitis (frozen shoulder).cochrane Database Syst Rev. 2008 Jan 23;(1):CD007005 11.R. B. Zwar, J. W. Read, and J. B. Noakes Sonographically Guided Glenohumeral Joint Injection Am. J. Roentgenol., July 1, 2004; 183(1): 48-50. Page 10 of 10