Ultrasound-guided fascial hydrorelease versus anterior hydrodilatation via rotator interval in primary shoulder adhesive capsulitis: a randomized controlled study

Abstract

Adhesive capsulitis (AC), well-known as frozen shoulder, is characterized by restricted shoulder motility that affects daily activities. The prime of this study was to compare the long-term efficacy of fascia hydrorelease (FHR) versus anterior hydrodilatation via rotator interval (RI) in primary AC shoulders. The primary endpoint was the 12-month SPADI following both interventions. 120 patients diagnosed with unilateral resistant AC with moderate to profound pain and disability were recruited. Patients were randomized into two groups. Interrater reliability for the musculoskeletal ultrasound (MSUS) was investigated. Assessments were performed for up to 12 months. Both groups received guided rehabilitation after injection. Additionally, baseline, three, six, and 12-month Shoulder Pain, Disability Index (SPADI) and range of motion (ROM) had been recorded for all patients. There was no difference regarding clinical or sonographic characteristics between both groups at baseline. The interobserver reliability for MSUS demonstrated almost perfect agreement (kappa (κ) = 0.85, 95% confidence interval = 0.83–0.86). Both groups showed a decrease in SPADI and improvement in shoulder flexion and abduction immediately after injection. Repeated measures ANOVA showed a statistically significant difference in post-injection SPADI throughout follow-up across both groups (p < 0.0001). The FHR group exhibited progress in internal rotation (IR), external rotation (ER), and extension better than the RI group. A significantly longer-term improvement was observed in the FHR group in the follow-ups in function and global ROM. Ultrasound-guided FHR could be effective in addressing both pain and functional limitations with better longevity for AC. It is suggested that FHR could have enhanced hydration and gliding between the fascia and coracohumeral ligament (CHL) and may have freed extracapsular adhesions. What is already known on this topic: Hydrodilatation targeting the rotator interval (anterior approach) enhances short-term improvement in AC. How this study might affect practice: - Ultrasound-guided fascia hydrorelease could be safe and has long-term therapeutic benefits for primary AC of the shoulder. - A comparison of shoulder global ROM pre- and post-FHR follow-ups points out that the CHL with the overlying fascia mostly contributes to AC disability. - Fascia hydrorelease may have further advantages in managing concomitant fibroadhesive bursitis in AC.