| 제목 |
Hydraulic distension with pumping technique for treating frozen shoulder: A Case-Controlled Study |
| 소속 |
Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea1, Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea2 |
| 저자 |
Sang Hoon Shin1*, Yong Wook Kim1, Won Hyuk Jang2, Sang Chul Lee1†, Sang Chul Lee1† |
Objective
To determine effect of capsule-preserving hydraulic distension using a pumping technique compared to that of capsule-preserving hydraulic distension without the pumping technique on frozen shoulder.
Subject & Method
This study included outpatients with frozen shoulder who underwent hydraulic distension in the outpatient clinic of department of rehabilitation medicine of a single university hospital between March 2013 and October 2018. Patients (N = 47) with frozen shoulder who were treated with capsule-preserving hydraulic distension were assigned into the pumping group (N = 24) and the non-pumping group (N = 23). Capsule-preserving intra-articular hydraulic distension was performed on the affected shoulders for all patients with or without the pumping technique. Using aseptic technique, a 6-cm, 23-gauge needle was placed in the glenohumeral joint with verification of intra-articular position under ultrasonography. A mixture of 1 mL of triamcinolone (40 mg), 10 mL of local anesthetic (1% lidocaine), and 19 mL (0.9% NaCl) of normal saline solution (30 mL total) was prepared. The mixture solution was divided into three 10-mL syringes. For the first syringe, 40 mg triamcinolone was added before the injection. The mixture of 30 mL was injected into the joint slowly with pressure while monitoring by ultrasonography to preserve the joint capsule and maximize the injected volume. With the pumping technique the regurgitation occurred into the syringe as a result of increased intra-articular pressure during the procedure, the back flowed solution was pushed into the joint and the syringe was held for 10 seconds followed by regurgitation. The investigator repeated the same procedure 10 times. These injections were repeated a total of five times in two-week intervals. Individual range of motion (ROM) values in three shoulder joint directions (forward flexion, abduction, and external rotation) and their total sum, shoulder pain and disability index (SPADI), and visual analogue scale (VAS) scores were assessed on seven occasions (five times pre-procedurally and twice post-procedure at three and six months).
Results
Significant improvement of total ROMs, abduction, flexion, and external rotation were observed from the timepoint of the 2nd injection in each group. There were significant differences in total passive ROMs, abduction, and flexion between the two groups and external rotation was significantly higher in the pumping group. Significant improvement of SPADI was observed in each group and there was significant difference in the disability domain of SPADI between the two groups. Significant improvement of VAS was observed in each group.
Conclusion
While the effect on pain reduction was excellent in both groups, the superiority of the new pumping technique was demonstrated by reduction of SPADI disability subscale score and improvement of ROM of the shoulder compared to the non-pumping technique. |
|
Table 1. Baseline Characteristics of Participants.
Figure 1. Capsule preserving hydraulic distension in frozen shoulder.
Figure 2. Outcomes change from baseline to each assessment and between-group differences.
|
