Adhesive capsulitis, or ”frozen shoulder” is a condition of the shoulder which results in the formation of inflammation and the subsequent production of scar like tissue in the shoulder joint to result in pain, stiffness and debility. The condition is common in diabetics and in this particular group, it may be recalcitrant, often requiring several injections.
The cause of adhesive capsulitis is often not known. However, when known, common causes include:
- Rotator cuff tendinosis/tendon tears
- Subacromial Bursitis
- Shoulder surgery
- Heart attack, chest surgery and stroke
Adhesive capsulitis has been reported to be a self limiting disease, meaning that untreated, it will eventually spontaneously improve, however this may take up to 2 years. In its early phase, the disease may result in vague shoulder pain which mimics other causes of shoulder pain. The diagnosis is often suggested at the time of ultrasound evaluation, when patients are unable to move their shoulder in the necessary positions required for the scan. An ultrasound also yields important information, as it may diagnose the underlying cause that resulted in the patient developing adhesive capsulitis in the first instance.
In mild cases, adhesive capsulitis usually responds to rehabilitation. If the condition progresses, often an injection, called a hydrodilatation (or hydrodilation) using cortisone and saline is required to suppress the inflammation and thus target the underlying disease process. The joint is then stretched with approximately 20-40mls of saline, often resulting in a popping sensation. It is debatable whether stretching the capsule with the addition of saline is of additional benefit and makes the procedure more painful. It is felt that the stretching part of the procedure tears the scarred capsule of the joint to improve mobility. Whether this is of additional long term benefit is as yet unproven, however stretching the capsule can often result in immediate improvement of a patient’s range of motion. Patients may require several injections to treat the condition, however if this is unresponsive, then another option includes manipulation under general anesthesia and surgery.
CT Guided Hydrodilatation
The skin is marked for accurate needle placement (image 1 of 9), with a needle then introduced into the shoulder joint.
Gas is then introduced into the joint to confirm position, with the medication then injected to relieve the patient of their adhesive capsulitis (frozen shoulder).
- Tveitå EK, Tariq R, Sesseng S, Juel NG, Bautz-Holter E. Hydrodilatation, corticosteroids and adhesive capsulitis: a randomized controlled trial. BMC Musculoskelet Disord 19;9:53 2008
- Bell S, Coghlan J, Richardson M. Hydrodilatation in the management of shoulder capsulitis. Australas Radiol 47(3):247-51, 2003
- Watson L, Bialocerkowski A, Dalziel R, Balster S, Burke F, Finch C. Hydrodilatation (distension arthrography): a long-term clinical outcome series. Br J Sports Med 41(3):167-73, 2007
For more information read:
Melbourne Radiology Clinic - Patient Fact Sheet on Hydrodilatation & Arthrography/Arthrogram