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KMID : 0948920160150010020
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Clinical Pain
2016 Volume.15 No. 1 p.20 ~ p.28
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Adhesive Capsulitis of the Shoulder: Updates on Imaging Study and Hydraulic Distension
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Cho Jang-Hyuk
Chung Sun-Gun
Kim Kee-Won
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Abstract
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Adhesive capsulitis of the shoulder joint is a common disease characterized by pain at insertional area of deltoid muscle and decreased range of motion. The pathophysiologic process involves fibrous inflammation of the capsule and intra-articular adhesion of synovial folds leading to capsular thickening and contracture. Multi-directional limitation of motion is especially prominent in external rotation, which is not only related to global fibrosis of the capsule but also localized tightness of the coracohumeral ligament. Ultrasound and magnetic resonance imaging provide can be applied to rule out other structural lesion and to show a thickened coracohumeral ligament in adhesive capsulitis. Recently, shear-wave elastography was suggested to diagnose adhesive capsulitis by evaluating reduced elasticity of the coracohumeral ligament. Hydraulic distension of shoulder joint capsule provides relief of pain and immediate improvement of range of motion by directly expanding the capsule along with infusion of steroid. However, the optimal technique for hydraulic distension is still a matter of controversy, with regard to infusion volume and rupture of the capsule. By monitoring real-time pressure-volume profile during hydraulic distension, the largest possible fluid volumes can be infused without rupturing the capsule. The improvement of biomechamical parameters and clinical outcomes was shown to be greater in the capsule-preserving hydraulic distension using the novel technique than in the capsule-rupturing distension. Moreover, because the capsular integrity is preserved, repeated distension is possible which provides additional clinical and biomechanical improvement. Capsule-preserving hydraulic distension with maximal volume can be suggested as an efficacious treatment option for persistent adhesive capsulitis
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KEYWORD
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Adhesive capsulitis, Hydraulic distension, Joint capsule rupture, Coracohumeral ligament
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