Assessing injectate spread in ultrasound-guided capsular hydro dilatation for adhesive capsulitis: A comparative MRI study of anterior rotator interval vs. posterior glenohumeral joint approaches

Nimish Mittal , David Salonen , Philip Peng
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Abstract

Adhesive capsulitis is a self-limiting condition of the shoulder, characterized by pain and limited range of motion (ROM). Intra-articular steroid injection and hydrodistension of the joint capsule are effective strategies for pain relief and improvement of ROM. Several randomized studies indicate that anterior rotator cuff interval (RCI) injections yield better outcomes than posterior glenohumeral (GH) joint injections. No study has examined the differences in injectate spread patterns between anterior RCI and posterior GH joint approaches. This study involved three patients with adhesive capsulitis who received ultrasound-guided shoulder joint injections with capsular hydrodilatation, utilizing 10 cc, via either the anterior RCI approach or the posterior GH joint approach. The injectate comprised 1 mL (80 mg) methylprednisolone acetate, 4 mL of 2 % lidocaine, and 5 mL of saline mixed with gadolinium contrast. Immediately following the injection, an MRI of the shoulder was performed to evaluate the distribution of the injectate. Injections via the anterior RCI approach exhibited significant intra-capsular spread and vital pathological intra-capsular and pericapsular structures. In contrast, posterior GH joint injections revealed restricted spread, mainly enlarging the joint recess without involvement of the pericapsular ligaments. This study highlights the distribution of injectate following an ultrasound-guided anterior shoulder joint injection, demonstrating that the anterior RCI approach effectively disperses a 10 mL injectate to the intra-capsular synovial lining and key pericapsular structures. The findings suggest that technique selection significantly impacts injectate distribution in adhesive capsulitis, with a 10 mL volume achieving optimal capsular distension without rupture.
粘连性肩关节囊炎是一种肩部自限性疾病,以疼痛和活动范围受限为特征。关节内类固醇注射和关节囊水膨胀是缓解疼痛和改善ROM的有效策略。一些随机研究表明,前肩袖间隔(RCI)注射比后盂肱(GH)关节注射效果更好。没有研究检查RCI前路和GH后路之间注射扩散模式的差异。本研究涉及3例粘连性囊炎患者,他们接受超声引导下的肩关节注射,通过RCI前路或GH后路,使用10cc的囊液扩张。注射剂包括1ml (80mg)醋酸甲基强的松龙,4ml 2%利多卡因和5ml混合钆造影剂的生理盐水。注射后立即对肩部进行MRI检查以评估注射剂的分布。通过前路RCI入路注射显示出明显的囊内扩散和重要的病理囊内和囊周结构。相比之下,后路GH关节注射显示扩张受限,主要是扩大关节隐窝而不累及囊包膜韧带。本研究强调了超声引导下肩关节前路注射后注射液的分布,表明RCI前路入路有效地将10ml注射液分散到囊内滑膜衬里和关键的囊周结构。研究结果表明,技术选择显著影响粘连性囊炎的注射分布,10毫升的体积可以达到最佳的囊膨胀而不会破裂。
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