A Double Blind Randomised Controlled Trial Comparing Glenohumeral Cortisone With and Without Hydrodilatation in Patients With Frozen Shoulder.

Abstract

Background: Frozen shoulder (FS) is a common condition causing pain and stiffness in the shoulder. There is controversy over whether hydrodilatation (HD) gives improved outcomes compared to corticosteroid injection (CSI) alone. The aim of this study was to investigate if HD improves outcomes compared to CSI alone.

Methods: This was a double-blinded RCT. Patients aged 18-90 with FS were included. The CSI group received an injection of contrast followed by local anaesthetic and steroid. The HD group received the same, followed by saline until capsular rupture or severe resistance. The primary outcome was pain-free range of motion (ROM), along with Shoulder Pain and Disability Index (SPADI) 8 weeks post-intervention, and American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST) and Constant score.

Results: Seventy-nine patients were included, with a mean age of 54 (29-70), 53% female. The ROM and SPADI improved in both groups (CSI from 57.4 to 35.8, HD from 57.7 to 32.7) along with ASES, SST and Constant. There were no significant differences between the groups at 8 weeks. HD was found to be more painful than CSI. Male patients achieved greater improvement in ER with HD, while females, patients with severe pain at presentation, and symptoms for less than 120 days favoured CSI.

Conclusion: Both groups significantly improved, but there were no significant differences between the groups, although there were some differences between subgroups. We recommend tailoring the first-line treatment according to patient symptoms and baseline characteristics.