Clinical efficacy of hydrodistention with joint manipulation under interscalene block compared with intra-articular corticosteroid injection for frozen shoulder: a prospective randomized controlled study

Background: Hydrodistention is known to be an effective method of treatment for frozen shoulder. However, hydrodistention is accompanied by severe pain during the procedure. An interscalene block may relieve the severe pain associated with the procedure of hydrodistention. This study compared the clinical efficacy of hydrodistention with joint manipulation under an interscalene block with that of intra-articular corticosteroid injection. Methods: This prospective randomized controlled study included 121 patients presenting with frozen shoulder. Patients were randomized into 2 groups; those in group A (60 patients) were treated by hydrodistention with joint manipulation under an interscalene block, and those in group B (61 patients) were managed with intra-articular corticosteroid injection. Pain intensity and patient satisfaction were assessed by the visual analog scale. Functional outcomes were assessed by the Constant score and the range of shoulder motion. Results: Group A demonstrated better patient satisfaction and earlier restoration of range of motion than group B at 6 weeks (P <= .001). At 12 weeks, the pain score was lower and the Constant score was better in group A than in group B. However, at 12 months after treatment, pain score (P = .717), patient satisfaction (P = .832), range of motion (P > .05), and Constant score (P = .480) were similar in the 2 groups. Conclusion: Hydrodistention combined with joint manipulation under an interscalene block provided earlier pain relief and restoration of shoulder range of motion and function compared with single intra-articular corticosteroid injection in patients with primary frozen shoulder. (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.