Frozen shoulder: long-term outcome following arthrographic distension

PainSci » bibliography » Clement et al 2013
updated Aug 7, 2019

Tags: surgery, treatment

One page on PainSci cites Clement 2013: Complete Guide to Frozen Shoulder

PainSci commentary on Clement 2013: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

It’s refreshing that this paper leads with a candid acknowledgement that arthrographic distension (joint capsule inflation) for frozen shoulder “gained widespread acceptance prior to full validation, and it is now both controversial and difficult to recruit patients into placebo controlled trials.” A 2008 review (Buchbinder et al) identified virtually no useful evidence, and what little there was focused on short term results. This study “is only the second study which has evaluated long-term functional outcome following arthrographic distension,” and it confirms the positive results of the first.

This was a study of 53 frozen shoulders, including 12 diabetic patients, and tracked results at 2 days, 1 month, and then once more 8-26 months later, finding that clinically significant improvements were maintained. On the other hand, this study has significant methological limitations: it “presents the work of a single radiologist” and it’s a case series with “no randomisation and no blinding of the patients, surgeon, radiologist or assessors.” Although better than nothing, such data cannot actually confirm that the treatment works, and there are many reasons to be pessimistic about surgical fixes for musculoskeletal problems (see Louw).

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Arthrographic distension of the glenohumeral joint was adopted as a mainstream treatment for frozen shoulder before any randomised controlled trials were performed. Interpretation of the effectiveness of this procedure rests mostly on data from cohort studies of which there are few of high quality. Papers reporting long-term results have either excluded diabetic patients or failed to report patient orientated outcomes. The authors present a long-term prospective cohort study of 51 patients (12 diabetics and 39 non-diabetics), with 53 frozen shoulders, who had an arthrographic distension performed by a single radiologist as a primary intervention. Oxford shoulder score (OSS), visual analogue pain score (VAS), and range of movement (ROM) were recorded pre-distension, at 2 days and 1 month post-distension. OSS and VAS were recorded again at a mean of 14 months post distension (range : 8-26 months). OSS improved from a pre-distension mean of 22.3 by 16.9 points at final follow-up (p < 0.001, 2 tailed paired samples t-test) whilst VAS improved from a mean pre-distension value of 7.1 by -3.5 (p < 0.001). ROM improved by a mean of 39.3 degrees in flexion, 55.2 degrees in abduction and 19.5 degrees in external rotation at one month (p < 0.001 for all). The outcome in diabetic patients was the same as in non-diabetic patients. Arthrographic distension is a safe and effective treatment for frozen shoulder; it is also effective in diabetic patients. It gives long-term improvement. The authors believe that the low number of patients requiring a secondary procedure makes arthrographic distension preferable to manipulation under anaesthesia.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

related content