Changes in Biomechanical Properties of Glenohumeral Joint Capsules With Adhesive Capsulitis by Repeated Capsule‐Preserving Hydraulic Distensions With Saline Solution and Corticosteroid

Abstract

Capsule-preserving hydraulic distension changed the biomechanical properties of the glenohumeral joint capsule, lessening the stiffness and enlarging the volume capacity. These alterations were accompanied by improved range of motion and relief of pain. Repeated capsule-preserving hydraulic distension with saline solution and corticosteroid would be useful to treat adhesive capsulitis and to evaluate the treatment results.

Early Intra‐articular Corticosteroid Injection Improves Pain and Function in Adhesive Capsulitis of the Shoulder: 1‐Year Retrospective Longitudinal Study

“…Primary adhesive capsulitis is caused by global capsular inflammation and fibrosis, which results in a global limitation of range of motion. Recent studies have, however, argued that an anterosuperior or anteroinferior capsular tightening is another characteristic [6], and have included a limitation of external rotation in the diagnostic criteria for adhesive capsulitis, namely, external rotation to less than one‐half of normal [28] or less than 20° of external rotation [13,41]. Considering these changes, it would be more nearly ideal to use diagnostic criteria that would include the limitation of external rotation in future studies on adhesive capsulitis.…”

“…To restrict the contribution of scapular rotation, the patient was asked to relax, and the evaluator held the clavicle and scapular spine with the hand. Passive elevation of the upper arm was stopped, and goniometric angles were taken when it was no longer possible to prevent the scapula from rotating [13]. Patients were excluded if they had any of the following: secondary adhesive capsulitis (secondary to other causes including inflammatory or infectious arthritis, stroke, tumor, trauma, or fracture); history of diabetes and/or thyroid dysfunction; rotator cuff disease on both physical and ultrasonographic examinations; medium-size to large (!3cm) partial-or fullthickness tear of the rotator cuff on ultrasonography [14,15]; calcific tendinitis; primary osteoarthritis of the glenohumeral joint on a simple radiograph; and previous corticosteroid injection on the affected shoulder.…”

Relationships Between Capsular Stiffness and Clinical Features in Adhesive Capsulitis of the Shoulder

“…On the other hand, we developed IHD with real‐time pressure monitoring to maximize the treatment effects of IHD by distending the capsule as much as possible without rupturing it [15]. Digital data acquisition and motor controlling techniques enabled preservation of the integrity of the capsule during IHD, providing better clinical outcomes than capsule‐rupturing procedures [17] and allowing multiple, repeated distensions for stepwise, additional improvements [18]. Fortunately, the capsule‐preserving IHD has granted another benefit in addition to its therapeutic value, because in vivo intra‐articular pressure profiles in relation to infused fluid volume have been readily available as a consequence of a treatment session.…”

“…), pressures of the starting (P 1 ) and ending (P 2 ) points of phase II were determined. The steepness of phase II, which represents the K cap (mmHg/mL) in the shoulder joint, was approximated by the slope of the linear regression computed from the data point between P 1 and P 2 (Figure 1) [15‐18]. The volume and pressure at the infusion terminating point were determined as the maximal volume ( V max ) and the maximal intra‐articular pressure ( P Vmax ), respectively [18].…”

“…During IHD, the stiff capsule is expanded by infusing a large amount of fluid into the tightened glenohumeral joint [7,14]. To further improve the therapeutic effects of IHD, we previously developed a novel IHD technique that uses a real‐time pressure monitoring system [15‐19] to preserve the capsule being distended. In addition, this procedure provides quantitative data characterizing the in vivo biomechanical properties of the capsule.…”