Intra‐articular Pressure Profiles of Painful Stiff Shoulders Compared With Those of Other Conditions

Abstract

The steeply rising, high IA pressure can be considered as a predominant characteristic of the PSS compared with other conditions that showed flat, low-pressure profiles, suggesting the P-V profiles might be used in evaluation of the capsular tightness of various shoulder problems. The triphasic curve appears to be a preruptural sign; however, there are several practical limitations to terminating hydraulic distension before rupture occurs.

Capsule preservation improves short‐term outcome of hydraulic distension in painful stiff shoulder

“…PSS was diagnosed if the shoulder ROM was limited in at least two directions for more than 1 month. ROM was determined as limited for each direction, if abduction < 80°, forward flexion < 130°, external rotation < 30° when measured by goniometer, or if external rotation ≥ C7, internal rotation ≤ L1 by scratch test 18, 19. Patients were excluded if they had any structural or systemic disorder that could result in pain or ROM limitation, such as inflammatory joint disease, osteoarthritis evidenced on radiographs, full‐thickness rotator cuff tear shown by ultrasound imaging, or history of major trauma or surgery involving the shoulder.…”

“…While the patient was seated on a stool, one of the authors (SGC) inserted a 3.5″ 22 gauge spinal needle, 1 cm lateral to the transducer and advanced it into the posterior intraarticular space under ultrasound guidance 18, 19. The needle was connected to a disposable pressure sensor (AMK 150; ACEMEDICAL, Seoul, Korea) and a 50‐ml syringe via a 3‐way stopcock.…”

“…The belief presumably stemmed from a practical obstacle of the conventional IHD technique; when IHD is intended to avoid rupture, it can hardly infuse a sufficient volume of fluid. A novel IHD technique, devised in our previous studies,18, 19 provided a measure to circumvent this obstacle. The technique monitors intraarticular pressure and volume (PV) in real‐time and characterizes the PV curves into three phases: initial filling, elastic deformation, and plastic deformation.…”

Effect of Hypertonic Saline in Intra‐Articular Hydraulic Distension for Adhesive Capsulitis

“…In addition, the intra-articular space pressure was not measured objectively, which created uncertainty about whether the fluid volume during IHD was determined at its maximum effectiveness. Finally, the average volume injected in this study was smaller than that reported in the original article by Chung et al [30]. Further studies are needed to resolve these limitations.…”

“…However, it is controversial as to whether the volume determined by this method was the maximum volume before capsular rupture would occur. Chung et al [30] used a real-time pressure monitoring device to determine the volume (or to find pre-rupture signs) and eventually suggested 24.4 AE 8.9 mL as an average rupturing volume for patients with a painful stiff shoulder. The mean distension volume in this study was 20.2 AE 5.2 mL for the hypertonic saline group and 19.5 AE 5.9 mL for the normal saline group.…”