Treatment of frozen shoulder by hydraulic distention and manipulation under dynamic arthrography of shoulder joint

摘要

Objective The investigation was to evaluate the efficiency of the frozen shoulder treated by hydraulic distention and manipulation under dynamic arthrography of shoulder joint, and analyze the influencing factors on the outcome. Methods One hundred patients with frozen shoulders were enrolled the prospective and controlled study, who were divided into two groups randomly. Fifty patients were treated by the hydraulic distention and manipulation under dynamic arthrography of shoulder joint (Group Ⅰ), and fifty patients were treated by NSAIDs administration (Group Ⅱ), The relationship of clinical results with the amounts of injected fluid during hydraulic distention and manipulation, the range of motion, the visualized rate of the vagina synovialis of long head of biceps brachii tendon and subacromial bursa, and releasing degree of joint adherence were observed. The patients consisting of 42 males and 58 females ageing from 42 to 74 years were assessed at two time-intervals.The short term follow-up period ranged from 3 to 6 months, and final follow-up from 10 to 21 months. Results The clinical results were significantly difference between Group Ⅰ and Group Ⅱ depending on daily activity and range of motion (P< 0.05).The percentage of excellent and good results in hydraulic distention and manipulation under dynamic arthrography group were 86% and 90% respectively, while that of medication group were 48% and 34% respectively. The range of motion in Group Ⅰ showed significant advantages compared to group Ⅱ( compensated x 2 test, P <0.05 ). If the injected amount was less than 15ml in hydraulic distention and manipulation under dynamic arthrography group, the excellent and food rate was only 25%. Furthermore, there were 9 cases of non-visualized vagina synovialis of long head of biceps brachii tendon in the arthrography, a good result was in 2 cases, poor result in 7 cases. Conclusion The hydraulic distention and manipulation under dynamic arthregraphy of shoulder joints is less traumatic, easy to perform and really an effective procedure to diagnose and treat the frozen shoulder. The amount of fluid and the degree of the shoulder adhesion are essential factors to outcome.Most frozen shoulder patients are middle age female, the performance of frozen shoulder is abrupt shoulder joint ache and joint crispation[1], the pathogenesis of it was not definite, doctors usually treat it with medicine and physical therapies clinically, but it showed poor curative effect in long term follow up. We chose 100 frozen shoulder patients according to our criterion and divided them into two groups at random. Fifty patients were treated by the hydraulic distention and manipulation under dynamic arthrography (HDMDA), and the other fifty patients were treated by non-steroidal anti-inflammatory drugs (NSAIDs), both groups adopted same recovery exercise after treatment. We evaluate the two methods by observing the function of shoulder joint and its activity through follow-up, and discuss the factor affecting HDMDA.