Radiology Department, São João Hospital Centre, Porto, Portugal.
Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece.
J Ultrasound Med. 2023 Feb;42(3):665-674. doi: 10.1002/jum.16063. Epub 2022 Jul 23.
To compare the additive value of immediate post-procedural manipulation versus physiotherapy, following ultrasound (US)-guided hydrodistention of the glenohumeral joint (GHJ) in patients with adhesive capsulitis (AC) and define predictors of outcome.
Within a 19-month period, 161 consecutive patients with AC were prospectively enrolled and allocated to two groups according to treatment, based on patients' individual preferences: 1) group-I, US-guided hydrodistension plus immediate post-procedural manipulations and 2) group-II, US-guided hydrodistension plus supervised physiotherapy program. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and a visual analog scale (VAS) were used for clinical assessment at baseline (immediately after treatment), 1, 3, and 6 months. Comparisons were performed with Mann-Whitney U test and Kolmogorov-Smirnov test. Linear regression was used to identify predictors of outcome. P value <.05 defined significance.
GHJ hydrodistension with manipulation or physiotherapy was linked to clinical improvement at all follow-up time-points. DASH scores of group-I remained constantly lower than DASH scores of group-II at all time-points (P < .001). VAS scores were lower in group-I than group-II at 1 and 3 months (P < .001 and P = .0019, respectively). Both groups had improved to a similar degree with respect to pain at 6 months (P = .29). The performance of post-interventional manipulations was predictive of improved shoulder functionality (as assessed with DASH scores) at all time-points, while low-grade disease and milder symptoms at presentation were associated with improved short-term pain.
Immediate post-procedural manipulations appeared to be superior to physiotherapy following GHJ hydrodistension for AC in terms of shoulder functionality during a 6-month follow-up period. Post-interventional manipulations, the stage of AC and lower DASH and VAS scores at presentations were predictive of improved outcome.
比较超声引导下肩关节腔内水扩张后即刻手法治疗与物理治疗在粘连性肩关节囊炎（AC）患者中的附加价值，并确定疗效的预测因素。
在 19 个月的时间内，前瞻性纳入 161 例连续 AC 患者，并根据患者的个人意愿分为两组：1）组 I，超声引导下水扩张加即刻术后手法治疗；2）组 II，超声引导下水扩张加监督下物理治疗计划。采用上肢功能障碍量表（DASH）和视觉模拟评分（VAS）在基线（治疗后即刻）、1、3 和 6 个月时进行临床评估。采用 Mann-Whitney U 检验和 Kolmogorov-Smirnov 检验进行比较。采用线性回归分析确定疗效的预测因素。P 值<.05 为有统计学意义。
关节腔内水扩张加手法或物理治疗均能改善肩关节功能，所有随访时间点均有临床改善。组 I 的 DASH 评分在所有时间点均明显低于组 II（P<.001）。组 I 的 VAS 评分在 1 和 3 个月时均低于组 II（P<.001 和 P=.0019）。两组在 6 个月时疼痛均有改善（P=.29）。术后手法治疗与所有时间点的肩关节功能改善（DASH 评分）相关，而介入治疗前疾病程度较低和症状较轻与短期疼痛改善相关。
在 6 个月的随访期内，与关节腔内水扩张后物理治疗相比，即刻术后手法治疗对 AC 的肩关节功能改善更具优势。术后手法治疗、AC 分期以及介入治疗前 DASH 和 VAS 评分较低与疗效改善相关。
