York and Scarborough Teaching Hospitals NHS FT, York, UK.
Manchester Metropolitan University, Manchester, UK.
Musculoskeletal Care. 2023 Sep;21(3):953-957. doi: 10.1002/msc.1736. Epub 2023 Jan 24.
Hydrodistension, where a relatively high volume of local anaesthetic, corticosteroid, and sterile saline are injected into the shoulder joint, is a treatment of interest for frozen shoulder. In the UK National Health Service this is typically provided in the hospital setting. In 2017 we introduced hydrodistension into our physiotherapy led musculoskeletal service. This report describes the findings from our audit of onward referral for orthopaedic assessment following the introduction of hydrodistension to our frozen shoulder treatment pathway.
A retrospective audit of data from 102 patients who followed our hydrodistension treatment pathway for frozen shoulder since 2017 was conducted. All 102 patients received at least one hydrodistension procedure performed by a physiotherapist. This involved injecting the glenohumeral joint with a combination of local anaesthetic, corticosteroid, and saline under ultrasound guidance with a total volume of 25-35 mls. This data was compared to the outcomes of 102 patients who presented with frozen shoulder prior to 2017 who did not receive hydrodistension.
Of 102 patients who received hydrodistension within the musculoskeletal service, six patients required onward referral to orthopaedics. Of the 102 patients who did not receive hydrodistension prior to 2017, 58 required onward referral to orthopaedics.
We report a reduction in onward referral to orthopaedics following the introduction of hydrodistension to our physiotherapist-led treatment pathway for patients with frozen shoulder. This preliminary data identifies the need to further evaluate the clinical and cost-effectiveness of hydrodistension performed by physiotherapists for patients with frozen shoulder.
向肩关节内注射大量局部麻醉剂、皮质类固醇和无菌生理盐水的水扩张术是治疗冻结肩的一种方法。在英国国民保健制度中，这种治疗通常在医院环境中进行。2017 年，我们将水扩张术引入了我们的以物理治疗为主导的肌肉骨骼服务。本报告介绍了我们对冷冻肩治疗途径中引入水扩张术治疗后向骨科评估转诊的审核结果。
对自 2017 年以来遵循我们的冷冻肩水扩张治疗途径的 102 例患者的数据进行了回顾性审核。所有 102 例患者均接受了至少一次由物理治疗师进行的水扩张治疗。这涉及在超声引导下向盂肱关节内注射局部麻醉剂、皮质类固醇和盐水的混合物，总量为 25-35 毫升。将该数据与 2017 年之前未接受水扩张治疗的 102 例患有冻结肩的患者的结果进行了比较。
在肌肉骨骼服务中接受水扩张治疗的 102 例患者中，有 6 例需要向骨科转诊。在 2017 年之前未接受水扩张治疗的 102 例患者中，有 58 例需要向骨科转诊。
我们报告称，在将水扩张术引入我们的以物理治疗师为主导的治疗方案治疗冻结肩患者后，向骨科转诊的人数有所减少。这初步数据表明，需要进一步评估物理治疗师为冻结肩患者进行水扩张治疗的临床和成本效益。
