Vita Fabio, Gualtierotti Roberta, Miceli Marco, Tedeschi Roberto, Origlio Flavio, Cavallo Marco, Galletti Stefano, Stella Salvatore Massimo, Guerra Enrico, Donati Danilo, Faldini Cesare
Department of Orthopedic and Traumatological Surgery, IRCCS Rizzoli Orthopedic Institute, University of Bologna, Bologna, Italy.
S.C. Medicine - Hemostasis and Thrombosis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milan, Italy.
Rheumatol Ther. 2024 Dec;11(6):1519-1532. doi: 10.1007/s40744-024-00716-8. Epub 2024 Sep 12.
Adhesive capsulitis, also known as "frozen shoulder," is a debilitating shoulder condition increasingly linked to fibroadhesive bursitis, particularly after COVID-19 and related vaccinations. There is no definitive gold standard for its treatment, the primary therapeutic objectives of which are the reduction of pain and the restoration of shoulder range of motion. The aim of our study was to analyze treatment outcomes based on quantitative measures of shoulder function and symptom relief.
Conducted between January 2022 and April 2023, the research involved 45 patients initially diagnosed with adhesive capsulitis and associated fibroadhesive bursitis. After excluding nine patients for other concomitant pathologies (five for calcific tendinopathy and four for rotator cuff injury), 36 patients were randomized into two groups: one group was treated with glenohumeral hydrodistension, the other with glenohumeral hydrodistension combined with bursal injection. Assessments were conducted at baseline and then 2, 4, and 6 months after treatment, focusing on changes in pain levels, functional scores, and range of motion in all planes. Each group followed a home-based rehabilitation protocol.
Significant improvements were observed in both treatment groups, with the combined hydrodistension and bursal injection group showing notably superior outcomes. Specifically, the range of motion in flexion improved from an initial median of 80° to 155° in the combined treatment group, compared to an increase from 75.5° to 129° in the group treated with hydrodistension alone. This enhancement was statistically significant (p < 0.001). Regarding pain reduction, the combined treatment group demonstrated a dramatic decrease in visual analogue scale (VAS) scores, from a baseline median of 7 to 1 at the 6-month follow-up. In contrast, the hydrodistension-only group showed a reduction from 7 to 3, with these differences also proving statistically significant (p < 0.001).
Ultrasound-guided hydrodistension of the glenohumeral joint, if combined with bursal injection and specific exercises, effectively reduces pain, decreases disability, and improves range of motion in patients with second-stage adhesive capsulitis. This study highlights the importance of a combined approach in the management of this complex condition, especially after the histological changes that occurred after COVID-19 and related vaccinations.
ClinicalTrials.gov identifier NCT06062654.
粘连性关节囊炎，又称“冻结肩”，是一种使人衰弱的肩部疾病，越来越多地与纤维粘连性滑囊炎相关，尤其是在感染新冠病毒及接种相关疫苗之后。其治疗尚无明确的金标准，主要治疗目标是减轻疼痛和恢复肩部活动范围。我们研究的目的是基于肩部功能和症状缓解的定量测量来分析治疗结果。
该研究于2022年1月至2023年4月进行，纳入了45例最初诊断为粘连性关节囊炎及相关纤维粘连性滑囊炎的患者。在排除9例患有其他合并病症的患者（5例为钙化性肌腱炎，4例为肩袖损伤）后，将36例患者随机分为两组：一组接受盂肱关节液压扩张治疗，另一组接受盂肱关节液压扩张联合滑囊注射治疗。在基线时以及治疗后2、4和6个月进行评估，重点关注疼痛程度、功能评分以及各个平面的活动范围变化。每组均遵循家庭康复方案。
两个治疗组均观察到显著改善，液压扩张联合滑囊注射组的效果明显更佳。具体而言，联合治疗组的前屈活动范围从初始中位数80°改善至155°，而单纯液压扩张治疗组则从75.5°增加至129°。这种改善具有统计学意义（p < 0.001）。在减轻疼痛方面，联合治疗组的视觉模拟评分（VAS）分数显著下降，从基线中位数7分降至6个月随访时的1分。相比之下，单纯液压扩张组从7分降至3分，这些差异也具有统计学意义（p < 0.001）。
超声引导下的盂肱关节液压扩张，如果联合滑囊注射和特定锻炼，可有效减轻二期粘连性关节囊炎患者的疼痛、减少功能障碍并改善活动范围。本研究强调了综合治疗方法在管理这种复杂病症中的重要性，特别是在新冠病毒及相关疫苗接种后发生组织学变化之后。
ClinicalTrials.gov标识符NCT06062654。
