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

Abstract

Background: Maintaining the integrity of the capsule along with infusing a sufficient amount of fluid is 1 of the therapeutic concepts in intra-articular hydraulic distension (IHD) for adhesive capsulitis. It has been known that hypertonic saline solution decreases tissue edema and increases the fluid volume within the epidural space, causing microdissection, in epidural adhesiolysis.

Objective: To investigate the effect of hypertonic saline solution in capsule-preserving intra-articular hydraulic distension (CPIHD) for adhesive capsulitis.

Design: Prospective randomized controlled trial.

Setting: University outpatient clinic of physical medicine and rehabilitation.

Participants: A total of 64 patients who were diagnosed as adhesive capsulitis of shoulder were randomly assigned to 1 of 2 treatment groups. The hypertonic saline group was treated by CPIHD with hypertonic saline (3% NaCl), and the normal saline group with normal saline solution (0.9% NaCl).

Methods: Both groups were treated with CPIHD, a method that preserves the capsule with maximal distension without inducing capsule rupture. The volume of saline solution necessary to adequately distend the capsule was recorded. Injection materials contained 4 mL of 1% lidocaine, 1 mL of triamcinolone (10 mg), and saline solution (hypertonic or normal saline). The intra-articular injection was monitored with ultrasound to maximize the infused volume while preserving the capsule.

Main outcome measurements: The Shoulder Pain and Disability Index (SPADI) and shoulder passive range of motion (PROM) was measured before the procedure and 2 weeks after CPIHD.

Results: The mean CPIHD volume was 20.2 ± 5.2 mL for the hypertonic saline group and 19.5 ± 5.9 mL for the normal saline group. The hypertonic saline group showed statistically significant improvement in shoulder PROM and SPADI score compared with the normal saline group. Side effects such as soreness or complications related to injection were not reported.

Conclusions: Our results suggest that CPIHD with hypertonic saline solution is more effective than that using normal saline solution in patients with adhesive capsulitis.