Hi all
Continuing the adhesive capsulitis discussion.
In our corner of the globe (Durban, South Africa), several of our orthopaedic surgeons refer their patients for image guided hydrodilation.
I prefer to do it it under fluoroscopic control and administer:
1. Steroid : 1-2ml Celestone
2. Local anaesthetic: 4 ml Naropin
3. Hydrodilation : followed by usually 25-30ml normal saline; little more if the patient can tolerate it.
Regards
Peter Mercouris
Hi Peter,
My doubt is if steroids in the early inflammatory phase of disease can
significantly change the degree and duration of limitation of movement. It
would come down to how early we can diagnose it and are able to provide an
injection (eg first month of presentation). Interesting review attached
found it does make a difference.
I find hydrodilatation controversial. There’s a meta-analysis from this
year concluding it is superior though (couldn’t download article, sorry). I
have been injecting Triamcinolone 40 mg + Ropivacaine 4ml. But
unfortunately I have no data on the outcomes.
Cheers
On Mon, 28 Jun 2021 at 01:45, Peter Mercouris <petermercouris@gmail.com>
wrote:
I’ve had good success with hydrodilation and betamethasone. Always late in
the disease after patients can’t take it anymore. I use lidocaine for local
and inject 1-2 cc into the joint figuring it probably won’t cause
chondrolysis. Patients then voluntarily go through an active range of
motion. Great majority of patients are very happy with the outcome.
On Wed, Jun 30, 2021 at 6:41 AM Ranieri Falcão Aguiar < ranierifaguiar@gmail.com> wrote:
I did almost the exact same trial, also in the 90’s, and came to the
identical conclusion.
Rob
On Wed, Jul 7, 2021 at 9:42 AM Phillip Tirman MD <ptirmanmd@gmail.com>
wrote: