John Read, one of the most experienced and sharpest Radiologists I know,
had the following comments that I thought would be germane to this
discussion:
———- Forwarded message ———
From: John Read <johnread499@gmail.com>
Date: Sat, Jul 3, 2021 at 2:23 AM
Subject: Re: Adhesive capsulitis
To: <ptirmanmd@gmail.com>
I always thought the rationale for hydrodilatation was either to break down
intra-articular ‘adhesions’ (which don’t exist) or to stretch out a ‘tight’
capsule (which is doubtful, as the capsule will leak and decompress from
the weakest recess before a truly tight capsule will uniformly distend). To
my mind the only real rationale for this procedure is therefore to
deliberately rupture the capsule and thereby allow steroid to infiltrate
the pericapsular as well as intracapsular space. After doing a small
comparison experiment in the early 1990s where I injected 10 shoulders
without distension and 10 shoulders to either 40cc volume or rupture
(whichever occurred 1st!), I abandoned full-on hydrodistension because
there was no obvious difference in clinical outcomes between these two
groups (according to the sports physician that I did the experiment with).
For many years I then injected to a total volume of not more than 10cc, and
in more recent years no more than 5cc —> I’ve never had any negative
feedback from either patients or referrers with this policy, and my
suspicion has gradually solidified to the view that it is only the steroid
that has any value (and even that has been questioned in at least one
recent publication!). Regards, JR
