This 1965 case series introduced joint distension during arthrography as a less radical alternative to manipulation for the stiff shoulder. The authors injected contrast under pressure to distend and rupture the contracted capsule. They asked whether this could restore mobility across frozen shoulders of different causes.
When you see a stiff, painful shoulder with restricted passive motion, think capsular contraction first. This paper documented that reduced capsule size is nearly universal in these shoulders, which is the anatomic model behind frozen shoulder.
The practical lesson is patient selection. Distension works best in mild to moderate rigidity where the capsule still stretches before it tears. In absolute stiffness the capsule ruptures early and leaks, so benefit is limited and manipulation may be needed.
A useful pearl: reproduction of the patient's typical radiating pain during pressurized injection localizes the source to the joint, not the cervical spine. This work is the early foundation for modern hydrodilatation. It also reminds you that post-fracture stiffness shares the same capsular pathology and can respond to the same treatment.
This 1965 case series introduced joint distension during arthrography as a less radical alternative to manipulation for the stiff shoulder. The authors injected contrast under pressure to distend and rupture the contracted capsule. They asked whether this could restore mobility across frozen shoulders of different causes.
When you see a stiff, painful shoulder with restricted passive motion, think capsular contraction first. This paper documented that reduced capsule size is nearly universal in these shoulders, which is the anatomic model behind frozen shoulder.
The practical lesson is patient selection. Distension works best in mild to moderate rigidity where the capsule still stretches before it tears. In absolute stiffness the capsule ruptures early and leaks, so benefit is limited and manipulation may be needed.
A useful pearl: reproduction of the patient's typical radiating pain during pressurized injection localizes the source to the joint, not the cervical spine. This work is the early foundation for modern hydrodilatation. It also reminds you that post-fracture stiffness shares the same capsular pathology and can respond to the same treatment.