This is the first placebo-controlled trial of arthrographic joint distension with saline and corticosteroid for painful stiff shoulder (adhesive capsulitis). Patients with at least 3 months of symptoms were randomised to distension versus a sham arthrogram. Outcomes were function, pain, and range of motion at 3, 6, and 12 weeks.
When you see a patient with a stiff, painful shoulder past the acute phase (3+ months, resting pain under 7/10, passive loss over 30 degrees in two planes), arthrographic distension with saline and steroid is a reasonable option to speed early recovery.
The key teaching point is timing of benefit. Distension gives a clear head start at 3 weeks, but the placebo arm caught up by 12 weeks, matching the favourable natural history of adhesive capsulitis. So counsel patients that distension buys faster relief, not necessarily a better endpoint at 3 months.
Watch the outcome-measure lesson too: the fixed-item SPADI missed late benefit because of a ceiling effect, while the individualized PET still detected it. Choice of measure changes what a trial can show. Remember frozen shoulder is not reliably self-limiting. Up to 40% have residual restriction beyond 3 years, which justifies active treatment in the stiff phase.
This is the first placebo-controlled trial of arthrographic joint distension with saline and corticosteroid for painful stiff shoulder (adhesive capsulitis). Patients with at least 3 months of symptoms were randomised to distension versus a sham arthrogram. Outcomes were function, pain, and range of motion at 3, 6, and 12 weeks.
When you see a patient with a stiff, painful shoulder past the acute phase (3+ months, resting pain under 7/10, passive loss over 30 degrees in two planes), arthrographic distension with saline and steroid is a reasonable option to speed early recovery.
The key teaching point is timing of benefit. Distension gives a clear head start at 3 weeks, but the placebo arm caught up by 12 weeks, matching the favourable natural history of adhesive capsulitis. So counsel patients that distension buys faster relief, not necessarily a better endpoint at 3 months.
Watch the outcome-measure lesson too: the fixed-item SPADI missed late benefit because of a ceiling effect, while the individualized PET still detected it. Choice of measure changes what a trial can show. Remember frozen shoulder is not reliably self-limiting. Up to 40% have residual restriction beyond 3 years, which justifies active treatment in the stiff phase.