Ann Rehabil Med.  2022 Aug;46(4):192-201. 10.5535/arm.22059.

Effects of Hydrodilatation With Corticosteroid Injection and Biomechanical Properties in Patients With Adhesive Capsulitis After Breast Cancer Surgery

• Lee CW
• Kim IS
• Kim JG
• Hwang H
• Jung IY
• Lee SU
• Seo KS

• KMID: 2532952
• DOI: http://doi.org/10.5535/arm.22059

Abstract

Objective
To compare the biomechanical properties of the glenohumeral joint capsule between adhesive capsulitis (AC) after breast cancer surgery and idiopathic AC and demonstrate the effects of hydrodilatation (HD) with corticosteroid injection for AC after breast cancer surgery.
Methods
Twenty-three prospective patients with AC after breast cancer surgery (BC group) and 44 retrospective patients with idiopathic AC without breast cancer (CON group) underwent HD with corticosteroid injection and home exercise training. We compared their biomechanical characteristics (capsular capacity, maximal pressure, and capsular stiffness). In the BC group, the passive range of motion (ROM) of the affected shoulder and a questionnaire (Shoulder Pain and Disability Index [SPADI]) were evaluated at baseline and 2 and 4 weeks after treatment.
Results
The BC group showed higher biomechanical characteristics (maximal pressure and capsular stiffness) than did the CON group. The mean maximal pressure and capsular stiffness were 519.67±120.90 mmHg and 19.69±10.58 mmHg/mL in the BC group and 424.78±104.42 mmHg and 11.55±7.77 mmHg/mL in the CON group (p=0.002 and p=0.001, respectively). And, the BC group showed significant improvements in all ROMs (abduction, flexion, and external rotation) and the SPADI pain and disability sub-scores following the treatment.
Conclusion
The glenohumeral joint capsular stiffness was greater in the patients with AC after breast cancer surgery than in those with idiopathic AC. HD with corticosteroid injection was effective in treating AC after breast cancer surgery.

Keyword

Breast Neoplasms; Adhesive capsulitis; Hydrodilatation; Capsular distention; Shoulder joint

Figure

• 

  Fig. 1 The study design for the prospective (patients with AC after breast cancer surgery) and retrospective groups (patients with idiopathic AC) that underwent ultrasound-guided IHD is presented. AC, adhesive capsulitis; IHD, intra-articular hydrodilatation.

• 

  Fig. 2 An example of the biomechanical profiles of the shoulder joint capsule is presented. (A) Pressure–time curve. (B) Pressure–volume curve in the second phase. The slope of the second phase (solid line) is reflected in the stiffness of the shoulder joint capsule (Scap). Pmax, capsular pressure at the maximal volume; Vmax, maximal infused volume; Scap, capsular stiffness.

• 

  Fig. 3 The SPADI score changes for pain and disability at the initial and 2- and 4-week follow-up evaluations (*p<0.017 using Bonferroni correction) in the prospective breast cancer surgery group (total, BCS, and RM subgroups) are presented. BCS, breast-conserving surgery; RM, radical mastectomy.

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