Hydrodilatation for adhesive capsulitis: a systematic review exploring efficacy and optimal technique

Objective Patients with adhesive capsulitis are often referred for conservative management, including corticosteroid injection or hydrodilatation of the glenohumeral joint. This systematic review aimed to evaluate the efficacy of hydrodilatation compared with other interventions and summarise reported techniques. Design Systematic review with meta-analysis. Data sources PubMed, Embase and Web of Science. Eligibility criteria for selecting studies Randomised clinical trials (RCTs) and non-RCTs reporting outcomes related to hydrodilatation for idiopathic adhesive capsulitis. Results A total of 103 studies (9951 patients and 44 RCTs) were included, and the selected RCTs were used to perform meta-analyses. The mean hydrodilatation volume from the included studies was 36.0±26.3 mL, and the median volume was 28 mL (range: 8.3–200). The anterior approach was more common with fluoroscopy guidance (anterior n=31 vs posterior n=5), while the posterior approach was more common with ultrasound guidance (anterior n=9 vs posterior n=40). At 12 weeks, hydrodilatation resulted in greater external rotation (standardised mean difference (SMD) 0.61, 95% CI 0.14 to 1.08, I 2 81.6%) than corticosteroid injection alone (low certainty of evidence), but without significant differences in pain Visual Analog Scores (VAS), shoulder pain and disability index (SPADI), abduction and forward flexion. When combined with physical therapy or exercise, at 12 weeks, hydrodilatation resulted in better pain VAS scores (low certainty of evidence) (SMD 0.288, 95% CI 0.01 to 0.57, I 2 20.7%) and SPADI scores (very low certainty of evidence) (SMD 0.52, 95% CI 0.08 to 0.96, I 2 52.3%) compared with physical therapy alone, but no additional gains in range of motion. The reported incidence of infection associated with hydrodilatation was 0.02% (two cases among 8754 patients). Conclusion Significant variability exists in hydrodilatation techniques. Current evidence, combining these various techniques, does not support meaningful clinical improvements from hydrodilatation compared with corticosteroid injection alone or as an adjunct to physical therapy in patients with adhesive capsulitis. The ideal injection volume, capsular status, and number of injections remain inconclusive.