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The stiff, painful shoulder is one of the most common conditions of the shoulder, 1 yet there is little consensus regarding its cause, classification or optimal treatment. Often, the assumption is made that a stiff, painful shoulder is the same as a "frozen shoulder"; however, this seems to be an umbrella term with little consensus regarding the diagnostic criteria for this disorder. 2, 3 Thus, many clinicians suggest that the stiff and painful shoulder should be classified into glenohumeral joint contracture types, such as primary and secondary contracture, 2- 6 based on the history regarding the onset of shoulder pain and stiffness.
Many treatment options have been proposed for glenohumeral joint contractures, irrespective of the type of contracture. These include exercise, physiotherapy, manipulation under anaesthetic, glucocorticosteroid injections and oral treatment, hydrodilatation and arthroscopic release in refractory cases. 7- 9 However, there is a paucity of data to support the efficacy of these interventions. 10, 11 Previous studies have often lacked explicit inclusion and exclusion criteria, failed to consider the type or degree of shoulder stiffness and have not described the method used or psychometric properties (validity, reliability and responsiveness) of the outcome measures. Hence, there is no consensus regarding the most appropriate treatment for glenohumeral joint contracture.
Hydrodilatation, sometimes referred to as distension arthrography, has been proposed as a therapeutic procedure for glenohumeral joint contracture. 7, 12- 14 It is proposed that its benefits are derived from a combination of the anti-inflammatory effect of cortisone with the mechanical effect of joint distension (reflected by radiological distension of the subscapularis bursa), thereby reducing the stretch on pain receptors in the glenohumeral joint capsule and its periosteal attachments. 15 Hydrodilatation was first used by Andren and Lundberg 16 in 1965, who reported variable results ranging from extremely effective to extremely painful. More recent studies have also cited variable results. 7, 8, 12- 15, 17- 19 This may be a consequence of varying hydrodilatation techniques and post-hydrodilatation treatment regimens (such as physiotherapy), small sample sizes, lack of explicit inclusion criteria and variable methods of outcome measurement. Despite these limitations, most authors conclude that hydrodilatation has a role in the treatment of glenohumeral joint contracture, 7, 8, 12- 15, 17- 19 on the basis of results of short-term...