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Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial

R Buchbinder¹, S Green², A Forbes², S Hall³ and G Lawler⁴

¹ Department of Clinical Epidemiology, Cabrini Hospital and Department of Epidemiology and Preventive, Medicine, Monash University, Victoria, Australia
² Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
³ Department of Medicine, Monash University and Cabrini Medical Centre, Victoria, Australia
⁴ St Francis Xavier Cabrini Hospital, Victoria, Australia

Correspondence to:
Correspondence to:
Associate Professor R Buchbinder
Department of Clinical Epidemiology, Suite 41 Cabrini Medical Centre, 183 Wattletree Rd, Malvern, Victoria, Australia 3144; rachelle.buchbinder{at}med.monash.edu.au

Objective: To determine whether arthrographic distension with a mixture of saline and steroid, in patients with painful stiff shoulder for at least 3 months, is better than placebo in improving function, pain, and range of motion at 3, 6, and 12 weeks.

Methods: A randomised, placebo controlled trial with participant and outcome assessor blinding in which shoulder joint distension with normal saline and corticosteroid was compared with placebo (arthrogram). Outcome measures, assessed at 3, 6, and 12 weeks, included a shoulder-specific disability measure (SPADI), a patient preference measure (Problem Elicitation Technique (PET)), pain, and range of active motion.

Results: From 96 potential participants, 48 were recruited. Four withdrew from the placebo group after the 3 week assessment and three subsequently received arthrographic distension with saline and steroid. At 3 weeks, significantly greater improvement in SPADI (p = 0.005), PET, overall pain, active total shoulder abduction, and hand behind back was found in participants in the joint distension and steroid group than in the placebo group. At 6 weeks the results of the intention to treat analysis favoured joint distension, although the between-group differences were only significant for improvement in PET (difference in mean change in PET between groups = 45.9 (95% CI 3.2 to 88.7). Excluding the four withdrawals, the between-group differences for the disability and pain measures significantly favoured distension over placebo. At 12 weeks, both the intention to treat analysis and an analysis excluding the four withdrawals demonstrated a significantly greater improvement in PET score for the distension group.

Conclusions: Short term efficacy of arthrographic distension with normal saline and corticosteroid over placebo was demonstrated in patients with painful stiff shoulder.

Keywords: shoulders; arthrographic distension; hydrodilatation; clinical trial; adhesive capsulitis

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