Objective: To compare the clinical efficacy of capsule-rupturing versus capsule-preserving ultrasound-guided hydrodilatation in patients with shoulder adhesive capsulitis (AC). To determine potential factors affecting the outcome over a 6-month follow-up. Materials and methods: Within a 2-year period, 149 consecutive patients with AC were prospectively enrolled and allocated into (i) group-CR, including 39 patients receiving hydrodilatation of the glenohumeral joint (GHJ) with capsular rupture and (ii) group-CP, including 110 patients treated with GHJ hydrodilatation with capsular preservation. Demographics, affected shoulder, and AC grade were recorded. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and visual analog scale (VAS) were used for clinical assessment at baseline/1/3/6 months. Comparisons were performed with Mann-Whitney U test and Kolmogorov-Smirnov test. Linear regression was used to identify predictors of outcome. P value < 0.05 defined significance. Results: DASH and VAS scores in both groups improved significantly compared to baseline (P < 0.001) and were significantly lower in the CP compared to CR group at all time-points following intervention (P < 0.001). Capsule rupture was a significant predictor of DASH score at all time-points (P < 0.001). DASH scores correlated to initial DASH score at all time-points (P < 0.001). DASH/VAS scores at 1 month were correlated to the AC grade (P = 0.025/0.02). Conclusion: GHJ hydrodilatation results in pain elimination and functional improvement till the mid-term in patients with AC, with improved outcome when adopting the capsule-preserving compared to the capsule-rupturing technique. Higher initial DASH score is predictive of impaired functionality in the mid-term.

Ultrasound-guided hydrodistention has been established as an effective minimally invasive treatment option for glenohumeral joint adhesive capsulitis (AC). Nonetheless, the long-term outcomes of the procedure have not yet been established. A total of 202 patients with AC were prospectively recruited and followed up for a total of 2 years. Pain and functionality were assessed with the use of the visual analogue scale (VAS) and the disabilities of the arm, shoulder, and hand (DASH) score, respectively, at the beginning and the end of the follow-up period. The relapse of AC over the 2-year period and the effect of diabetes were also evaluated in the treatment cohort. The Mann–Whitney U test was used to compare mean scores at the two time points, and Cox survival analysis and χ² test were used to assess the effect of diabetes on AC relapse. VAS and DASH scores were significantly lower at 2 years compared with the beginning of the follow-up period (p < 0.001). Diabetes was diagnosed in 38/202 patients (18.8%) and was found to be significantly associated with recurrence of the disease (p < 0.001). In conclusion, in this observational study, we have demonstrated that ultrasound-guided hydrodistention is linked to excellent long-term outcomes for the treatment of AC, which are significantly worse in patients with diabetes.

To investigate the association between cardiometabolic factors, obesity, radiographic severity, and symptomatic hand osteoarthritis (HOA), as the role of these factors in HOA remains unclear. A cross-sectional analysis in the EPIPorto cohort included participants with HOA (≥ 1 joint with Kellgren-Lawrence (KL) grade ≥ 2 and/or American College of Rheumatology criteria). Cardiovascular risk factors, anthropometric measures, and radiographic severity (sum of KL hand score [0–128]) and number of affected joints [0–32]) were analysed. We tested the association between these factors and symptomatic HOA (≥ 1 joint with KL ≥ 2 and hand pain in the last month) by multivariable logistic regression. Of the 858 participants with HOA (61% women, mean age 59.6 years), 807 met radiographic criteria, and 160 presented symptomatic HOA. Among these, 77% were overweight or obese, 81% hypertensive, 95% had dyslipidaemia, and 20% were diabetic. Body mass index, waist circumference, and waist-to-height ratio, were associated with symptomatic HOA (OR 1.04, 95% CI 1.00; 1.09), (OR 1.02, 95% CI 1.00; 1.04), (OR 1.03, 95% CI 1.01; 1.06). Diabetes, hypertension, and dyslipidaemia showed no association. We observed an association between the KL score, the number of affected joints, and symptomatic HOA (OR 1.09, 95% CI 1.07; 1.12), (OR 1.09, 95% CI 1.06; 1.12). Increased central obesity and radiographic severity are associated with symptomatic HOA, highlighting the potential role of adiposity in HOA pain. These findings underscore the importance of weight management to improve pain outcomes in HOA. Furthermore, assessing radiographic changes may aid monitoring of disease symptoms. Further studies are needed to validate these associations and inform evidence-based clinical practice.

Background: Diabetes is associated with microvascular and macrovascular complications. Although it is less recognized, diabetes also has an important role in the development of musculoskeletal disorders. Our objective was to evaluate the effect of type 2 diabetes (T2D) on the severity of adhesive capsulitis of the shoulder (AC) and on the efficacy of ultrasound guided hydrodistension treatment. Methods: We conducted a retrospective longitudinal observational study, of patients with AC who underwent ultrasound guided hydrodistension at our Centre. Severity was measured with DASH (Disabilities of Arm, Shoulder and Hand) score and pain was evaluated with a score between 0 and 10. The association of T2D with baseline characteristics of AC, and with outcomes at 6–12 months was analyzed using linear and logistic regression models. Results: We evaluated 120 ultrasound guided hydrodistension treatments of AC, 85 in patients without diabetes and 35 in patients with T2D. Patients with diabetes had a higher prevalence of dyslipidemia, hypertension and higher HbA1c values. The average duration of diabetes was 4.8 years (2.0, 7.9). The baseline characteristics of AC were not significantly different between patients with and without diabetes. Patients with T2D relapsed more frequently and required more reinterventions than patients without diabetes (20.0% vs 4.7%, p = 0.008), had higher post-intervention pain scale values [4.0 (0.0–5.0) vs 0.0 (0.0–5.0), p = 0.022] and higher post-intervention DASH score [0.8 (0.0–1.8) vs 0.0 (0.0–0.8), p = 0.038]. Conclusion: Although baseline characteristics of AC in patients with diabetes were similar to those without diabetes, patients with diabetes had a worse response to treatment, more frequent relapses and a greater need for new interventions.