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Musculoskeletal and Sports Medicine

Session: Comparing functional outcomes between anterior versus posterior approaches for hydrodilatation for treatment of adhesive capsulitis: a systematic review with meta-analysis

Comparing Functional Outcomes Between Anterior Versus Posterior Approaches for Hydrodilatation for Treatment of Adhesive Capsulitis: A Systematic Review with Meta-Analysis

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Original Research Theater

    Poster Presenter(s)

  • Raymond Guo, MD

    Resident Physician
    MassGeneral Brigham/Spaulding Rehabilitation/Harvard Medical School PM&R Program
    Plano, Texas

    • Co-Author(s)

  • Jaehyung Shin, BS

    Undergraduate Student (Graduated)
    Georgia Institute of Technology
    Corona, California

  • Grace Olson, Other

    Medical Student
    Boston University Chobanian & Avedisian School of Medicine
    Roxbury, Massachusetts

  • XP

    Xiaoyu Pan, MD, PhD, MPH

    Research Instructor
    University of Texas Southwestern Medical Center
    Dallas, Texas

  • DC

    Dylan Combs, MD

    resident physician
    MassGeneral Brigham/Spaulding Rehabilitation/Harvard Medical School PM&R Program
    Charlestown, Massachusetts

  • JR

    Joseph Ruiz, MD

    Resident Physician
    MassGeneral Brigham/Spaulding Rehabilitation/Harvard Medical School PM&R Program
    Somerville, Massachusetts

  • Rachel Fetterman, MA (she/her/hers)

    Medical Student
    University of Massachusetts Medical School
    Worcester, Massachusetts

  • KM

    Katelyn McCarron, Other

    Researcher
    Mass General Brigham
    Carver, Massachusetts

  • HR

    Hye Chang Rhim, MD

    Sports Medicine Fellow
    Spaulding Rehabilitation Hospital/Harvard Medical School PM&R Program
    Charlestown, Massachusetts

Disclosure(s):
Raymond Guo, MD: No financial relationships to disclose
Jaehyung Shin, BS: No financial relationships to disclose
Grace Olson, Other: No financial relationships to disclose
Joseph Ruiz, MD: No financial relationships to disclose
Rachel Fetterman, MA: No financial relationships to disclose
Background and/or Objectives: Hydrodilatation is a procedure that has been shown to be effective for patients with adhesive capsulitis. However, the optimal approach to hydrodilatation remains unknown. The objective of this study was to compare functional outcomes between anterior and posterior approaches when performing hydrodilatation for adhesive capsulitis.

Design: Systematic review and meta-analysis

Setting : Outpatient clinics

Participants : 178 patients (57 males and 121 females, mean age 51.1 years and mean duration of symptoms 7.45 months)

Interventions: Hydrodilatation using an anterior approach targeting the rotator interval versus hydrodilatation using a posterior approach

Main Outcome Measures: Visual analogue scale (VAS) score; flexion, abduction, and external rotation ROM; shoulder pain and disability index (SPADI)

Results: A total of 679 studies were identified through searching PubMed, Embase, and Web of Science databases. After screening and removing duplicates, a total of 3 randomized controlled trials (RCTs) were included with low risk of bias for 2 RCTs and some concerns for the other RCT. Meta-analysis showed that the anterior approach resulted in greater mean improvement in pain VAS (SMD 0.593, 95% CI 0.291 to 0.894) at 9-12 weeks when compared to the posterior approach. The anterior approach also resulted in greater mean improvement in flexion (WMD 4.97, 95% CI 1.927 to 8.016), abduction (WMD 7.79, 95% CI 3.30 to 12.28), and external rotation ROM (WMD 13.95, 95% CI 7.62 to 20.29). There was no significant difference in SPADI (WMD 13.81, 95% CI -8.99 to 36.61) between the two approaches. For both groups, adverse events were minor and included pain and facial flushing.

Conclusions: When compared to a posterior approach, an anterior approach of hydrodilatation may lead to greater improvements in pain and ROM for patients with adhesive capsulitis at 9-12 weeks. However, further, high-quality RCTs should substantiate these findings.