(Kiosk 2) A Case Report: Ultrasound-guided Capsular Distention for Post-operative Adhesive Capsulitis of the Hip

Case Diagnosis: Pressure Dilation to treat hip adhesive capsulitis

Case Description or Program Description: Adhesive capsulitis (AC), or arthrofibrosis, is a pathologic process in which excessive collagen depositions form across a joint leading to stiffness, pain, and limited joint mobility.(1,2) While the one-year prevalence of AC of the shoulder is approximately 2-5% in the general population, AC of the hip is less common and the incidence unknown.(2–5)

Setting: A 48-year-old male presented with right hip pain. He had a history of a arthroscopic labral repair and had done well with substantial improvement in his symptoms. Approximately five months after the surgery, he reported recurrence of the pain and limited range of motion in the hip. He reported temporary improvement in his symptoms following an intra-articular hip corticosteroid injection at an outside institution with 10-days of relief. Plain radiographs were unremarkable. An MRI of the hip showed post-operative changes without a re-tear of the labrum.

Assessment/Results: At presentation 8-months after the surgery, hip internal rotation was limited. A therapeutic hip injection with dexamethasone 4 mg (1 cc) and capsular distention with lidocaine 1% (2 cc) and normal saline 0.9% (20 cc) was performed using ultrasound-guidance and an anterior approach. One-month after the dilation, he reported resolution of the pain and hip internal rotation was symmetric.

Discussion (relevance): Most patients with AC of the hip can be managed non-surgically with NSAIDs, corticosteroid injections, and physical therapy. Surgical treatment includes manipulation under anesthesia, synovectomy, lysis of adhesions, and capsular release.(2) There is a lack of data on pressure dilation or distention for AC of the hip,(6,7) and prior case series excluded patients that had a history of surgery.

Conclusions: In this case report, the patient developed AC after labral surgery and was successfully treated with pressure dilation. Resolution of the patient’s symptoms suggests this procedure can potentially be performed in post-surgical AC without adverse events.