Adhesive capsulitis, MRI patholgoy and US guided intervention, lecture & clinical case

[@massimogasparri295]

Thank you Dr.Lee, i love your us guided injections lectures, this is the best pain management channel ❤

[@practicalpainmanagementwit8115]

Glad you think so!

[@shahidhafeez1521]

Really impressive 😘

[@practicalpainmanagementwit8115]

thank you

[@jimmy7276]

Dr. Lee, thanks for the lecture. well, recently, one of my patient could not move her arm with severe pain after the axillary nerve block, the injection point was right under the posterior surgical humeral neck with bone-touch, where the teres minor tendon attached back side of humerus. i am thinking the pain is from nerve injury induced by needle,, or is there any other possibility that i did not notice? is there any dangerous critical problem i have missed?

[@practicalpainmanagementwit8115]

sometines, I rely on the patient's response. I move the needle very slowly. It can help to avoid inadvertant nerve injury.

[@medads9401]

Excellent video. Is there any video detail ing US guided CHL and inf capsule injections?

[@practicalpainmanagementwit8115]

thank you for asking. I posted video details. you should learn CHL and inferior capsule first.

[@silver4360]

Thank you doctor. Do you perform hidrodistension? Or only infiltration

[@practicalpainmanagementwit8115]

only infiltration. total volume of each site is about 2ml

[@EricMark]

Dr. Lee, Thanks for your wonderful teaching. Distension arthrogram with steroid is a commonly used and effective method for adhensive capsulitis. Your innovative method looks great and focuses on the pathology target. In your opinon, which method is better or how to choose between these two methods?

[@practicalpainmanagementwit8115]

how much do you need to distend the capsule ? you need manual mobilization after intra-articular distension. I think the effect is more depend on manual technique not the distension. So, I think pathologic target approach is more reasonable.

[@EricMark]

@@practicalpainmanagementwit8115 Thanks for your reply. I would like to try your method. Thanks a lot!

[@chinminw1]

Thank you Dr. Lee. Should this intervention be repeated, if so, what is the best interval?

[@practicalpainmanagementwit8115]

On the protocol, I can finish the treatment in three sessions in 70% of the cases. inject every 2 weeks and start MET home exercise from 2nd FU. thank you for asking

[@sabiston002]

좋은 영상 감사합니다. 저는 보통 intra-articular inj만 했었는데 물리치료를 소홀히 하면 재발을 잘하더라구요. 혹시 Recurrent adhesive capsulitis에서 coraco-humeral ligament를 치료하면 재발율을 줄일수 있는 tip이 될까요? 선생님?

[@practicalpainmanagementwit8115]

네 그렇습니다. inferior capsule 특히 humeral side inflammation and fibrosis가 원인이기도 합니