Anterior vs Posterior vs Combined Intra-Articular Injections for Adhesive Capsulitis

Comparison of Anterior, Posterior, and Combined Intra-Articular Injection Techniques in Patients With Adhesive Capsulitis

This randomized controlled clinical trial aims to compare the efficacy of three different intra-articular injection approaches (anterior, posterior, and combined anterior-posterior) in patients with adhesive capsulitis of the shoulder. Thirty participants will be randomly assigned to one of three groups and treated with a standardized injection solution consisting of corticosteroid, lidocaine, and saline. Clinical outcomes will be evaluated using pain scores, functional scales, and imaging parameters.

Study Overview

• Status: Not yet recruiting
• Conditions: Adhesive Capsulitis of the Shoulder; Intra Articular Injection
• Intervention / Treatment: Drug: Intervention Name: Posterior Intra-articular Injection; Drug: Anterior Intra-articular Injection; Drug: Combined Anterior + Posterior Intra-articular Injection

Detailed Description

Adhesive capsulitis (frozen shoulder) is a disabling condition characterized by progressive pain and stiffness of the glenohumeral joint. Intra-articular corticosteroid injections are frequently used to reduce pain and improve mobility; however, the optimal injection approach remains controversial.

This single-center randomized controlled trial will investigate three different approaches: posterior, anterior, and combined anterior-posterior injections. The primary endpoint is improvement in active and passive range of motion. Secondary endpoints include pain scores (VAS), functional outcome measures (SPADI, qDASH, ASES, Constant-Murley, Scratch Test, Subjective Shoulder Value), and ultrasound evaluation of axillary capsule thickness. Assessments will be performed at baseline, immediately after injection, and at weeks 3, 6, and 12.

• Study Type: Interventional
• Enrollment (Estimated): 30
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Aslinur K Keles, MD., PhD; Phone Number: +905395010707; Email: aslinur.ercisli@gmail.com
• Study Contact Backup: Name: esra K giray, Assoc Prof; Phone Number: +90 555 813 43 94; Email: girayesra@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria Age 18-70 years Unilateral shoulder pain and stiffness (symptom duration 1-9 months) NRS pain score ≥ 7/10 Passive range of motion limitation >50% in at least two planes, or >30° restriction in ≥2 planes "Freezing stage" (stage 2 adhesive capsulitis) No analgesic use (NSAIDs, opioids, acetaminophen) within 12 hours before intervention Radiography and/or MRI excluding other pathologies (rotator cuff tear, labral lesion, osteoarthritis, etc.) Exclusion Criteria Secondary adhesive capsulitis (trauma, surgery, systemic disease) Prior shoulder surgery or intra-articular steroid injection within 3 months Bilateral frozen shoulder Neurological disorders (Parkinson's disease, ALS, neuropathies) Malignancy, infection, cellulitis, septic arthritis, acute fracture Cognitive impairment, psychiatric disorders, pregnancy Steroid or local anesthetic allergy Poor glycemic control or other contraindications to steroid injections

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm A: Posterior Injection; Single intra-articular injection with corticosteroid + lidocaine + saline via the posterior glenohumeral approach.	Drug: Intervention Name: Posterior Intra-articular Injection; A single intra-articular injection consisting of 1 cc corticosteroid, 4 cc 2% lidocaine, and 5 cc saline (total 10 cc) administered via the posterior glenohumeral approach.; Other Names: Posterior Intra-articular Injection
Experimental: Arm B - Anterior Injection; Same injection solution administered via the anterior (rotator interval) approach.	Drug: Anterior Intra-articular Injection; A single intra-articular injection consisting of 1 cc corticosteroid, 4 cc 2% lidocaine, and 5 cc saline (total 10 cc) administered via the anterior (rotator interval) approach.; Other Names: Anterior hydrodilatation
Experimental: Arm C - Combined Anterior + Posterior Injection; Same injection solution administered using both anterior and posterior approaches.	Drug: Combined Anterior + Posterior Intra-articular Injection; A single intra-articular injection consisting of 1 cc corticosteroid, 4 cc 2% lidocaine, and 5 cc saline (total 10 cc) administered using both anterior and posterior approaches during the same procedure.; Other Names: combined joint injection

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Shoulder Range of Motion (ROM)	Change in active and passive shoulder joint range of motion (flexion, extension, abduction, external rotation, internal rotation) measured with a goniometer.	Baseline, immediately post-injection, week 3, week 6, week 12

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Pain Intensity (NRS)	Number Rating Scale (0-10) for pain at rest, during activity, and at night.	Baseline, immediately post-injection, week 3, week 6, week 12
Subjective Shoulder Value (SSV)	Patient's self-reported percentage of normal shoulder function (0-100%).	Baseline, immediately post-injection, week 3, week 6, week 12
Shoulder Pain and Disability Index (SPADI)	Questionnaire assessing pain and disability (0-100 score, higher scores = worse function).	Baseline, week 3, week 6, week 12
Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH)	Questionnaire measuring upper limb disability and symptoms (0-100 score, higher = worse).	Baseline, week 3, week 6, week 12
American Shoulder and Elbow Surgeons (ASES) Score	Composite score including pain and function (0-100, higher = better).	Baseline, week 3, week 6, week 12
Constant-Murley Shoulder Score	Clinical score combining pain, activities of daily living, strength, and ROM (0-100).	Baseline, week 3, week 6, week 12
Scratch Test Score	Functional test measuring the patient's ability to reach behind the back.	Baseline, immediately post-injection, week 3, week 6, week 12
Axillary Capsule Thickness (Ultrasound)	Ultrasound measurement of axillary recess capsule thickness on the affected shoulder.	Baseline, immediately post-injection (only).

Collaborators and Investigators

• Sponsor: Aslinur Keles Ercisli, MD, PhD
• Investigators: Principal Investigator: Aslinur keles, MD., PhD, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2026
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: January 15, 2026
• First Submitted That Met QC Criteria: January 15, 2026
• First Posted (Actual): January 23, 2026

Study Record Updates

• Last Update Posted (Actual): January 23, 2026
• Last Update Submitted That Met QC Criteria: January 15, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Ultrasound; Shoulder Pain; Intra-articular Injection; Frozen Shoulder; Adhesive Capsulitis of the Shoulder
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Musculoskeletal Diseases; Joint Diseases; Arthralgia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Bursitis; Shoulder Pain
• Other Study ID Numbers: ADC2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No