Comparison of Outcomes of Two Different Corticosteroid Injection Approaches for Primary Frozen Shoulder: A Randomized Controlled Study

Zhibo Deng, Zhi Li, Xiangwei Li, Zhongqiu Chen, Chen Shen, Xianding Sun, Han Shu, Jiangping Wu, Kaiying Tang, Zhibo Deng, Zhi Li, Xiangwei Li, Zhongqiu Chen, Chen Shen, Xianding Sun, Han Shu, Jiangping Wu, Kaiying Tang

Abstract

Objective: Corticosteroid injection is a common treatment for primary frozen shoulder, but controversy remains regarding whether different injection approaches to the glenohumeral joint have similar clinical benefits.

Design: Randomized controlled clinical trial.

Patients: A total of 60 patients with primary frozen shoulder were divided randomly into either anterior or posterior approach groups.

Methods: Both groups received a 5-mL drug injection, including 1 mL 40 mg/mL triamcinolone acetonide and 4 mL 2% lidocaine. Follow-up time-points were 4, 8 and 12 weeks post-injection. Outcome measures included visual analogue scale score, Constant-Murley score, and passive range of motion of the shoulder joint.

Results: All outcome measures improved over the follow-up period compared with those of previous follow-up time-points within the groups. The primary finding was that the visual analogue scale score in the anterior group was better than that in the posterior group at each follow-up time-point (all p < 0.05). In addition, improvement in function score and external rotation was faster and significant in the anterior group in the early stages (p = 0.02).

Conclusion: The anterior approach achieves more satisfactory results in pain control and offers better recovery of functional activity than posterior approach in the early period for primary frozen shoulder.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flow chart of patient randomization and follow-up. VAS: visual analogue scale; ROM: range of motion.
Fig. 2
Fig. 2
(A, B) Photographs of anterior approach and posterior approach with the anatomical landmark. Black dot: coracoid process. Black cross indicates the target point of the needle in the injection approach.

References

    1. Ricci M. Adhesive capsulitis: a review for clinicians. Jaapa 2021; 34: 12–14.
    1. de la Serna D, Navarro-Ledesma S, Alayón F, López E, Pruimboom L. A comprehensive view of frozen shoulder: a mystery syndrome. Front Med (Lausanne) 2021; 8: 66–78.
    1. Zreik NH, Malik RA, Charalambous CP. Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence. Muscles Ligaments Tendons J 2016; 6: 26–34.
    1. Cheng X, Zhang Z, Xuanyan G, Li T, Li J, Yin L, et al. . Adhesive capsulitis of the shoulder: evaluation with us-arthrography using a sonographic contrast agent. Sci Rep 2017; 7: 45–62.
    1. Robinson C, Seah K, Chee Y, Hindle P, Murray I. Frozen shoulder. J Bone Joint Surg Br 2012; 94: 1–9.
    1. Sun Y, Zhang P, Liu S, Li H, Jiang J, Chen S, et al. . Intra-articular steroid injection for frozen shoulder: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis. Am J Sports Med 2017; 45: 2171–2179.
    1. Challoumas D, Biddle M, McLean M, Millar NL. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open 2020; 3: 11–38.
    1. Lee D, Yoon S, Lee M, Kwack K, Rah U. Capsule-preserving hydrodilatation with corticosteroid versus corticosteroid injection alone in refractory adhesive capsulitis of shoulder: a randomized controlled trial. Arch Phys Med Rehabil 2017; 98: 815–821.
    1. Kim DY, Lee SS, Nomkhondorj O, Cho MG, Lee JJ, Hwang JT, et al. . Comparison between anterior and posterior approaches for ultrasound-guided glenohumeral steroid injection in primary adhesive capsulitis: a randomized controlled trial. J Clin Rheumatol 2017; 23: 51–57.
    1. Tobola A, Cook C, Cassas KJ, Hawkins RJ, Wienke JR, Tolan S, et al. . Accuracy of glenohumeral joint injections: comparing approach and experience of provider. J Shoulder Elbow Surg 2011; 20: 1147–1154.
    1. Mattie R, Kennedy DJ. Importance of image guidance in glenohumeral joint injections: comparing rates of needle accuracy based on approach and physician level of training. Am J Phys Med Rehabil 2016; 95: 57–61.
    1. Elnady B, Rageh E, Hussein M, Abu-Zaid M, Desouky D, Ekhouly T, et al. . In shoulder adhesive capsulitis, ultrasound-guided anterior hydrodilatation in rotator interval is more effective than posterior approach: a randomized controlled study. Clin Rheumatol 2020; 39: 3805–3814.
    1. Rijs Z, de Groot P, Zwitser E, Visser C. Is the anterior injection approach without ultrasound guidance superior to the posterior approach for adhesive capsulitis of the shoulder? a sequential, prospective trial. Clin Orthop Relat Res 2021; 10: 47–58.
    1. Cho C, Min B, Bae K, Lee K, Kim D. A prospective double-blind randomized trial on ultrasound-guided versus blind intra-articular corticosteroid injections for primary frozen shoulder. Bone Joint J 2021; 103-B(2): 353–359.
    1. Buchbinder R, Hoving JL, Green S, Hall S, Forbes A, Nash P. Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial. Ann Rheum Dis 2004; 63: 1460–1469.
    1. Kanto K, Lähdeoja T, Paavola M, Aronen P, Järvinen TLN, Jokihaara J, et al. . Minimal important difference and patient acceptable symptom state for pain, Constant-Murley score and Simple Shoulder Test in patients with subacromial pain syndrome. BMC Med Res Methodol 2021; 21: 45–54.
    1. Lin HH, Huang TF, Ma HL, Liu CL. Body mass index and active range of motion exercise treatment after intra-articular injection in adhesive capsulitis. J Chin Med Assoc 2013; 76: 225–228.
    1. Hand GC, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br 2007; 89: 928–932.
    1. Yoon SH, Lee HY, Lee HJ, Kwack KS. Optimal dose of intra-articular corticosteroids for adhesive capsulitis: a randomized, triple-blind, placebo-controlled trial. Am J Sports Med 2013; 41: 1133–1139.
    1. Ranalletta M, Rossi LA, Bongiovanni SL, Tanoira I, Elizondo CM, Maignon GD. Corticosteroid injections accelerate pain relief and recovery of function compared with oral NSAIDs in patients with adhesive capsulitis: a randomized controlled trial. Am J Sports Med 2016; 44: 474–481.
    1. Oh JH, Oh CH, Choi JA, Kim SH, Kim JH, Yoon JP. Comparison of glenohumeral and subacromial steroid injection in primary frozen shoulder: a prospective, randomized short-term comparison study. J Shoulder Elbow Surg 2011; 20: 1034–1040.
    1. Hopewell S, Keene DJ, Marian IR, Dritsaki M, Heine P, Cureton L, et al. . Progressive exercise compared with best practice advice, with or without corticosteroid injection, for the treatment of patients with rotator cuff disorders (GRASP): a multicentre, pragmatic, 2 × 2 factorial, randomised controlled trial. Lancet 2021; 398: 416–428.
    1. Prestgaard T, Wormgoor MEA, Haugen S, Harstad H, Mowinckel P, Brox JI. Ultrasound-guided intra-articular and rotator interval corticosteroid injections in adhesive capsulitis of the shoulder: a double-blind, sham-controlled randomized study. Pain 2015; 156: 1683–1691.
    1. Balazs CGC. In frozen shoulder, US-guided versus blind administration of intra-articular corticosteroid injections increased accuracy of injections but did not improve clinical outcomes at 12 weeks. J Bone Joint Surg Am 2021; 103: 2144–2148.
    1. Soh E, Li W, Ong KO, Chen W, Bautista D. Image-guided versus blind corticosteroid injections in adults with shoulder pain: a systematic review. BMC Musculoskelet Disord 2011; 12: 137–152.
    1. Esenyel CZ, Ozturk K, Demirhan M, Sonmez M, Kahraman S, Esenyel M, et al. . Accuracy of anterior glenohumeral injections: a cadaver study. Arch Orthop Trauma Surg 2010; 130: 297–300.
    1. Sethi PM, Kingston S, Elattrache N. Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy 2005; 21: 77–80.
    1. Sethi PM, El Attrache N. Accuracy of intra-articular injection of the glenohumeral joint: a cadaveric study. Orthopedics 2006; 29: 149–152.
    1. Kraeutler MJ, Cohen SB, Ciccotti MG, Dodson CC. Accuracy of intra-articular injections of the glenohumeral joint through an anterior approach: arthroscopic correlation. J Shoulder Elbow Surg 2012; 21: 380–383.
    1. Hall S, Buchbinder R. Do imaging methods that guide needle placement improve outcome? Ann Rheum Dis 2004; 63: 1007–1008.
    1. Ogul H, Bayraktutan U, Ozgokce M, Tuncer K, Yuce I, Yalcin A, et al. . Ultrasound-guided shoulder MR arthrography: comparison of rotator interval and posterior approach. Clin Imaging 2014; 38: 11–17.
    1. Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology 2004; 233: 486–492.
    1. Sun Y, Liu S, Chen S, Chen J. The effect of corticosteroid injection into rotator interval for early frozen shoulder: a randomized controlled trial. Am J Sports Med 2018; 46: 663–670.
    1. Akkaya H, Söker E, Dilek O, Söker G, Gülek B. Evaluation of magnetic resonance imaging findings in adhesive capsulitis: which quantitative findings are most valuable? Rev Assoc Med Bras (1992) 2021; 67: 1719–1723.

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