A comparison of outcomes in ultrasonography guided versus landmark guided corticosteroid injection for the treatment of adhesive capsulitis

Authors

  • Gopinath K. M. Department of Orthopaedics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
  • Aishwarya G. Nair Department of Orthopaedics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India https://orcid.org/0000-0001-8367-8447
  • Suresh I. Department of Orthopaedics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
  • Suhas Gowda Department of Orthopaedics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
  • Bysani Swaroop Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
  • Venkatesh Kadiri Department of Orthopaedics, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20230572

Keywords:

Adhesive capsulitis, Frozen shoulder, Corticosteroid injection, Intra-articular injection

Abstract

Background: Adhesive capsulitis is a debilitating disease in an otherwise healthy individual. Intra-articular corticosteroid injections offer a cost-effective, non-operative treatment option. However, it is currently unclear whether an ultrasound-guided injection relieves the symptoms of shoulder pain more effectively than if the injection was delivered landmark-guided.

Methods: Eighty patients with adhesive capsulitis were randomized to two intervention groups - landmark guided and ultrasound (USG) guided. The functional status of the patients was documented prior to the intervention. Following allocation, the intra-articular steroid was administered either under USG guidance or following identification of the site of injection using landmarks. Follow-up was done on day 5, 3 weeks, 6 weeks, and 12 weeks post procedure to document the functional status.

Results: The difference in visual analogue score (VAS) between the two arms was found to be statistically significant in favour of the ultrasound guided technique only on day 5 and day 21. On the other hand, the difference in disability of arm, shoulder, and hand (DASH) score between the 2 arms was found to be statistically significant in favour of the ultrasound guided technique on day 5, 21, 42 and 84. Finally, in our study, both shoulder flexion and abduction on day 84 achieved a statistically significant improvement, favouring the ultrasound guided arm.

Conclusions: Ultrasound guided corticosteroid injections may offer modestly better short-term functional outcome and symptom relief when compared with landmark guided corticosteroids.

References

Neviaser AS, Neviaser RJ. Adhesive capsulitis of the shoulder. J Am Acad Orthop Surgeons. 2011;19(9):536-42.

Azar FM. Shoulder and Elbow Injuries. In: Campbell’s Operative Orthopaedics. 13th edition. 2020;2322-4.

Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4(4):193-6.

Owens-Burkhart H. Management of Frozen Shoulder. In: Donatelli RA Physical Therapy of Shoulder. 5th edition. 2011;91-116.

Sheridan MA, Hannafin JA. Upper extremity: Emphasis on frozen shoulder. Orthop Clin. 2006;37(4):531-9.

Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am. 2000;82(10):1398-407.

Boyle-Walker KL, Gabard DL, Bietsch E, Masek-VanArsdale DM, Robinson BL. A profile of patients with adhesive capsulitis. J Hand Therap. 1997;10(3):222-8.

Prodromidis AD, Charalambous CP. Is there a genetic predisposition to frozen shoulder? A systematic review and meta-analysis. JBJS Rev. 2016;4(2).

D’Orsi GM, Via AG, Frizziero A, Oliva F. Treatment of adhesive capsulitis: A review. Muscles Ligaments Tendons J. 2012;2(2):70.

Harris JD, Griesser MJ, Copelan A, Jones GL, et al. Treatment of adhesive capsulitis with intra-articular hyaluronate: A systematic review. Int J Shoulder Surg. 2011;5(2):31.

Huang SW, Lin JW, Wang WT, Wu CW, Liou TH, Lin HW. Hyperthyroidism is a risk factor for developing adhesive capsulitis of the shoulder: A nationwide longitudinal population-based study. Scientific Rep. 2014;4(1):1-4.

Bruckner FE, Nye CJ. A prospective study of adhesive capsulitis of the shoulder ("frozen shoulder') in a high-risk population. Q J Med. 1981;50(198):191-204.

Smith SP, Devaraj VS, Bunker TD. The association between frozen shoulder and Dupuytren's disease. J Shoulder Elbow Surg. 2001;10(2):149-51.

Arkkila P, Kantola IM, Viikari J, Rönnemaa T. Shoulder capsulitis in type i and II diabetic patients: Association with diabetic complications and related diseases. Ann Rheum Dis. 1996;55(12):907-14.

Reeves B. The natural history of the frozen shoulder syndrome. Scand J Rheumatol. 1975;4(4):193-6.

Neviaser RJ, Neviaser TJ. The frozen shoulder. Diagnosis and management. Clin Orthop Relat Res. 1987;(223):59-64.

Rizk TE, Pinals RS, Talaiver AS. Corticosteroid injections in adhesive capsulitis: Investigation of their value and site. Arch Physical Med Rehab. 1991;72(1):20-2.

Bulgen DY, Binder AI, Hazleman BL, Dutton J, Roberts S. Frozen shoulder: Prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis. 1984;43(3):353-60.

Bal A, Eksioglu E, Gulec B, Aydog E, Gurcay E, Cakci A. Effectiveness of corticosteroid injection in adhesive capsulitis. Clin Rehab. 2008;22(6):503-12.

Windt DA van der, Koes BW, Devillé W, Boeke AJ, Jong BA de, Bouter LM. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: Randomised trial. BMJ (Clinical research ed). 1998;317(7168):1292-6.

Carette S, Moffet H, Tardif J, Bessette L, Morin F, Frémont P, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: A placebo-controlled trial. Arthritis Rheumatism. 2003;48(3):829-38.

Lloyd-Roberts G, French P. Periarthritis of the shoulder. Br Med J. 1959;1(5137):1569.

Hazleman BL. The painful stiff shoulder. Rheumatol Physical Med. 1972;11(8):413-21.

Aly AR, Rajasekaran S, Ashworth N. Ultrasound-guided shoulder girdle injections are more accurate and more effective than landmark-guided injections: A systematic review and meta-analysis. Br J Sports Med. 2015;49(16):1042-9.

Dogu B, Yucel SD, Sag SY, Bankaoglu M, Kuran B. Blind or ultrasound-guided corticosteroid injections and short-term response in subacromial impingement syndrome: A randomized, double-blind, prospective study. Am J Physical Med Rehab. 2012;91(8):658-65.

Rutten MJCM, Maresch BJ, Jager GJ, Waal Malefijt MC de. Injection of the subacromial-subdeltoid bursa: Blind or ultrasound-guided? Acta Orthopaedica. 2007;78(2):254-7.

Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M, et al. A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain. Clin J Pain. 2009;25(9):786-9.

Lee HJ, Lim KB, Kim DY, Lee KT. Randomized controlled trial for efficacy of intra-articular injection for adhesive capsulitis: Ultrasonography-guided versus blind technique. Arch Physical Med Rehab. 2009;90(12):1997-2002.

Downloads

Published

2023-02-28

How to Cite

K. M., G., G. Nair, A., I., S., Gowda, S., Swaroop, B., & Kadiri, V. (2023). A comparison of outcomes in ultrasonography guided versus landmark guided corticosteroid injection for the treatment of adhesive capsulitis. International Journal of Research in Medical Sciences, 11(3), 905–913. https://doi.org/10.18203/2320-6012.ijrms20230572

Issue

Section

Original Research Articles