Comparison of Outcomes of Two Different Corticosteroid Injection Approaches for Primary Frozen Shoulder: A Randomized Controlled Study
DOI:
https://doi.org/10.2340/jrm.v55.2201Keywords:
frozen shoulder, adhesive capsulitis, anterior approach, posterior approach, corticosteroid injectionAbstract
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.
LAY ABSTRACT
Although many studies have been published in recent years on corticosteroid injection in the glenohumeral joint for primary frozen shoulder, the injection approaches described by current reports are not consistent and not described in detail, which is not conducive for their use to be repeated by clinicians. Meanwhile, controversy remains regarding whether different approaches have similar clinical outcomes. This study used a modified anterior approach based on anatomical landmarks, taking the acromioclavicular joint as a reference, to accurately and quickly complete the injection process. The study showed that the anterior approach could reduce pain severity more significantly than the regular posterior approach, and this advantage can be maintained for 3 months. Meanwhile, the function score of the anterior approach could recover to the maximum more quickly. In addition, recovery of external rotation in the anterior approach was faster and greater that for the posterior approach.
Downloads
References
Ricci M. Adhesive capsulitis: a review for clinicians. Jaapa 2021; 34: 12-14.
https://doi.org/10.1097/01.JAA.0000800236.81700.d4 DOI: https://doi.org/10.1097/01.JAA.0000800236.81700.d4
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.
https://doi.org/10.3389/fmed.2021.663703 DOI: https://doi.org/10.3389/fmed.2021.663703
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.
https://doi.org/10.32098/mltj.01.2016.04 DOI: https://doi.org/10.32098/mltj.01.2016.04
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.
https://doi.org/10.1038/s41598-017-05491-x DOI: https://doi.org/10.1038/s41598-017-05491-x
Robinson C, Seah K, Chee Y, Hindle P, Murray I. Frozen shoulder. J Bone Joint Surg Br 2012; 94: 1-9.
https://doi.org/10.1302/0301-620X.94B1.27093 DOI: https://doi.org/10.1302/0301-620X.94B1.27093
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.
https://doi.org/10.1177/0363546516669944 DOI: https://doi.org/10.1177/0363546516669944
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.
https://doi.org/10.1001/jamanetworkopen.2020.29581 DOI: https://doi.org/10.1001/jamanetworkopen.2020.29581
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.
https://doi.org/10.1016/j.apmr.2016.10.012 DOI: https://doi.org/10.1016/j.apmr.2016.10.012
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.
https://doi.org/10.1097/RHU.0000000000000475 DOI: https://doi.org/10.1097/RHU.0000000000000475
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.
https://doi.org/10.1016/j.jse.2010.12.021 DOI: https://doi.org/10.1016/j.jse.2010.12.021
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.
https://doi.org/10.1097/PHM.0000000000000338 DOI: https://doi.org/10.1097/PHM.0000000000000338
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.
https://doi.org/10.1007/s10067-020-05131-2 DOI: https://doi.org/10.1007/s10067-020-05131-2
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.
https://doi.org/10.1097/CORR.0000000000001803 DOI: https://doi.org/10.1097/CORR.0000000000001803
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.
https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-0755.R1 DOI: https://doi.org/10.1302/0301-620X.103B2.BJJ-2020-0755.R1
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.
https://doi.org/10.1136/ard.2003.018218 DOI: https://doi.org/10.1136/ard.2003.018218
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.
https://doi.org/10.1186/s12874-021-01241-w DOI: https://doi.org/10.1186/s12874-021-01241-w
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.
https://doi.org/10.1016/j.jcma.2012.12.008 DOI: https://doi.org/10.1016/j.jcma.2012.12.008
Hand GC, Athanasou NA, Matthews T, Carr AJ. The pathology of frozen shoulder. J Bone Joint Surg Br 2007; 89: 928-932.
https://doi.org/10.1302/0301-620X.89B7.19097 DOI: https://doi.org/10.1302/0301-620X.89B7.19097
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.
https://doi.org/10.1177/0363546513480475 DOI: https://doi.org/10.1177/0363546513480475
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.
https://doi.org/10.1177/0363546515616238 DOI: https://doi.org/10.1177/0363546515616238
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.
https://doi.org/10.1016/j.jse.2011.04.029 DOI: https://doi.org/10.1016/j.jse.2011.04.029
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.
https://doi.org/10.1016/S0140-6736(21)00846-1 DOI: https://doi.org/10.1016/S0140-6736(21)00846-1
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.
https://doi.org/10.1097/j.pain.0000000000000209 DOI: https://doi.org/10.1097/j.pain.0000000000000209
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.
https://doi.org/10.2106/JBJS.21.01007 DOI: https://doi.org/10.2106/JBJS.21.01007
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.
https://doi.org/10.1186/1471-2474-12-137 DOI: https://doi.org/10.1186/1471-2474-12-137
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.
https://doi.org/10.1007/s00402-008-0811-7 DOI: https://doi.org/10.1007/s00402-008-0811-7
Sethi PM, Kingston S, Elattrache N. Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy 2005; 21: 77-80.
https://doi.org/10.1016/j.arthro.2004.09.009 DOI: https://doi.org/10.1016/j.arthro.2004.09.009
Sethi PM, El Attrache N. Accuracy of intra-articular injection of the glenohumeral joint: a cadaveric study. Orthopedics 2006; 29: 149-152.
https://doi.org/10.3928/01477447-20060201-01 DOI: https://doi.org/10.3928/01477447-20060201-01
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.
https://doi.org/10.1016/j.jse.2011.06.013 DOI: https://doi.org/10.1016/j.jse.2011.06.013
Hall S, Buchbinder R. Do imaging methods that guide needle placement improve outcome? Ann Rheum Dis 2004; 63: 1007-1008.
https://doi.org/10.1136/ard.2004.020685 DOI: https://doi.org/10.1136/ard.2004.020685
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.
https://doi.org/10.1016/j.clinimag.2013.07.006 DOI: https://doi.org/10.1016/j.clinimag.2013.07.006
Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology 2004; 233: 486-492.
https://doi.org/10.1148/radiol.2332031219 DOI: https://doi.org/10.1148/radiol.2332031219
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.
https://doi.org/10.1177/0363546517744171 DOI: https://doi.org/10.1177/0363546517744171
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.
https://doi.org/10.1590/1806-9282.20210808 DOI: https://doi.org/10.1590/1806-9282.20210808
Additional Files
Published
How to Cite
License
Copyright (c) 2023 Zhibo Deng, Zhi Li, Xiangwei Li, Zhongqiu Chen, Chen Shen, Xianding Sun, Han Shu, Jiangping Wu, Kaiying Tang
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
