Original article
Randomized Controlled Trial for Efficacy of Intra-Articular Injection for Adhesive Capsulitis: Ultrasonography-Guided Versus Blind Technique

Presented to the Annual Assembly of American Academy of Physical Medicine and Rehabilitation, November 22, 2008, San Diego, CA.
https://doi.org/10.1016/j.apmr.2009.07.025Get rights and content

Abstract

Lee H-J, Lim K-B, Kim D-Y, Lee K-T. Randomized controlled trial for efficacy of intra-articular injection for adhesive capsulitis: ultrasonography-guided versus blind technique.

Objective

To evaluate the clinical effect of ultrasonography (US)-guided intra-articular injections compared with a blind (unguided) technique for the treatment of adhesive capsulitis.

Design

Randomized controlled trial.

Setting

Outpatient rehabilitation clinic.

Participants

Patients (N=43) diagnosed as having adhesive capsulitis after clinical examinations and radiologic and ultrasonographic study.

Intervention

Under either US-guided or a blind technique, patients received a 20-mg intra-articular injection of triamcinolone mixed with 1.5mL 2% lidocaine and 4mL normal saline in the first week followed by 5 weekly injections of sodium hyaluronate.

Main Outcome Measures

A visual analog scale for pain intensity, range of motion (ROM) of the shoulder (flexion, abduction, external rotation, and internal rotation), and general shoulder function during daily activities at preinjection as a baseline and then every week after injection for 6 weeks for each patient.

Results

Twenty patients out of 22 in the blind injection group and 20 out of 21 in the US-guided group finished the entire 6-week study period. The improvement in pain intensity, ROM, and shoulder function score was significantly greater in the US-guided injection group than in the blind injection group by the second week postinjection (P<.05). However, there were no further significant differences in the improvement between the 2 groups beyond the third week.

Conclusions

US-guided intra-articular injections may offer advantages over a blind technique for the treatment of adhesive capsulitis and may deliver clinical benefits during the first few weeks of treatment. This finding suggests that the improved targeting to the intra-articular space by using US can result in better treatment of adhesive capsulitis.

Section snippets

Participants

We selected the subjects from patients who visited the Department of Rehabilitation Medicine of our hospital between October 2006 and May 2007 with the main complaint of limited ROM of the shoulder joint and pain. The subjects in this study were patients diagnosed as having clinical disease stage II idiopathic adhesive capsulitis10 after clinical and physical examinations, x-ray test, and US. Patients with the diagnosis of other disorders that can cause similar clinical symptoms were excluded.

Clinical Characteristics of the Patients

Twenty patients out of 22 in the blind injection group and 20 out of 21 in the US-guided group finished the entire 6-week study period. The average ages of the 2 groups were similar at 53.1 and 54.1. The man to woman ratio was 10:10 for the blind injection group and 9:11 for the US-guided injection group. The weight and height were similar between the 2 groups. The average morbid period of shoulder pain was 10.6 months for the blind injection group and 8.5 months for the US-guided group, and

Discussion

Also referred to as frozen shoulder, adhesive capsulitis brings about gradually increasing pain and restricted joint ROM of the affected shoulder. Patients often complain of serious limitations in external rotation and abduction. The intra-articular injection of steroids for adhesive capsulitis has shown treatment effects through its reduction of the inflammatory reaction in the pathologic progress and has led to a relatively rapid improvement of symptoms.13, 14 The injection of sodium

Conclusions

We found that for intra-articular injection for patients with adhesive capsulitis, the US-guided technique offers faster reduction of pain and higher improvement of the range of joint motion and general shoulder functions during the early stage of treatment compared with the blind technique. Therefore, we believe that the US-guided injection technique can be a useful treatment that leads to earlier improvements in patients with adhesive capsulitis.

References (16)

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