Comparison of pain relief and functional improvement in landmark vs. ultrasound-guided corticosteroid injections for adhesive capsulitis: a prospective study
Coene, Ryan Patrick
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BACKGROUND: Adhesive capsulitis is an idiopathic disorder of the shoulder that is characterized by pain in combination with the gradual loss of passive and active range of motion. It is typically self-limiting, although the disease still remains poorly understood. However, there are several treatment modalities, both conservative and surgical, that provide significant clinical benefit for patients with adhesive capsulitis. Corticosteroid injections are an established conservative treatment method for adhesive capsulitis. Several studies have demonstrated that injections provide short-term benefits in terms of shoulder mobility and pain reduction. The intra-articular injections can be performed blindly (landmark) or with ultrasound (US) guidance. Physicians administer injections under US guidance in an attempt to improve the accuracy of the injection. However, it remains unclear whether US-guided injections relieve symptoms of adhesive capsulitis more effectively than landmark injections. OBJECTIVE: To compare the pain relief, self-reported function, and shoulder range of motion (ROM) outcomes of landmark versus US-guided corticosteroid injections for adhesive capsulitis. Methods: A total of 21 patients with adhesive capsulitis were randomized to receive either a landmark or US-guided intra-articular corticosteroid injection. Clinical outcome measures were documented at baseline, 6 weeks, and 12 weeks. These measures included a visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE) score for self-reported function, and passive shoulder ROM, including forward flexion, external rotation, and abduction. RESULTS: Both US-guided and landmark glenohumeral (GH) joint injections significantly improved VAS scores, SANE scores, and shoulder ROM outcomes. Improvement was maintained for all outcome measures in both groups throughout the 12 week treatment period. However, there were no significant differences seen in outcome measures between the two groups except that US-guided provided greater improvement in abduction at the 6 week follow-up (P = .004). CONCLUSIONS: This preliminary report found that there is no significant difference in the effectiveness of US-guided and landmark cortisone injection in terms of pain improvement, self-reported functions, and ROM outcomes for adhesive capsulitis.