Skip to main content

Advertisement

Log in

Comparing the accuracy and efficacy of ultrasound-guided versus blind injections of steroid in the glenohumeral joint in patients with shoulder adhesive capsulitis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Shoulder adhesive capsulitis is a condition mainly characterized by a decreased range of motion (ROM), with a lifelong prevalence of 2–5 %. Intra-articular steroid injection is an important treatment in this disease. It has been suggested that ultrasound-guided (US-guided) intra-articular injections are more accurate and effective than blind injections. This randomized clinical trial was designed to compare efficacy and accuracy of US-guided injections versus blind injections of steroid in the glenohumeral joint. Forty-one patients diagnosed with shoulder adhesive capsulitis were included. Patients randomly underwent intra-articular injection either blind or under guidance of ultrasound by a specialist. Immediately after injection, radiograms were obtained to assess the accuracy of injection. Demographic characteristics, their functional status, the severity of pain, and the ROM were gathered and compared between the two groups. Twenty patients in the US-guided group and 21 in the blind group finished the 4-week period of the study. Improvements in pain, ROM, and functional score after 1 and 4 weeks were more prominent in the US-guided group, but the differences were not statistically significant, except for the changes in extension where the improvements were significantly higher in the US-guided group (p = 0.01). The accuracy of injections was also higher in the US-guided group (90 % vs. 76.19 %), but the differences were not found to be significant (p = 0.24). US-guided injections can be more accurate and yield better improvements in pain, ROM, and function of the patients, but they cost more and are time-consuming.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ROM:

Range of motion

US-guided:

Ultrasound-guided

VAS:

Visual analog scale

GH:

Glenohumeral

MRI:

Magnetic resonance imaging

References

  1. Luime J, Koes B, Hendriksen I, Burdorf A, Verhagen A, Miedema H, et al. (2004) Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol 33(2):73–81

    Article  CAS  PubMed  Google Scholar 

  2. Griggs SM, Ahn A, Green A (2000) Idiopathic adhesive capsulitis. J Bone Joint Surg Am 82(10):1398

    Article  PubMed  Google Scholar 

  3. Robinson C, Seah KM, Chee Y, Hindle P, Murray I (2012) Frozen shoulder. Journal of Bone & Joint Surgery, British Volume 94(1):1–9

    Article  CAS  Google Scholar 

  4. Maund E, Craig D, Suekarran S, Neilson A, Wright K, Brealey S, et al. (2012) Management of frozen shoulder: a systematic review and cost-effectiveness analysis

  5. Skedros JG, Hunt KJ, Pitts TC (2007) Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians. BMC Musculoskelet Disord 8(1):1

    Article  Google Scholar 

  6. Speed CA (2007) Injection therapies for soft-tissue lesions. Best Practice & Research Clinical Rheumatology 21(2):333–347

    Article  Google Scholar 

  7. Eustace J, Brophy D, Gibney R, Bresnihan B, FitzGerald O (1997) Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis 56(1):59–63

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Gruson KI, Ruchelsman DE, Zuckerman JD (2008) Subacromial corticosteroid injections. J Shoulder Elb Surg 17(1):S118–SS30

    Article  Google Scholar 

  9. Hegedus EJ, Zavala J, Kissenberth M, Cook C, Cassas K, Hawkins R, et al. (2010) Positive outcomes with intra-articular glenohumeral injections are independent of accuracy. J Shoulder Elb Surg 19(6):795–801

    Article  Google Scholar 

  10. Aly A-R, Rajasekaran S, Ashworth N (2015) 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 49(16):1042–1049

    Article  PubMed  Google Scholar 

  11. Soh E, Li W, Ong KO, Chen W, Bautista D (2011) Image-guided versus blind corticosteroid injections in adults with shoulder pain: a systematic review. BMC Musculoskelet Disord 12(1):137

    Article  PubMed  PubMed Central  Google Scholar 

  12. Huskisson E (1983) Visual analogue scales. Pain Measurement and Assessment 33-7

  13. Roy JS, MacDermid JC, Woodhouse LJ (2009) Measuring shoulder function: a systematic review of four questionnaires. Arthritis Care & Research 61(5):623–632

    Article  Google Scholar 

  14. SPSS I (2013) IBM SPSS statistics 22. IBM Corp, New York

    Google Scholar 

  15. Ewald A (2011) Adhesive capsulitis: a review. Am Fam Phys 83(4).

  16. Hannafin JA, Chiaia TA (2000) Adhesive capsulitis: a treatment approach. Clin Orthop Relat Res 372:95–109

    Article  Google Scholar 

  17. Ekelund AL, Rydell N (1992) Combination treatment for adhesive capsulitis of the shoulder. Clin Orthop Relat Res 282:105–109

    Google Scholar 

  18. Rizk TE, Gavant ML, Pinals RS (1994) Treatment of adhesive capsulitis (frozen shoulder) with arthrographic capsular distension and rupture. Arch Phys Med Rehabil 75(7):803–807

    CAS  PubMed  Google Scholar 

  19. De Jong B, Dahmen R, Hogeweg J, Marti R (1998) Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens. Clin Rehabil 12(3):211–215

    Article  CAS  PubMed  Google Scholar 

  20. Park GY, Hwnag SE (2000) Comparison of intraarticular steroid injection with and without capsular distension in adhesive capsulitis of the shoulder. Journal of Korean Academy of Rehabilitation Medicine 24(6):1174–1179

    Google Scholar 

  21. Naredo E, Cabero F, Beneyto P, Cruz A, Mondéjar B, Uson J, et al. (2004) A randomized comparative study of short term response to blind injection versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol 31(2):308–314

    PubMed  Google Scholar 

  22. Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M, et al. (2009) A comparison of the effectiveness of landmark-guided injections and ultrasonography guided injections for shoulder pain. The Clinical Journal of Pain 25(9):786–789

    Article  PubMed  Google Scholar 

  23. Lee H-J, Lim K-B, Kim D-Y, Lee K-T (2009) Randomized controlled trial for efficacy of intra-articular injection for adhesive capsulitis: ultrasonography-guided versus blind technique. Arch Phys Med Rehabil 90(12):1997–2002

    Article  PubMed  Google Scholar 

  24. Gokalp G, Dusak A, Yazici Z (2010) Efficacy of ultrasonography-guided shoulder MR arthrography using a posterior approach. Skelet Radiol 39(6):575–579

    Article  Google Scholar 

  25. Ogul H, Bayraktutan U, Yildirim OS, Suma S, Ozgokce M, Okur A, et al. (2012) Magnetic resonance arthrography of the glenohumeral joint: ultrasonography-guided technique using a posterior approach/Omuz ekleminin MR artrografisi: ultrasonografi klavuzlugunda posterior yaklasim teknigi. Eurasian. J Med 44(2):73

    Google Scholar 

  26. Cicak N, Matasović T, Bajraktarević T (1992) Ultrasonographic guidance of needle placement for shoulder arthrography. J Ultrasound Med 11(4):135–137

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maryam Khoiniha.

Ethics declarations

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Raeissadat, S.A., Rayegani, S.M., Langroudi, T.F. et al. Comparing the accuracy and efficacy of ultrasound-guided versus blind injections of steroid in the glenohumeral joint in patients with shoulder adhesive capsulitis. Clin Rheumatol 36, 933–940 (2017). https://doi.org/10.1007/s10067-016-3393-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-016-3393-8

Keywords

Navigation