A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized Controlled Trial

Koraman, Emre; Türkmen, İsmail; Uygur, Esat; Poyanlı, Oğuz

doi:10.1016/j.arthro.2021.01.069

Cited by 21 publications

(53 citation statements)

References 27 publications

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“…In the treatment of adhesive capsulitis, intra-articular injections appear superior to subacromial injections for shortterm pain control, and multisite injections may be superior to single-site injections for pain control and range of motion. 1,2,[11][12][13] Any injection is likely to be superior to physical therapy alone for short-term pain control. 1 However, the heterogeneity among the studies should be considered when individualizing a patient's treatment plan.…”

Section: Discussionmentioning

confidence: 99%

“…12 In the Koraman et al prospective randomized comparative study, the multisite injection group received 2 mL of triamcinolone acetonide (40 mg/mL), 4 mL of bupivacaine (0.5%), and 34 mL of saline solution divided between the glenohumeral joint, posteroinferior capsule, subacromial space, posterosuperior capsule, biceps long head, and coracohumeral ligament. 13 The single injection group received 1 mL of triamcinolone acetonide (40 mg/mL) and 2 mL of bupivacaine (0.5%) in the glenohumeral joint. Both groups underwent ultrasound-guided injections.…”

Section: Review Of Evidencementioning

confidence: 99%

“…The multisite corticosteroid injections resulted in significantly lower VAS scores at 1 month (P<0.001), 3 months (P<0.001), 6 months (P<0.01), and 1 year (P=0.012) compared with the single-site injection group, as well as significantly better active and passive range of motion at all time points (P<0.05). 13 Koh published a systematic review in 2016 examining the safety of corticosteroid injections. 3 The main side effects reported were pain after injection (29.8%), facial flushing (12.3%), and menstrual irregularities (10.1%), with a number needed to harm for steroid injection vs physical therapy of 11.4 for pain, 9.5 for menstrual irregularities, and 7.1 for facial flushing.…”

Section: Review Of Evidencementioning

confidence: 99%

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Optimizing Pain Control and Function in Patients With Adhesive Capsulitis by Choosing the Best Injection Site

DeStefano

Oberle

Donohoe

et al. 2022

TOJ

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Two patients present to the sports medicine clinic with shoulder pain and limited range of motion. A 51-year-old healthy female rower presents 5 months after developing left shoulder pain. She had no specific inciting injury, although she increased overhead workouts with dumbbells prior to the onset of pain. She describes soreness that started in the left biceps and then shifted to the lateral shoulder. The other patient, a 61-year-old male golfer with a history of hyperlipidemia and hypertension, developed right shoulder pain also after increasing overhead exercises with weights 3 months prior to presentation. His pain is most significant with sleeping on the right side, abducting the right arm, and lifting heavy objects. Both patients have limited shoulder flexion, abduction, and internal rotation despite 8 weeks of physical therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Review Of Evidencementioning

confidence: 99%

Section: Review Of Evidencementioning

confidence: 99%

See 1 more Smart Citation

Optimizing Pain Control and Function in Patients With Adhesive Capsulitis by Choosing the Best Injection Site

DeStefano

Oberle

Donohoe

et al. 2022

TOJ

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“…I n the present issue of Arthroscopy, authors Koraman, Turkmen, Uygur, and Poyanli published an interesting paper entitled: "A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized, Controlled Trial." 1 In it, the authors conclude that "both treatments were effective in patients with primary frozen shoulder. However, the multisite injection technique provided better pain palliation, better ROM restoration and better functional results than the single glenohumeral injection in patients with primary frozen shoulder who were treated with the same physiotherapy regimen.…”

Section: See Related Article On Page 2031mentioning

confidence: 99%

Editorial Commentary: Corticosteroid Injections and Physical Therapy Are Effective First-Line Treatments for Frozen Shoulder

Kartus¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Various shoulder injection techniques have been used by orthopedic surgeons or radiologists in their efforts to perform arthrograms. These injection techniques include: (1) blind injections with structures that can be palpated from the body surface, such as the acromion and coracoid process; and (2) image-guided injections with fluoroscopic or ultrasonic guidance, using the anterior, posterior, or supraclavicular approach[ 2 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of shoulder joint injections with ultrasound guidance: Confirmed by magnetic resonance arthrography

Kuratani¹,

Tanaka²,

Hanai³

et al. 2022

WJO

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BACKGROUND Intra-articular glenohumeral joint injections are essential procedures for treating various shoulder disorders. Fluoroscopy-guided injections have been extensively used; however, they pose a risk of radiation exposure and are expensive and time-consuming. Recently, it has been suggested that ultrasound-guided injections are accurate and cost effective procedures. AIM To evaluate the accuracy of ultrasound-guided glenohumeral injections using a posterior approach that is confirmed using magnetic resonance arthrography (MRA). METHODS The study included 179 shoulders of patients with recurrent anterior instability (150 patients; 103 and 76 right and left shoulders, respectively; 160 males and 19 females; average age = 20.5 years; age range: 14-63 years) who underwent MRA for preoperative diagnosis. They were injected with 12 mL lidocaine (1%) using the ultrasound-guided posterior approach and then underwent magnetic resonance imaging. Two shoulder surgeons, except for the injector, evaluated the transverse relaxation (T2)-weighted images of axial planes and classified the intra-articular condition of injected contrast into three groups based on one of the three following scenarios: no leakage, injection into the glenohumeral joint without leakage; minor leakage, practical intra-articular injection with some leakage outside the posterior rotator cuffs; and major leakage, inaccurate injection with mass leakage without any contrast into the joint. The inter-rater reliability between two assessors was also evaluated by calculating Cohen’s kappa coefficient. The learning curve was assessed regarding the inaccurate injection rate by analyzing Spearman’s rank correlation coefficient. RESULTS Of the 179 injections, 163 shoulders (91.0%) had no leakage, 10 shoulders (5.6%) had minor leakage, and six shoulders (3.4%) had major leakage. In total, 173 shoulders (96.6%) were intra-articularly injected; thus, we could detect anterior labrum and capsular pathologies. Regarding the inter-rater reliability, the kappa coefficient was 0.925, indicating consistency in the evaluations by both examiners. Regression analysis of the inaccurate injection rate for assessingtechnical learning showed a logarithmic curve with a downward trend (R 2 = 0.887, P < 0.001). Three (50%) of the six inaccurate injections classified into “major leakage” were observed in the first 30 injections, indicating that the accurate injection showed a leaning effect. CONCLUSION Ultrasound-guided intra-articular glenohumeral injections using a posterior approach had high accuracy; however, injection accuracy depends on clinical experience.

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A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized Controlled Trial

Cited by 21 publications

References 27 publications

Optimizing Pain Control and Function in Patients With Adhesive Capsulitis by Choosing the Best Injection Site

Optimizing Pain Control and Function in Patients With Adhesive Capsulitis by Choosing the Best Injection Site

Editorial Commentary: Corticosteroid Injections and Physical Therapy Are Effective First-Line Treatments for Frozen Shoulder

Accuracy of shoulder joint injections with ultrasound guidance: Confirmed by magnetic resonance arthrography

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