Comparison of two techniques of steroid injections in the management of Frozen shoulder
Abstract
Background: Frozen shoulder is a condition in which movement of the shoulder becomes restricted. It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary, when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately 1 to 3 years' duration, though incomplete resolution can occur. The aetiology of shoulder pain is diverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicular joint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source of shoulder pain is the rotator cuff, accounting for over two-thirds of cases.
Material and methods: This was a prospective study with 50 patients coming to our OPD. Patients of all stages were included and randomized into two groups. Group 1: Single Site Injection (SSI) group received steroid injection through posterior approach and Group 2: Novel three-site ( NTS )group received the same dose of steroid in diluted doses at three sites (posterior capsule, subacromial and subcoracoid). The second sitting was repeated after 3 weeks. Both groups had received the same physiotherapy. The patients were evaluated by the CONSTANT score at initial, 3 weeks, 6 weeks and 6 months.
Results: Patients of Group 2 (NTS group) had significant pain relief and early improvement in activities of daily living (p < 0.005) as compared to Group 1 (SSI Group). Also, although there was an improvement in shoulder movements in both the groups but in Group 2 (NTS) patients, early near-normal scores were attained and sustained even after 6 months. About 40% in Group 1 (SSI) could not attain near-normal levels and had relapses.
Conclusion: The Novel three-site approach of steroid injections in frozen shoulder provides early recovery, better pain relief and better improvement in shoulder function with fewer relapses.
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References
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