Shoulder manipulation under targeted ultrasound-guided rotator interval block for adhesive capsulitis

Abstract Shoulder adhesive capsulitis, also called frozen shoulder, is a musculoskeletal disorder associated with pain and functional disability. This study aimed to compare the effectiveness of shoulder ultrasound-guided hydrodilatation with corticosteroid, via rotator interval (RI) anteriorly, versus posterior approach, in adhesive capsulitis patients. All patients received exercise program following injection. Patients and methods A prospective randomized controlled study among 60 consecutive adhesive capsulitis patients was randomized into two equal groups. Group I received ultrasound-guided hydrodilatation with corticosteroid, saline, and local anesthetic via posterior intra-articular approach; group II received the same ultrasound-guided hydrodilatation via anterior rotator interval approach. Both groups received guided stretching exercises for 3 months after injection. Baseline and 3 months evaluation of pain by visual analogue scale (VAS), shoulder pain and disability index (SPADI), and range of motion (ROM) had been recorded for all patients. Results Both groups showed significant improvement 3 months after hydrodilatation regarding VAS pain, external rotation, and SPADI. Only in group II (RI anterior approach) improvement was observed regarding flexion and abduction. There was no improvement regarding extension or internal rotation in either group. When comparing the improvement in both groups after hydrodilatation, group II (anterior approach) showed a statistically significant higher level of improvement regarding VAS pain (p = 0.003), SPADI, flexion, abduction, and external rotation, compared to group I (p < 0.001). Extension, internal rotation, and adduction were not different. Conclusions Ultrasound-guided anterior rotator interval hydrodilatation for adhesive capsulitis, followed by guided exercise, is clinically and functionally more effective than the conventional posterior approach. Key Points• Ultrasound-guided hydrodilatation (with prednisolone acetate (40 mg), 1 ml of 2% lidocaine, and 15 ml saline) for adhesive capsulitis followed by guided exercise is clinically and functionally effective.• The ultrasound-guided anterior rotator interval approach is clinically and functionally significantly more effective than the conventional intra-articular posterior approach as it targets mainly the area of pathology.• This is the first prospective study comparing the effect of the anterior rotator interval approach versus the posterior approach in ultrasound-guided hydrodilatation in adhesive capsulitis patients.

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Ultrasound-Guided Interventional Release of Rotator Interval and Posteroinferior Capsule for Adhesive Capsulitis of the Shoulder Using a Specially Designed Needle

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/531 ◽

2011 ◽

Vol 6;14 (6;12) ◽

pp. 531-537

Author(s):

Hyung-Joon Jhun

Keyword(s):

Adhesive Capsulitis ◽

Methodological Approach ◽

Rotator Interval ◽

Ultrasound Probe ◽

Dry Needling ◽

Ultrasound Guided ◽

Supraspinatus Muscle ◽

Technical Report ◽

Ultrasonographic Guidance

Background: Adhesive capsulitis is a common but poorly understood disorder of the shoulder. Various treatments have been developed to manage this condition, but the efficacy of these treatments is controversial. We developed an ultrasound-guided, minimally invasive interventional technique to manage adhesive capsulitis of the shoulder using a specially designed needle. Objective: To describe the methodological approach of our intervention. Study Design: Technical report. Setting: Pain management clinic. Methods: Thirteen participants with adhesive capsulitis of the shoulder underwent ultrasound-guided interventional release of the rotator interval and posteroinferior capsule using a specially designed curved Round Needle. A convex ultrasound probe was placed along the oblique coronal plane over the supraspinatus muscle and acromion. Under ultrasonographic guidance, the needle was passed through the supraspinatus muscle and superior labrum and reached the rotator interval. It was moved forward and backward until no resistance was felt. After finishing the rotator interval release, the needle was inserted toward the posteroinferior capsule. While the operator released the adhesion in the posteroinferior capsule by moving the needle forward and backward, an assistant gradually abducted the shoulder. When full abduction of the affected shoulder was achieved, the intervention was completed. Results: Following our intervention, significant improvements in pain levels, glenohumeral range of motion, and Quick Disability of the Arm, Shoulder, and Hand scores were attained at follow-up. Limitations: Technical report only. Efficacy of this technique is beyond the scope of the article. Conclusion: Ultrasound-guided interventional release of the rotator interval and posteroinferior capsule appears to have clinical significance in the management of adhesive capsulitis of the shoulder. Key words: adhesive capsulitis, shoulder, ultrasound, intervention, dry needling, technique

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Ultrasound-guided intra-articular and rotator interval corticosteroid injections in adhesive capsulitis of the shoulder

Pain ◽

10.1097/j.pain.0000000000000209 ◽

2015 ◽

Vol 156 (9) ◽

pp. 1683-1691 ◽

Cited By ~ 20

Author(s):

Tore Prestgaard ◽

Marjon E.A. Wormgoor ◽

Simen Haugen ◽

Herlof Harstad ◽

Petter Mowinckel ◽

...

Keyword(s):

Adhesive Capsulitis ◽

Rotator Interval ◽

Ultrasound Guided ◽

Corticosteroid Injections

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Letter to editor on “Proximal vs Distal Approach of Ultrasound-guided Suprascapular Nerve Block for Patients With Adhesive Capsulitis of the Shoulder: Prospective Randomized Controlled Trial”

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2020.12.034 ◽

2021 ◽

Author(s):

Ke-Vin Chang ◽

Wei-Ting Wu

Keyword(s):

Randomized Controlled Trial ◽

Nerve Block ◽

Controlled Trial ◽

Adhesive Capsulitis ◽

Suprascapular Nerve ◽

Ultrasound Guided ◽

Randomized Controlled ◽

Suprascapular Nerve Block ◽

Prospective Randomized Controlled Trial

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Effects of ultrasound-guided suprascapular nerve pulsed radiofrequency on chronic shoulder pain

Medical Ultrasonography ◽

10.11152/mu-1543 ◽

2018 ◽

Vol 20 (4) ◽

pp. 461 ◽

Cited By ~ 6

Author(s):

Tolga Ergonenc ◽

Serbulent Gokhan Beyaz

Keyword(s):

Shoulder Pain ◽

External Rotation ◽

Adhesive Capsulitis ◽

Suprascapular Nerve ◽

Pulsed Radiofrequency ◽

Ultrasound Guided ◽

Duration Of Action ◽

Vas Score ◽

Long Duration ◽

Chronic Shoulder Pain

Aim: Pulsed radiofrequency (PRF) therapy has become increasingly popular in the treatment of chronic shoulder pain due to its long duration of action and non-destructive method. The aim of the study was to reveal the effects of PRF therapy of the suprascapular nerve (SSN) under ultrasound guidance (UG) in patients with chronic shoulder pain on both shoulder pain and function.Material and methods: This study included 74 patients diagnosed with at least one of the following: adhesive capsulitis, rotator cuff syndrome and impingement syndrome of shoulder. The PRF therapy of the SSN under UG was performed in those patients with a reduction of 50% or more Visual Analog Scale (VAS) score and those that reported healing in the active range of motion (AROM) in the diagnostic SSN block. The resting, motion and sleeping shoulder pain assessments of the patients were done with VAS score. The shoulder joint function was assessed with the Shoulder Pain and Disability Index (SPADI) questionnaire and the AROM of the joint was measured using a goniometer.Results: In 70 of the 74 patients a 50% or more reduction was found in the VAS score with diagnostic SSN block. After the PRF therapy of the SSN, the 15thday, 1st month, 3rd month, and 6th month follow-up VAS averages, SPADI averages and the flexion, internal rotation, external rotation, and abduction values were statistically significantly lower than the baseline values (p<0.05).Conclusion: This study is the largest series in the literature evaluating the efficacy of PRF therapy of the SSN under UG and has shown that pain canbe controlled quickly, for a long period of time, using ultrasound guided PRF therapy of the SSN in chronic shoulder pain.

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