Introduction

& Purpose:
Ultrasound(USG) guided corticosteroid(CS) injection into the glenohumeral joint(GH) is widely employed for treating early frozen shoulder(FS). However the ideal site for injection still remains unclear. This study aimed at analysing pain relief, range of movement(ROM) improvement, functional outcomes and also the safety of CS injection at intra-articular(IA), rotator interval(RI), subacromial(SA), and multi-site(MS) approaches.

Materials & methods:
120 cases of Idiopathic FS were randomised into four groups: IA, RI, SA & MS for USG guided CS injections. Outcome variables namely pain grading using visual analogue scale, ROM & functional scoring using CONSTANT scores, SPADI(Shoulder pain and disability index)& patient satisfaction score(PS) were measured pre & post procedure at 3,6,12,24 weeks. MRI was done at 6 months post procedure to study the effect of steroids on the rotator cuff.

Results

& Discussion:
All parameters significantly improved post injection in all groups(P<0.001). ROM & PS was best achieved with MS approach(P<0.001) while improvement in pain & functional outcomes were equivalent with both MS and IA approaches. Maximum clinical benefit among the single site approaches was for IA and least for RI approach. There were no local/systemic adverse effects and MRI analysis did not show any cuff tears at 24 weeks follow up.

Conclusion

MS approach for steroid injection yields the maximum clinical benefit with respect improvement in range of movement and patient satisfaction in treating frozen shoulder. USG guided steroid injections are safe with no adverse effects in patients with adequate glycaemic control.