The role of suprascapular nerve block in hydrodilatation for frozen shoulder

Corticosteroid Injections for Frozen Shoulder: A Global Online Survey of Health Professionals' Current Practice and Opinion

INTRODUCTION

Frozen shoulder is a disabling condition characterised by severe pain and loss of shoulder movement. Corticosteroid injections are targeted at reducing pain in the earlier painful phase. There are multiple studies on the effectiveness of injections for frozen shoulder, but none were identified to assess if this guidance has been translated into clinical practice. The aim of this survey was to investigate the current practice and opinion of musculoskeletal health professionals regarding corticosteroid injections for frozen shoulder.

DESIGN AND METHODS

The online survey was disseminated via the social media platform 'X' (at the time of the survey known as Twitter) over a 5-week period. Recruitment was by the 'snowball' effect. Responses to multiple choice survey questions were analysed with descriptive data. Free text questions were analysed using content analysis.

RESULTS

The number of respondents to the survey was 235. Respondents felt injections have an important role in the management of frozen shoulder (155/235, 66%) and the best time to inject is during the pain predominant phase (191/233; 82%). The glenohumeral joint was the preferred anatomical site to inject (136/235; 58%) with triamcinolone as the preferred steroid (66/155; 43%). A steroid dose of 40 mg/mL was favoured by 55% (83/151) of respondents.

CONCLUSION

Corticosteroid injections play an important role in the management of frozen shoulder. There was consensus for the type and dose of corticosteroid and anaesthetic; however, the range of preparations used indicated that many decisions may be based on personal preference or local guidelines.

A team approach to adhesive capsulitis with ultrasound guided hydrodilatation: a retrospective study

BACKGROUND

Adhesive capsulitis (AC) causes shoulder pain and limited range of motion. While ultrasound-guided suprascapular nerve block, glenohumeral joint hydrodilatation, and physical therapy are effective individually, their combined use is not well-studied.

OBJECTIVE

This study evaluates the effect and safety of combining ultrasound-guided suprascapular nerve block, glenohumeral joint hydrodilatation, and physical therapy on range of motion and pain, comparing diabetic and non-diabetic patients.

DESIGN

Retrospective Cohort; Level of Evidence 3.

METHODS

150 patients (30-75 years) with AC received ultrasound-guided suprascapular nerve block, glenohumeral joint hydrodilatation with corticosteroid injection, and subsequent physical therapy. Baseline Visual Analog Scale (VAS) pain score, active forward flexion, and external rotation range of motion were measured using a goniometer. At 3 months post-procedure, range of motion and pain were reevaluated.

RESULTS

Significant improvements in active forward flexion (median improvement of 25 degrees) and external rotation (median improvement of 19 degrees) were observed at 3 months (p < 0.001). No complications were reported.

CONCLUSION

Combining ultrasound-guided suprascapular nerve block, glenohumeral joint hydrodilatation, and physical therapy is safe, effective, and improves pain, flexion, and external rotation range of motion in patients with adhesive capsulitis.

Additive effect of glenohumeral joint hydrodilatation applied in addition to suprascapular nerve blockage in patients with adhesive capsulitis

BACKGROUND

We aimed to investigate the efficacy of shoulder hydrodilatation (HD) applied in addition to suprascapular nerve blockage (SSNB) on severity of pain, shoulder joint range of motion (ROM), functional status, handgrip (HG) strength in patients with adhesive capsulitis (AC).

METHODS

Forty-eight patients who were diagnosed with AC based on physical examination findings included in the study. The patients were randomized into two groups as combination of SSNB + HD and SSNB alone. Injections were performed under ultrasonography guidance. Shoulder ROM angles were measured with a goniometer. Pain intensity was evaluated with visual analog scale. Functional status was evaluated with Quick Disability of Arm, Shoulder, and Hand (QDASH). HG strength was measured by a Jamar dynometer. After the injection, a home-based exercise program was given to all patients. Patients were evaluated at baseline, 1st and 3rd month.

RESULTS

Abduction and external rotation ROM angles were statistically significantly limited in SSNB group, at baseline (p = 0.020, p = 0.018, respectively). In terms of other parameters, both groups were similar at baseline (p > 0.05). At comparison of baseline-1st month, a significant improvement was observed in VAS score, abduction and flexion ROM and QDASH score, in both groups (p < 0.05), however, there was no statistically significant difference between the groups. There is a statistically significant decrease in VAS score in both groups, at all times, but, no significant difference between the groups. At the comparison of baseline-3rd month measurements, it was observed that all of the parameters significantly improved in both groups, and there was no statistically significant difference between the groups except for abduction and external rotation ROM (p > 0.05). Abduction ROM and external rotation ROM were significantly higher in the SSNB group than SSNB + HD group at 3rd month.

CONCLUSIONS

Both SSNB + HD and SSNB alone provide significant improvement clinically especially in shoulder pain. HD added to SSNB does not seem to provide any additional benefit. SSNB is an effective treatment option for up to 3 months in patients with AC, mainly in abduction and external rotation limitation.

Efficacy of hydrodilatation in frozen shoulder: a systematic review and meta-analysis

INTRODUCTION

It is unclear whether hydrodilatation is beneficial in the management of frozen shoulder compared with other common conservative management modalities. This systematic review evaluates the efficacy of hydrodilatation for the management of frozen shoulder.

SOURCES OF DATA

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An extensive search of PubMed, Embase, Scopus, Cochrane Central, Web of Science and CINAHL databases using multiple keyword combinations of 'shoulder', 'rotator', 'adhesive capsulitis', 'hydrodilatat*', 'distension' since inception of the databases to June 2023 was implemented.

AREAS OF AGREEMENT

Hydrodilatation leads to at least transient more marked improvements in shoulder disability and passive external rotation compared with intra-articular corticosteroid injections.

AREAS OF CONTROVERSY

Hydrodilatation improves passive external rotation in the longer term. Moreover, hydrodilatation may be a preferable option over manipulation under anaesthesia, given its lower cost and better patient convenience.

GROWING POINTS

Intensive mobilization after hydrodilatation is a promising adjuvant treatment option for patients suffering from a frozen shoulder.

AREAS TIMELY FOR DEVELOPING RESEARCH

Although current evidence suggests that hydrodilatation provides a transient improvement in disability in patients with frozen shoulder, its clinical relevance remains unclear. Further research is necessary to establish its role in the management of the condition.

Arthroscopic rotator interval release for frozen shoulder, comparative study between diabetic and non-diabetic patients

INTRODUCTION

The objective of this study is to evaluate the outcomes of arthroscopic rotator interval release for the treatment of frozen shoulder and compare the results in patients with and without diabetes.

METHODS

thirty-two patients with frozen shoulders were divided into two groups; 19 diabetics and 13 non-diabetics. All patients underwent arthroscopic rotator interval release. The VAS and UCLA score were assessed pre-operatively and post-operatively; after 1, 3, and 12 months and compared between groups.

RESULTS

The VAS and UCLA score was significantly improved in both groups during follow-up intervals (p < 0.01). There was no significant difference between diabetic and non-diabetic patients in VAS and UCLA scores during follow-up times (p-values > 0.05).

CONCLUSION

Arthroscopic rotator interval release provides significant improvement of frozen shoulder with no difference in results between diabetic and non-diabetic patients.

LEVEL OF EVIDENCE

Level 2; Prospective Comparative study.