Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea.
Department of Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Pain Physician. 2022 May;25(3):313-321.
Intraarticular (IA) corticosteroid injection is commonly performed in patients with primary frozen shoulder (PFS). However, the best administration site remains controversial.
To compare the efficacy of rotator interval (RI) vs posterior capsule (PC) approach for ultrasound-guided corticosteroid injections into the glenohumeral joint of patients with PFS.
A randomized, exploratory, prospective study.
A single fellowship training institution in Daegu, Republic of Korea.
This study was approved by the Institutional Review Board (2019-04-047-001). Ninety patients with PFS were randomly assigned to either RI approach (RI group, n = 43) or PC approach (PC group, n = 45) for ultrasound-guided IA corticosteroid injection. Fluoroscopic images to assess the accuracy of the injection were obtained immediately after injection by a shoulder specialist. Visual Analog Scale for pain, the American Shoulder and Elbow Surgeons score, the subjective shoulder value, and range of motion (ROM) were used to assess clinical outcomes for all patients at the time of presentation, and at 3, 6, and 12 weeks after injection.
The accuracy of injection was 76.7% (33/43) and 93.3% (42/45) in the RI and PC groups, respectively; the between-group difference was statistically significant (P = .028). Significant improvements were observed in both groups in terms of all clinical scores and ROMs throughout follow-up until 12 weeks after the injection (all P < .001). At 12 weeks, better improvements in forward flexion and abduction (P = .049 and .044) were observed in the RI group than in the PC group. No adverse effect related to injection was observed in either group.
This study had no control group receiving placebo injections and limited follow-up time.
Both groups showed significant pain reduction and functional improvement until 12 weeks after injection. Although no significant differences were observed in pain and functional scores between the 2 groups, the RI group showed better improvement of ROM than the PC group. These results indicate that the RI and anterior structures are a major site in the pathogenesis and treatment target of PFS.
关节内（IA）皮质类固醇注射常用于原发性冻结肩（PFS）患者。然而，最佳给药部位仍存在争议。
比较超声引导下 PFS 患者肩胛下肌间隙（RI）与后囊（PC）入路行关节内糖皮质激素注射的疗效。
一项随机、探索性、前瞻性研究。
韩国大邱的一个单一研究员培训机构。
本研究经机构审查委员会批准（2019-04-047-001）。90 例 PFS 患者随机分为 RI 入路（RI 组，n = 43）或 PC 入路（PC 组，n = 45）行超声引导下 IA 皮质类固醇注射。肩关节专家在注射后立即获得评估注射准确性的荧光透视图像。所有患者在就诊时、注射后 3、6 和 12 周时使用视觉模拟量表（VAS）评估疼痛、美国肩肘外科评分（ASES）、主观肩部值和活动范围（ROM）来评估临床结果。
RI 组和 PC 组的注射准确率分别为 76.7%（33/43）和 93.3%（42/45）；组间差异有统计学意义（P =.028）。两组患者在整个随访过程中（直至注射后 12 周）的所有临床评分和 ROM 均有显著改善（均 P <.001）。在 12 周时，RI 组在前屈和外展方面的改善优于 PC 组（P =.049 和.044）。两组均未观察到与注射相关的不良反应。
本研究无接受安慰剂注射的对照组且随访时间有限。
两组患者在注射后 12 周内疼痛均明显减轻，功能明显改善。虽然两组间疼痛和功能评分无显著差异，但 RI 组的 ROM 改善优于 PC 组。这些结果表明，RI 和前结构是 PFS 发病机制和治疗靶点的主要部位。
