Department of Orthopedics, Indian Spinal Injuries Center, New Delhi, India.
Department of Orthopedics, Shree Hariram Hospital and Research Center, Nagaur, Rajasthan.
J Shoulder Elbow Surg. 2024 Dec;33(12):2553-2562. doi: 10.1016/j.jse.2024.06.015. Epub 2024 Aug 3.
Contracture and thickening of the coracohumeral ligament (CHL) occur in patients with adhesive capsulitis. This adversely affects the movement and function of the shoulder joint. There is limited evidence that explores the effectiveness of an isolated steroid injection into the CHL in combination with physical therapy. This prospective randomized control trial aimed to evaluate the clinical effects of ultrasonography-guided corticosteroid injection compared to a sham injection into the CHL in subjects with adhesive capsulitis.
Forty patients (23 males, 52.2 ± 8 years of age) with unilateral adhesive capsulitis (with 5.4 ± 2 months' mean duration of symptoms) were randomly assigned to either the experimental or control group. Both groups received ultrasonography-guided injections into the CHL. The experimental group (n = 20) received corticosteroids and the control group (n = 20) received a sham lidocaine injection. All subjects underwent supervised conventional physical therapy 3 times a week for 3 months. Subjects were evaluated for improvements in pain, range of motion, and disability at 6 and 12 weeks compared with preinjection baseline measurements. Data were compared statistically across groups and times at P < .05. The CHL thickness was compared at baseline across sides using paired t tests.
The experimental group showed statistically greater improvements in pain, functional scores, flexion, abduction, and internal and external rotation range of motion at 12 weeks compared with the control group. Pain reduction was observed in both groups at 6 and 12 weeks, but the experimental group exhibited significantly greater reductions. The CHL was significantly thicker on the affected side than on the unaffected side (P < .001).
This study partially supported the hypothesis. Notably, significant improvements in pain, range of motion, and functional scores were observed at 12 weeks in the experimental group. The greater improvements in pain and external rotation may have resulted in lower disability scores in the experimental group. The results emphasize the importance of targeted intervention into the CHL.
粘连性肩关节囊炎患者的喙肱韧带（CHL）会发生挛缩和增厚，这会对肩关节的活动和功能产生不利影响。目前，仅有有限的证据表明，在物理治疗的基础上，联合 CHL 内单独类固醇注射具有一定的效果。本前瞻性随机对照试验旨在评估超声引导下皮质类固醇注射与 CHL 假注射相比，对粘连性肩关节囊炎患者的临床效果。
40 名（23 名男性，年龄 52.2±8 岁）单侧粘连性肩关节囊炎患者（症状持续时间平均 5.4±2 个月）被随机分为实验组或对照组。两组均接受超声引导下 CHL 注射。实验组（n=20）接受皮质类固醇注射，对照组（n=20）接受假利多卡因注射。所有患者均接受每周 3 次的监督常规物理治疗，共 3 个月。与基线测量相比，在 6 周和 12 周时评估患者的疼痛、活动范围和功能障碍改善情况。使用配对 t 检验比较组间和时间点的 CHL 厚度。P<0.05 时认为数据具有统计学差异。
与对照组相比，实验组在 12 周时的疼痛、功能评分、屈曲、外展、内旋和外旋活动范围的改善均具有统计学意义。两组患者在 6 周和 12 周时均观察到疼痛减轻，但实验组的疼痛减轻更为明显。患侧 CHL 明显比健侧厚（P<0.001）。
本研究部分支持了这一假说。值得注意的是，实验组在 12 周时疼痛、活动范围和功能评分均显著改善。实验组疼痛和外旋活动度的改善可能导致其功能障碍评分降低。结果强调了针对 CHL 进行靶向干预的重要性。
