Comparing the accuracy and efficacy of ultrasound-guided versus blind injections of steroid in the glenohumeral joint in patients with shoulder adhesive capsulitis.

Abstract

Shoulder adhesive capsulitis is a condition mainly characterized by a decreased range of motion (ROM), with a lifelong prevalence of 2-5%. Intra-articular steroid injection is an important treatment in this disease. It has been suggested that ultrasound-guided (US-guided) intra-articular injections are more accurate and effective than blind injections. This randomized clinical trial was designed to compare efficacy and accuracy of US-guided injections versus blind injections of steroid in the glenohumeral joint. Forty-one patients diagnosed with shoulder adhesive capsulitis were included. Patients randomly underwent intra-articular injection either blind or under guidance of ultrasound by a specialist. Immediately after injection, radiograms were obtained to assess the accuracy of injection. Demographic characteristics, their functional status, the severity of pain, and the ROM were gathered and compared between the two groups. Twenty patients in the US-guided group and 21 in the blind group finished the 4-week period of the study. Improvements in pain, ROM, and functional score after 1 and 4weeks were more prominent in the US-guided group, but the differences were not statistically significant, except for the changes in extension where the improvements were significantly higher in the US-guided group (p=0.01). The accuracy of injections was also higher in the US-guided group (90% vs. 76.19%), but the differences were not found to be significant (p=0.24). US-guided injections can be more accurate and yield better improvements in pain, ROM, and function of the patients, but they cost more and are time-consuming.