Is the graft position critical for functional outcomes following arthroscopy-assisted lower trapezius tendon transfer for posterosuperior irreparable rotator cuff tears? A comparison of anterior vs. posterior position of graft.

BackgroundAlthough arthroscopically assisted lower trapezius tendon transfer (aLTT) is an effective treatment option for posterosuperior irreparable rotator cuff tear (PSIRCT), interpositional grafts should be used because of the length limitations of the LTT. This study compared the radiologic and clinical results of an Achilles tendon allograft (ATA) versus a fascia lata autograft (FLA) as the interpositional graft.MethodsThis study included 64 and 26 patients treated with aLTT using an ATA or FLA, respectively. Clinical outcomes were compared using the visual analog scale score, University of California Los Angeles shoulder score, American Shoulder and Elbow Surgeons score, Constant shoulder score, activities of daily living that require active external rotation score, and range of motion. Arthritic changes of the glenohumeral joint were evaluated by acromiohumeral distance (AHD) and Hamada grade. Extent of arthritis was evaluated by magnetic resonance imaging.ResultsBoth groups showed significant improvement after the surgery in intra-group analysis, and no significant difference in clinical outcomes were observed between the two groups. AHD and Hamada grades were also comparable. The rate of graft retear was higher in the ATA group than in the FLA group, but without statistical significance.ConclusionsaLTT may lead to significant improvement in clinical and radiologic outcomes in PSIRCT, regardless of whether an ATA or FLA is used as the interpositional graft. The retear rate of the interpositional bridging graft was not associated with graft status. However, measures to promote graft healing should be considered.Level of evidenceIII.

To evaluate the clinical outcomes of anterior and posterior instrumentation with different debridement and graft fusion methods for multi-level contiguous thoracic spinal tuberculosis. We retrospectively evaluated 81 patients with multi-level contiguous thoracic spinal tuberculosis who underwent anterior or posterior instrumentation combined with different methods of debridement, decompression, and graft fusion from January 2002 to December 2012. All patients were divided into an anterior instrumentation group and a posterior instrumentation group. In the anterior instrumentation group, there were 39 patients who underwent transthoracic debridement. In the posterior instrumentation group, there were 34 patients who underwent trans-costotransverse decompression and strut grafting with posterior instrumentation, and another 8 patients underwent combined anterior debridement and strut grafting with posterior instrumentation in a single-stage or two-stage procedure. The kyphotic angles were calculated from lateral spinal X-rays using the modified Konstam method. The symptoms and signs of tuberculosis, fusion level, fusion time of the bone graft, average kyphosis angle, average correction, average loss of correction, and clinical complications were recorded. The average follow-up period was 37 months (range, 17-72 months). The cohort consisted of 47 males and 34 females with an average age of 38 years. The mean durations of the operations were 3.5 ± 0.4 h in the anterior group and 4.0 ± 0.3 h in the posterior group ( P < 0.05). The mean blood loss volumes during surgery were 450 ± 42 and 560 ± 51 mL for the anterior group and the posterior group, respectively ( P < 0.01). The kyphotic deformities were corrected from 32.1° ± 10.3° to 10.2° ± 2.1° in the anterior group and from 33.8° ± 11.7° to 12.6° ± 2.7° in the posterior group ( P < 0.01). The neurologic statuses of the 23 patients with preoperative neurologic deficits improved in each group. Fusion was confirmed radiographically at 5.4 ± 1.2 months (range, 4-12 months) in the anterior group and 5.6 ± 1.4 months (range, 4-13 months) in the posterior group ( P > 0.05). Postoperative relapses were noted in 1 and 3 patients in the anterior and the posterior group, respectively. Posterior instrumentation was more effective than anterior instrumentation in the correction of kyphosis and the maintenance of the correction. However, postoperative sinus formation was more frequent in patients who underwent a single-stage posterior procedure.

Background The best surgical approach for management of degenerative cervical myelopathy remains area of debate between spinal surgeons. The purpose of this study compare between anterior approach (anterior cervical discectomy with fusion) and posterior approach (laminectomy with and without fusion) for treatment of multilevel spondylotic myelopathy according to clinical, radiological outcomes, recovery rates and complications. Material and Methods A total of 20 patients were operated by anterior cervical discectomy and fusion (ACDF) and 20 patients were operated by cervical laminectomy with and without fusion in this study. Preoperative and postoperative clinical assessment were done using modified Japanese Orthopedic Association (mJOA) score and Myelopathy scale (MS). Postoperative complications, recovery rate and intraoperative blood loss are recorded. Preoperative and postoperative radiological analysis were done using Cobb angle measurement (C2-7 angle) and canal diameter assessment by measuring the canal through the center of each vertebra and intervertebral discs (C2–C7) on 10 transverse planes on mid-sagittal T2WI image. Results There was significant decrease in pre-operative mJOA scale in posterior approach group; compared to anterior group (P = 0.41). There was highly significant decrease in duration of symptoms in anterior approach group; compared to anterior group (P &amp;lt; 0.01) and significant decrease in pre-operative MS scale in anterior approach group; compared to anterior group (P &amp;lt; 0.05). There is non-significant difference as regards post-operative mJOA scale and MS scale between anterior and posterior group (p &amp;gt; 0.05). Although recovery rate was higher in anterior group than posterior group (49.5 ± 27.2 vs 39.51 ± 11.30), but finally There was no significant difference as regards postoperative recovery, improvement and complications rates (p &amp;gt; 0.05). postoperative canal diameter change was greater in posterior surgery than anterior group (11.1 ± 1.98 vs 9.5 ± 0.76). Reoperation rate was higher in anterior group. Postoperative C5 palsy and axial neck pain were higher in posterior group. Conclusions Both anterior and posterior approaches were successful to treat multilevel CSM, but no definitive surgical approach was proved for management of CSM and each case should be evaluated carefully for determination of best surgical approach according to preoperative Cobb angle and canal diameter.

Objective: To compare the outcomes between anterior cervical discectomy and fusion (ACDF) and posterior laminectomy and fusion(LF) for multilevel cervical spondylotic myelopathy combined with cervical kyphosis. Methods: From January 2010 to June 2014, 54 patients with cervical spondylotic myelopathy combined with cervical kyphosis underwent surgical treatment.Among them, 29 patients were underwent ACDF, and 25 patients were underwent LF in Department of spine surgery, Tianjin Union Medical Centre. The operation time, intraoperative blood loss, fusion segments, Japanese Orthopaedic Association (JOA)score, Neck Disability Index (NDI), Visual Analog Scale (VAS), change of cervical curvature, range of motion(ROM)and complications were recorded and compared between the two groups. Results: Mean operative time was (162.7±21.3)min in the anterior approach group versus (176.3±29.8)min in the posterior group(P>0.05). Mean intraoperative blood loss was (135.6±27.8)ml in the anterior approach group and (255.2±32.3)ml in the posterior approach group(P<0.05). Mean fusion levels are (4.1±0.3)in the anterior approach group and (5.3±0.5) in the posterior approach group(P<0.05). The mean preoperative JOA score were(8.3±2.7)in the anterior approach group and( 8.9±2.1) in the posterior approach group (P>0.05). Mean postoperative JOA score were(13.6±2.5) in the anterior approach group and (14.0±1.7)in the posterior approach group at final follow-up(P>0.05). Mean improvement rate was (55.7%±16.3%)in the anterior approach group and (58.3%±15.7%) in the posterior approach group (P>0.05). Mean preoperative NDI score were(33.8±11.0)in the anterior approach group and (34.4±8.7)in the posterior approach group (P>0.05). Mean postoperative NDI score were (16.9±7.5) in the anterior approach group and (15.5±8.1) in the posterior approach group at final follow-up (P>0.05). Mean VAS score were (2.9±1.5) in the anterior approach group and (2.5±1.0) in the posterior approach group before operation(P>0.05), they are improved to (1.2±1.2) and (1.2±1.3), respectively(P>0.05). Mean Cobb angle of the operative site were (-24.3±4.4)°in the anterior approach group and (-22.7±3.7)° in the posterior approach group before operation(P>0.05). At final follow-up, the Cobb angle of the operative site were (13.7±3.2)°in the anterior approach group and (6.2±4.2)° in the posterior approach group(P<0.01). Mean preoperative ROM were (29.0±6.7)°and (30.4±5.4)° in the anterior approach group and posterior approach group, respectively(P>0.05). Mean postoperative ROM were (11.7±6.5)° and (8.2±5.9)°in the anterior approach group and the posterior approach group, respectively(P<0.05). There were 16 patients with complications in the anterior approach group and 7 patients with complications in the posterior approach group(P<0.05). Conclusion: For multilevel cervical spondylotic myelopathy combined with cervical kyphosis, ACDF can restore the lordosis better, fuse less levels but have more complications compared with LF. Patients treated with LF can get as good life quality as with ACDF and have less complications although fuse more levels compared with ACDF.

This study aimed to evaluate the clinical and radiologic outcomes of arthroscopy-assisted Latissimus dorsi tendon transfer (LDT) combined with middle trapezius tendon transfer (MTT) in posterosuperior irreparable rotator cuff tears (PSIRCTs) patients without arthritic changes. This retrospective case series reviewed the 15 PSIRCTs patients who underwent arthroscopy-assisted LDT combined with MTT from January to December 2020. Clinical outcomes were evaluated using the visual analog scale (VAS) score, patient-reported outcome measurements (PROMs) including Constant-Murley, American Shoulder and Elbow Surgeons (ASES), University of California Los Angeles (UCLA), and single assessment numeric evaluation (SANE) shoulder score, active range of motion (aROM) and aROM strength. The progression of arthritic changes was assessed using acromiohumeral distance (AHD) and Hamada grade. The integrity of transferred tendon was evaluated using magnetic resonance imaging. Significant improvements were observed in VAS score and PROMs including Constant-Murley, ASES, UCLA, and SANE shoulder score between preoperative and postoperative periods. Significant improvement was also noted in aROM including forward elevation, abduction, and external rotation. Moreover, the strength of forward elevation, abduction strength, and external rotation were significantly improved postoperatively. There was no significant change between the preoperative and postoperative AHD and Hamada grade. However, osteoarthritic changes were found in two patients. One patient was presented with latissimus dorsi tendon retear, and one patient had middle trapezius tendon retear. As a dual transfer, arthroscopy-assisted LDT combined with MTT could be a good treatment option in PSIRCTs patients without arthritic changes due to the complete restoration of glenohumeral joint kinematics. Level IV.

This was a prospective study of two cohort groups of patients (one group receiving anterior instrumentation and the other posterior instrumentation) receiving treatment for thoracic idiopathic scoliosis. To present the 2-year postoperative results of a prospective multicenter study comparing the use of anterior instrumentation with that of posterior multisegmented hook instrumentation for the correction of adolescent thoracic idiopathic scoliosis. Despite reports of satisfactory results, problems have been reported with posterior systems, including worsening of the lumbar curve after surgery and failure to correct hypokyphosis. Theoretically, the advantages of anterior instrumentation include prevention of lumbar curve decompensation by shortening the convexity of the thoracic curve. In addition, by removing the disc, better correction of thoracic hypokyphosis could be obtained. Seventy-eight patients who underwent an anterior spinal fusion using flexible threaded rods and nuts (Harms-MOSS instrumentation, De Puy-Motech-Acromed, Cleveland, OH) were analyzed and compared with 100 patients who underwent posterior spinal fusion with multisegmented hook systems. Parameters of comparison included coronal and sagittal correction, balance, distal lumbar fusion levels, and complication. All patients had idiopathic thoracic curves of King Types II to V. The average age at surgery was 14 years in each group, the average preoperative curve 57 degrees, and the minimum duration of follow-up for all patients 24 months. All data were collected prospectively and analyzed via Epl into statistical analysis (Centers of Disease Control, Atlanta, GA). Average coronal correction of the main thoracic curve was 58% in the anterior group and 59% in the posterior group (P = 0.92). Analysis of sagittal contour showed that the posterior systems failed to correct a preoperative hypokyphosis (sagittal T5 to T12 less than 20 degrees) in 60% of cases, whereas 81% were normal postoperatively in the anterior group. However, hyperkyphosis (sagittal T5 to T12 greater than 40 degrees) occurred after surgery in 40% of the anterior group when the preoperative kyphosis was greater than 20 degrees. Postoperative coronal balance was equal in both groups. An average of 2.5 (range, 0-6) distal fusion levels were saved using the anterior spinal instrumentation according to the criteria used for determining posterior fusion levels in this study. Selective fusion of the thoracic curve (distal fusion level T11, T12, L1) was performed in 76 of 78 patients (97%) in the anterior group as compared with only 18 of 100 (18%) in the posterior group. Surgically confirmed pseudarthrosis occurred in 4 of 78 patients (5%) in the anterior group and in 1 of 100 patients (1%) in the posterior group (P = 0.10). Loss of correction greater than 10 degrees occurred in 18 of 78 patients (23%) in the anterior group and in 12 of 100 patients (12%) in the posterior group (P = 0.01). Implant breakage occurred in 24 patients (31%) of the anterior group and in only 1 patient (1%) of the posterior group. 1) Coronal correction and balance were equal in both the anterior and posterior groups, even though the anterior group had the majority of curves (97%) fused short or to L1, whereas only 18% were fused short or to L1 in the posterior group. 2) In the anterior group there was a better correction of sagittal profile in those with a preoperative hypokyphosis less than 20 degrees. However, hyperkyphosis (with a mean of 54 degrees) occurred in 40% of those in the anterior group with a preoperative kyphosis of more than 20 degrees. 3) An average of 2.5 lumbar levels can be saved with anterior fusion and instrumentation according to the criteria used for choosing posterior fusion levels in this study. 4) Using the 3.2-mm flexible rod in this study, loss of correction, pseudarthrosis, and rod breakage were unacceptably highe

To compare the quality of anaesthesia and complication rates between three sub-Tenon cannula of increasing length (anterior Greenbaum, mid Kumar-Dodds, and posterior Steven's sub-Tenon's cannulae). A total of 150 patients undergoing cataract extraction were randomised to receive a sub-Tenon injection of 5 ml of 2% lidocaine with hyaluronidase with one of the three cannulae. The development of akinesia was assessed every 2 min over a 6-min period. Complications were also recorded. There was no difference in the onset of akinesia, with 46, 50, and 46 patients achieving adequate akinesia within 6 min for the anterior, mid, and posterior groups respectively (P>0.05). There was an increase in retained lid opening with anterior compared to mid and posterior cannulae (P=0.0001). There was significantly less retained lid closure with the posterior compared to the mid or anterior cannulae (P<00001). The mean (range, SD) scores for pain during injection were 0.4 (0-5, 0.83), 1.2 (0-9, 1.96), and 1.1 (0-6, 1.19) for the anterior, mid, and posterior groups, respectively. These were not significantly different between the anterior and mid groups, or the mid and posterior groups (P>0.05), but there was significantly more pain on injection with the posterior compared to the anterior groups (P<0.01). All patients scored intraoperative pain as zero. There was significantly more chemosis in the anterior group (76%) compared to the mid (20%) and posterior (32%) groups (P<0.0001). There were significantly (P=0.0004) more conjunctival haemorrhages in the anterior group (56%) than the mid (20%) or posterior (20%) groups. We have shown that all three cannulae provide high-quality anaesthesia with minor differences in retained muscle activity, chemosis, and haemorrhage rates.

Background Cervical myelopathy is a dysfunction of the spinal cord. It is often caused by a narrowing of the cervical spinal canal. Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly. Ossification of the posterior longitudinal ligament (OPLL) is a rare but potentially devastating cause of degenerative cervical myelopathy (DCM). The pathogenesis of OPLL is poorly understood. Some have suggested it as a variant of diffuse idiopathic skeletal hyperostosis (DISH). Purpose The purpose of the study is to perform a systematic review and meta-analysis to evaluate the Clinical results of anterior and posterior approaches for the treatment of cervical compressive myelopathy Due to cervical ossification of the posterior longitudinal ligament (OPLL). Methods Randomized clinical trials, prospective cohort, retrospective observational cohort, and case-control Studies that compare the surgical outcome of an anterior versus a posterior approach for cervical myelopathy due to OPLL from January 2006 to October 2021. Databases (PubMed, EMBASE, Cochrane library). A total of 12 studies (1070patients) were included in this systematic review and meta-analysis. Results indicated that no statistically significant differences between the anterior group and posterior group in terms of preoperative mJOA score [P = 0.23, SMD = 0.9; heterogeneity: (P = 0.85); I2 = 18%, while the postoperative JOA score was significantly higher in the anterior surgery group compared with the posterior surgery group [P 0.004, SMD = 0.67; heterogeneity: P &amp;lt; 0.001; I2 = 82%. The recovery rate was significantly higher in the anterior surgery group compared with the posterior surgery group of patients with canal-occupying ratio &amp;lt; 50%- ≥ 60% [P &amp;lt; 0.01, SMD = 0, 43; heterogeneity: (P &amp;lt; 0.57); I 2 = 91%]. The overall recovery rate (regardless the canal occupying ratio) was significantly higher in the anterior surgery group compared with the posterior surgery group [P &amp;lt; 0.01 SMD = 0.84. It also revealed that the postoperative complication rate [P &amp;lt; 0.01 OR = 1.88, operation time [P &amp;lt; 0.01 SMD = 1.52, intra operative blood loss [P = 0.04 SMD = 0.74 are higher in the anterior group. Conclusion Based on the results of this meta-analysis, anterior approach surgery was associated with better overall (Regardless of the canal-occupying ratio) postoperative neural function than posterior approach in the treatment of cervical compressive myelopathy due to OPLL. We thought anterior approach especially preferable to patients with canal-occupying ratio &amp;gt; 50%-60%, although it leads to a higher surgical trauma and incidence of surgery- related complications. Posterior approach surgery was relatively safer with lower surgical trauma and incidence of complications. We also suggest posterior approach for patients with canal-occupying ratio &amp;lt; 50%-60%.

Mid-term outcomes of arthroscopically assisted lower trapezius tendon transfer using Achilles allograft in treatment of posterior-superior irreparable rotator cuff tear

Endovascular treatment (EVT) for intracranial atherosclerotic disease (ICAD)-related acute large vessel occlusion (LVO) has not been established in patients with posterior circulation occlusion. This study aimed to investigate the disparities in clinical outcomes after EVT between anterior and posterior circulation ICAD-related LVO. Using nationwide data from the retrospective multicenter registry, we conducted a post hoc analysis of 451 patients with acute ischemic stroke and ICAD-related LVO. Patients were categorized into the anterior (occlusion of the internal carotid artery or M1 or M2 segment of the middle cerebral artery) and posterior (occlusion of the basilar or intracranial vertebral arteries) groups. The primary outcome was a modified Rankin Scale score of 0 to 2 at 90 days. The posterior group exhibited a higher proportion of male patients, National Institute of Health Stroke Scale score, and prevalence of diabetes and hyperlipidemia. Although the onset-to-door and door-to-puncture times were comparable, the procedure time was significantly longer in the posterior group than in the anterior group (59 [33-99] vs 46 [29-72], P = .009). The use of stent retrievers was less frequent, and balloon angioplasty was more common in the posterior group. Adjusted analyses revealed that the posterior group had lower odds of achieving an modified Rankin Scale score of 0 to 2 at 90 days (adjusted odds ratio: 0.54, 95% CI: 0.31-0.95, P = .03) and a higher mortality rate (adjusted hazard ratio: 2.97, 95% CI: 1.27-6.95, P = .01) than the anterior group. Poorer clinical outcomes were associated with EVT for ICAD-related LVO in the posterior circulation. These findings emphasize the need to optimize treatment strategies for this patient population to improve overall prognosis.

Previous studies have demonstrated that Lenke lumbar modifier A contains 2 distinct types (AR and AL), and the AR curve pattern is likely to develop adding-on (i.e., a progressive increase in the number of vertebrae included within the primary curve distally after posterior surgery). However, the results of anterior surgery are unknown. The purpose of this study was to present the surgical results in a cohort of patients undergoing scoliosis treatment for type 1AR curves and to compare anterior and posterior surgeries to consider the ideal indications and advantages of anterior surgery for type 1AR curves. Patients with a Lenke type 1 or 2 and lumbar modifier AR (L4 vertebral tilt to the right) and a minimum 2-year postoperative follow-up were included. The incidence of adding-on and radiographic data were compared between the anterior and posterior surgery groups. The numbers of levels between the end, stable, neutral, and last touching vertebra to the lower instrumented vertebra (LIV) were also evaluated. Forty-four patients with a mean follow-up of 57 months were included. There were 14 patients in the anterior group and 30 patients in the posterior group. The main thoracic Cobb angle was not significantly different between the groups preoperatively and at final follow-up. At final follow-up, the anterior group had significantly less tilting of the LIV than the posterior group (-0.8° ± 4.5° vs 3° ± 4°). Distal adding-on was observed in no patient in the anterior group and in 6 patients in the posterior group at final follow-up (p = 0.025). In the anterior group, no LIV was set below the end vertebra, and all LIVs were set above last touching vertebra. The LIV was significantly more proximal in the anterior group than in the posterior surgery patients without adding-on for all reference vertebrae (p < 0.001). This is the first study to investigate the surgical results of anterior surgery for Lenke type 1AR curve patterns, and it showed that anterior surgery for the curves could minimize the distal extent of the instrumented fusion without adding-on. This would leave more mobile disc space below the fusion.

BackgroundThe coracoid process plays an important role in maintaining the stability of the elbow joint. A fracture of the coronoid process is often treated via surgical approaches, including open reduction and internal fixation, which aim to regain a stable, flexible, and loadable joint. In this study, we compared the anterior, medial, and posterior approaches of internal fixation in the repair of fractures of the coronoid process of the ulna.MethodsIn this retrospective study, 147 patients with fractures in the coronoid process of the ulna were recruited and classified into the anterior group (n = 73), the medial group (n = 32), and the posterior group (n = 42) according to the surgical approach used for internal fixation. These patients were assessed with respect to incision, operative time, estimated blood loss, fracture healing, and postoperative complications. The Mayo Elbow Performance Score was used to evaluate any form of disability associated with elbow injuries. Multivariate logistic regression analysis was performed to investigate the factors influencing the efficacy of fractures of the coronoid process of the ulna.ResultsIn the medial approach group, the operative time was longer, and perioperative blood loss and postoperative drainage volume were obviously increased compared with the anterior and posterior groups. The anterior group exhibited a better postoperative recovery compared with the medial, and posterior groups. Compared with the anterior group, fracture-healing time in the posterior group was further reduced, whereas elbow joint flexion extension and forearm rotation degree improved. Complications were significantly reduced in the posterior approach group compared with the anterior and medial groups. The factors influencing the efficacy of fractures of the coronoid process of the ulna included the Regan–Morrey classification, perioperative blood loss, and the internal fixation approach.ConclusionIn summary, the approach used influences fracture healing or the outcome after osteosynthesis. The posterior internal fixation method produced satisfactory functional outcomes in patients with fractures of the coronoid process of the ulna.

Latissimus dorsi transfer vs. lower trapezius transfer for posterosuperior irreparable rotator cuff tears.

Study DesignRetrospective comparative study.ObjectivesOptimal surgical treatment for low-grade L5-S1 isthmic spondylolisthesis (IS) is still subject of debate. While various surgical approaches exist, anchored stand-alone (SA) ALIF has emerged as a promising alternative technique. This study aimed to compare the efficacy, as well as the clinical and radiological outcomes of anchored SA-ALIF and posterior lumbar interbody fusion in the management of low-grade L5-S1 IS.MethodsA total of 53 patients, 26 from the anterior group and 27 from the posterior group, met the inclusion criteria. Intraoperative blood loss, operative time, radiation exposure and postoperative length of hospitalization were retrospectively evaluated. Clinical outcomes were assessed using the ODI and VAS scales. Upright lumbosacral X-ray and lumbosacral CT scan were used to evaluate spinopelvic parameters and intersomatic fusion according to Brantigan-Steffee-Fraser (BSF) scale, respectively.ResultsThe mean postoperative follow-up was 39 months. Intraoperative blood loss, radiation exposure, operative time, and postoperative length of hospitalization were significantly lower in the anterior group. Effective ODI and VAS improvement was achieved in both anterior and posterior groups. No significant differences were observed between the two groups in postoperative spinopelvic parameters assessment. Effective spinal fusion was achieved in 23 patients (88.4%) in the anterior group, and in 21 patients (77.8%) in the posterior group.ConclusionWhile both techniques effectively achieve spinal fusion and symptom relief, anchored SA-ALIF offers significant advantages over posterior fusion techniques in terms of intraoperative blood loss, radiation exposure, operative time, and postoperative length of hospitalization.

Corticosteroid injection is a common treatment for primary frozen shoulder, but controversy remains regarding whether different injection approaches to the glenohumeral joint have similar clinical benefits. Randomized controlled clinical trial. A total of 60 patients with primary frozen shoulder were divided randomly into either anterior or posterior approach groups. Both groups received a 5-mL drug injection, including 1 mL 40 mg/mL triamcinolone acetonide and 4 mL 2% lidocaine. Follow-up time-points were 4, 8 and 12 weeks post-injection. Outcome measures included visual analogue scale score, Constant-Murley score, and passive range of motion of the shoulder joint. All outcome measures improved over the follow-up period compared with those of previous follow-up time-points within the groups. The primary finding was that the visual analogue scale score in the anterior group was better than that in the posterior group at each follow-up time-point (all p < 0.05). In addition, improvement in function score and external rotation was faster and significant in the anterior group in the early stages (p = 0.02). The anterior approach achieves more satisfactory results in pain control and offers better recovery of functional activity than posterior approach in the early period for primary frozen shoulder.