Comparison of Pain Relief and Functional Improvement in Landmark vs Ultrasound-Guided Corticosteroid Injections for Adhesive Capsulitis: A Prospective Study

Abstract

Purpose: Corticosteroid injections are commonly prescribed to treat adhesive capsulitis. It is currently unclear whether an ultrasound-guided injection relieves the symptoms of shoulder pain more effectively than if the injection was delivered landmark-guided or ’blind’, i.e., without imaging. This study aims to address these uncertainties, and we propose conducting a randomized study on patients with adhesive capsulitis to determine if there is a significant difference in pain relief, function, and range of motion between patients treated via landmark-guided and ultrasound-guided corticosteroid injections at 12 weeks after injection. Methods: A total of 23 patients with adhesive capsulitis were randomized to receive either a landmark or ultrasound-guided intra-articular corticosteroid injection. Patients with pain lasting longer than three months duration that is consistent with adhesive capsulitis were eligible to participate. Patients were randomized to receive an intra-articular corticosteroid injection into the affected shoulder via a landmark-guided injection or an injection delivered via ultrasound guidance. Pain, function, and range of motion were assessed at baseline visits and at 6 week and 12 week follow-up appointments. Results: A total of 23 patients were randomized (10 landmark and 13 ultrasound) into the study. There were no significant differences in patient demographics. No significant differences between treatment groups were found in mean VAS pain, SANE function scores, forward flexion or external rotation range of motion measurements at 6 or 12 weeks. The ultrasound group demonstrated statistically significant improvement in shoulder abduction at 6 weeks compared to the landmark group but there were no significant differences in abduction at 12 weeks between the groups. Within each group, there were statistically significant improvements in pain and function at 6 weeks and at 12 weeks compared to baseline. The landmark group demonstrated significant improvement in forward flexion and abduction at 12 weeks compared to baseline. The ultrasound group demonstrated significant improvement in forward flexion, external rotation, and abduction at both 6 and 12 weeks. Conclusions: The preliminary data suggests that patient outcomes for pain, function, and range of motion improve with glenohumeral corticosteroid injection but that modality chosen (ultrasound or landmark guidance) does not impact the efficacy of injection.