Shoulder distension during arthrography with intraarticular corticosteroid injection versus suprascapular nerve block in treatment of frozen shoulder

ABSTRACT

To evaluate and compare the effectiveness of therapeutic shoulder distension during arthrography with intraarticular steroid injection and suprascapular nerve block [SSNB], to relieve pain and improve the range of movement [ROM] of the shoulder joint, in patients with frozen shoulder. Forty patients presenting with idiopathic frozen shoulder, as proved after full history taking and thorough clinical examination, were randomly classified into two groups [20 each]. The first group was treated with therapeutic shoulder distension during arthrography with intraarticular steroid injection, while the second group was treated with suprascapular nerve block. All patients were subjected to the same therapeutic exercises program for 4 weeks. The patients were evaluated at baseline, 1week, 4 weeks and 12 weeks, to assess the degree of improvement. Parameters of evaluation were pain intensity [rest and movement pain], tenderness severity, ROM [active and passive] of shoulder joint and subjective evaluation of improvement. In both groups, there was a highly significant [p<0.001] improvement of pain and tenderness as compared with baseline, which was maintained up to 12 weeks. SSNB produced a higher significant [p<0.05] improvement in rest pain, movement pain and tenderness at week 1, as compared to distension during arthrography. The percentage of patients using analgesics and the number of analgesic use per day decreased significantly [p <0.05] in both groups. Also, SSNB had a more significant decrease [p <0.05] of analgesic usage at week 1, compared to distension during arthrography. Regarding ROM, most planes of shoulder movements [active and passive], improved significantly [p<0.001] in both groups compared to baseline, which was maintained up to 12 weeks. There was no significant difference between the 2 groups except for the improvement of passive abduction at weeks 4 and 12, passive external rotation and passive flexion at week 12, the improvement of these movements was significantly higher [p<0.05] in patients treated with therapeutic distension during arthrography. As for subjective evaluation, there was no significant difference between the two groups. In group I, the percentages of patients who were satisfied or improved, were 70%, 85% and 82% at weeks 1, 4 and 12 respectively. In group II these percentages were 75%, 80% and 69% respectively. No significant adverse effects of both treatments were recorded. Therapeutic shoulder distension during arthrography with steroid injection and suprascapular nerve block are safe, effective and reliable methods in the treatment of idiopathic frozen shoulder. Also, suprascapular nerve block produces more pain relief especially early after treatment while therapeutic shoulder distension during arthrography gives more improvement in ROM in long term. So combination of both methods could be recommended to get advantages of each modality