Related Experiment Video
Updated: Jan 9, 2026
Author Spotlight: Treating Frozen Shoulder with Small Needle Knife Therapy
Published on: November 17, 2023
Improving accuracy for intra-articular injections for capsulitis of the shoulder by changing the injection technique
Jan M A Mens1, Ronald T M Van Kalmthout2
1Department of Huisartsgeneeskunde, Erasmus University Rotterdam, Rotterdam 3015 GD, Zuid-Holland, Netherlands. info@janmens.nl.
Background:
The accuracy of blind intra-articular injections in the shoulder is rather low. Inaccurate injections tend to lead to poorer treatment outcomes. The "Delaware posterior bone touch technique" has shown higher accuracy in young, slender, healthy volunteers than the classical "Cyriax technique".
Aim:
To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.
Methods:
We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone, lidocaine, and air. After the injection, the shoulder was moved to determine whether a squishing sound could be produced. The squishing sound was interpreted as an accurate injection. The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.
Results:
Squishing was heard after 87% of the injections. This was 13% (10% points) more than the 77% in the previous study (P = 0.004).
Conclusion:
The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis. We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.
