Outcomes of Clinico-radiologically Predetermined Patient-specific Multi-site Steroid Injection in Primary Frozen...

Frozen shoulder (FS) is characterized by pain and progressive restriction of motion, with treatment aimed at pain relief, functional improvement, and shortening disease duration. While conservative management is preferred, the best non-surgical modality remains unclear due to heterogeneity in the literature. The current study is to determine the efficacy of patient-specific multi-site landmark-based steroid injection in combination with a standardized physiotherapy protocol followed at our center in the management of Fss.

In this prospective study, 94 patients with primary FS, confirmed via ultrasound and X-ray, received intra-articular and multisite betamethasone injections (8 mg diluted in 8 mL of 2% lignocaine). A total of 5 mL was injected intra-articularly, while the remaining was divided among the areas of tenderness and inflammation pre-determined clinically or radiologically by ultrasound. Injections were performed by a single shoulder surgeon, followed by an 8-week physiotherapy protocol. Patients were assessed at 2, 4, 8- and 12-weeks using range of motion (ROM), Visual Analog Scale (VAS), American Shoulder and Elbow Scoring system (ASES), and Shoulder Pain and Disability Index scores.

Statistically significant improvements were observed: mean abduction increased from 124° to 173° (P = 0.001), forward flexion from 123° to 174° (P = 0.040), and external rotation from 26° to 55° (P = 0.009). The mean ASES score improved from 28.8 to 92.5 (P = 0.001), VAS decreased from 6.7 to 0.4, and internal rotation improved by 4 vertebral levels.

The results of our study demonstrate that patient-specific multi-site steroid infiltration significantly reduces pain and improves ROM and clinical outcomes in FS patients.