Title: Clinical and Functional outcome of Ultrasound guided versus Landmark guided Corticosteroid injections in adults with Frozen shoulder - A Randomised Control Trial

Abstract

Introduction: Frozen shoulder presents with painful and progressive loss of both active and passive ROM of shoulder joint which can be very debilitating for the patient. Intra-articular corticosteroid injections are an established treatment method in the early stages of frozen shoulder, as it reduces synovitis, limits the development of capsular fibrosis and alters the natural history of the disease.It can be given either by landmark guided or using ultrasonography guidance. Current literature has not confirmed the superiority of one technique over the other. This study was undertaken to compare the functional and clinical outcome of these two techniques of corticosteroid injection in the management of frozen shoulder.

Materials and Methods:This study included patients attending the Orthopaedics out patients clinic who were clinically diagnosed to have primary frozen shoulder- Stage I&II and Patients were divided into two groups using block randomization, one group received landmark guided steroid injection and the other group received ultrasound guided steroid injection.The patients were reviewed at 2nd week, 1 month, 3 months and 6 months postintraarticular injection and at each follow up they were evaluated using VAS score and the Constant and Murley(CM) score to assess pain and functional outcome respectively.

Results: 40 patients were included in the study, 20 in each group. CM score at 4 weeks was 89.9±7.74 and 95.6±2.72 in the landmark guidedand ultra sound guided group respectively and this difference was significant (p = 0.004).VAS score at 4 weeks was 2.1±1.08 and 1.2±0.41 in the landmark guided andultra sound guided group respectively which was significant (p< 0.001). 6 months post procedure mean VAS was 1.4±2.62 and 0.8±1.79 landmark and USG group which was not significant. Likewise the mean CM score in landmark and USG groups at 6 months was 93.2±14.13 and 95.6±10.65 respectively which was not significant.

Conclusion:Quicker pain relief and functional improvement was found in US-guided technique in the initial stage post-injection, with no significant difference between the two groups in the long term.