This randomized controlled clinical trial aims to compare the efficacy of three different intra-articular injection approaches (anterior, posterior, and combined anterior-posterior) in patients with adhesive capsulitis of the shoulder. Thirty participants will be randomly assigned to one of three groups and treated with a standardized injection solution consisting of corticosteroid, lidocaine, and saline. Clinical outcomes will be evaluated using pain scores, functional scales, and imaging parameters.
Adhesive capsulitis (frozen shoulder) is a disabling condition characterized by progressive pain and stiffness of the glenohumeral joint. Intra-articular corticosteroid injections are frequently used to reduce pain and improve mobility; however, the optimal injection approach remains controversial. This single-center randomized controlled trial will investigate three different approaches: posterior, anterior, and combined anterior-posterior injections. The primary endpoint is improvement in active and passive range of motion. Secondary endpoints include pain scores (VAS), functional outcome measures (SPADI, qDASH, ASES, Constant-Murley, Scratch Test, Subjective Shoulder Value), and ultrasound evaluation of axillary capsule thickness. Assessments will be performed at baseline, immediately after injection, and at weeks 3, 6, and 12.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
A single intra-articular injection consisting of 1 cc corticosteroid, 4 cc 2% lidocaine, and 5 cc saline (total 10 cc) administered via the posterior glenohumeral approach.
A single intra-articular injection consisting of 1 cc corticosteroid, 4 cc 2% lidocaine, and 5 cc saline (total 10 cc) administered via the anterior (rotator interval) approach.
A single intra-articular injection consisting of 1 cc corticosteroid, 4 cc 2% lidocaine, and 5 cc saline (total 10 cc) administered using both anterior and posterior approaches during the same procedure.
Change in Shoulder Range of Motion (ROM)
Change in active and passive shoulder joint range of motion (flexion, extension, abduction, external rotation, internal rotation) measured with a goniometer.
Time frame: Baseline, immediately post-injection, week 3, week 6, week 12
Change in Pain Intensity (NRS)
Number Rating Scale (0-10) for pain at rest, during activity, and at night.
Time frame: Baseline, immediately post-injection, week 3, week 6, week 12
Subjective Shoulder Value (SSV)
Patient's self-reported percentage of normal shoulder function (0-100%).
Time frame: Baseline, immediately post-injection, week 3, week 6, week 12
Shoulder Pain and Disability Index (SPADI)
Questionnaire assessing pain and disability (0-100 score, higher scores = worse function).
Time frame: Baseline, week 3, week 6, week 12
Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH)
Questionnaire measuring upper limb disability and symptoms (0-100 score, higher = worse).
Time frame: Baseline, week 3, week 6, week 12
American Shoulder and Elbow Surgeons (ASES) Score
Composite score including pain and function (0-100, higher = better).
Time frame: Baseline, week 3, week 6, week 12
Constant-Murley Shoulder Score
Clinical score combining pain, activities of daily living, strength, and ROM (0-100).
Time frame: Baseline, week 3, week 6, week 12
Scratch Test Score
Functional test measuring the patient's ability to reach behind the back.
Time frame: Baseline, immediately post-injection, week 3, week 6, week 12
Axillary Capsule Thickness (Ultrasound)
Ultrasound measurement of axillary recess capsule thickness on the affected shoulder.
Time frame: Baseline, immediately post-injection (only).
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