Pericapsular vs Intra-Articular Injection in Adhesive Capsulitis

Istanbul University - Cerrahpasa34 enrolled

Overview

Adhesive capsulitis is a common and disabling shoulder disorder characterized by progressive pain and restricted active and passive range of motion, leading to significant limitations in daily activities and reduced quality of life. Corticosteroid injections are widely used to relieve pain and improve shoulder function; however, the optimal injection site remains a matter of debate. While ultrasound-guided intra-articular injections are considered a standard treatment, ultrasound-guided pericapsular injections have recently emerged as a potential alternative by targeting the inflamed capsular tissues directly. The primary objective of this study is to compare the clinical effectiveness of ultrasound-guided pericapsular corticosteroid injection with ultrasound-guided intra-articular corticosteroid injection in patients diagnosed with adhesive capsulitis. The study aims to determine whether one injection technique provides superior improvements in pain, shoulder range of motion, functional status, and patient-reported outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Adhesive Capsulitis Corticosteroid Injection

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: -Diagnosis of unilateral adhesive capsulitis, characterized by shoulder pain and restriction of both active and passive range of motion. Exclusion Criteria: * Secondary glenohumeral joint motion limitation due to inflammatory, degenerative, metabolic, or infectious arthritis. * History of cerebrovascular accident (stroke). * History of fracture involving the affected shoulder. * Presence of any neurological deficit affecting the upper extremity. * Previous surgery involving the affected shoulder. * History of shoulder trauma. * Pregnancy or breastfeeding. * Known hypersensitivity or allergic reaction to local anesthetics or corticosteroids used in the study. * Current use of anticoagulant therapy. * Active inflammatory or infectious disease. * Active psychiatric disorder. * Uncontrolled hypertension. * Uncontrolled diabetes mellitus. * Uncompensated chronic heart, liver, or renal failure. * Presence of vascular or malignant disease affecting the shoulder region.

Outcomes

Primary Outcomes

Change in Constant-Murley Score

The Constant-Murley Score (CMS) is a validated, clinician-administered instrument used to assess shoulder function. It consists of four domains: pain (15 points), activities of daily living (20 points), range of motion (40 points), and muscle strength (25 points), yielding a total score ranging from 0 to 100. Higher scores indicate better shoulder function and less disability. Changes in the CMS from baseline to each follow-up visit will be used to evaluate treatment effectiveness.

Time frame: Baseline, Week 1, Week 4, and Month 3

Change in Numeric Rating Scale (NRS) pain score

Pain intensity will be assessed using the Numeric Rating Scale (NRS), an 11-point patient-reported scale ranging from 0 to 10, where 0 indicates no pain and 10 represents the worst pain imaginable. Participants will rate their pain at rest, during the night, and during activity. Changes in NRS scores from baseline to each follow-up visit will be used to evaluate the effectiveness of the interventions in reducing pain.

Time frame: Baseline,1-Hour, Week 1, Week 4, and Month 3

Secondary Outcomes

Change in Shoulder Disability Questionnaire (SDQ) score

The Shoulder Disability Questionnaire (SDQ) is a validated patient-reported outcome measure used to assess pain-related functional disability in individuals with shoulder disorders. It consists of 16 items evaluating limitations in daily activities experienced during the previous 24 hours. The total score ranges from 0 to 100, with higher scores indicating greater shoulder-related disability. Changes in SDQ scores from baseline to each follow-up visit will be used to assess the effectiveness of the interventions in improving shoulder function and reducing disability.