Comparison of the analgesic efficacy of intra-articular steroid injections and its combination with suprascapular nerve block for adhesive capsulitis of the shoulder joint: a randomized clinical trial

Yaal Elango; Adinarayanan S; Srinivasan Swaminathan; Kirthiha Govindaraj; Sandeep Nema; Navin Kumar

doi:10.1136/rapm-2024-105902

Comparison of the analgesic efficacy of intra-articular steroid injections and its combination with suprascapular nerve block for adhesive capsulitis of the shoulder joint: a randomized clinical trial

Reg Anesth Pain Med. 2024 Dec 20:rapm-2024-105902. doi: 10.1136/rapm-2024-105902. Online ahead of print.

Authors

Yaal Elango¹, Adinarayanan S¹, Srinivasan Swaminathan¹, Kirthiha Govindaraj², Sandeep Nema³, Navin Kumar⁴

Affiliations

¹ Anaesthesiology and Critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
² Anesthesiology, All India Institute of Medical Sciences Madurai, Madurai, India drkirthiharaj@gmail.com.
³ Orthopedics, AIIMS Raipur, Raipur, Chhattisgarh, India.
⁴ Physical Medicine and Rehabilitation, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

PMID: 39709187
DOI: 10.1136/rapm-2024-105902

Abstract

Background: Adhesive capsulitis is a distressing ailment that progressively limits the active and passive mobility of the shoulder joint. Physical therapy (PT) combined with intra-articular steroid (IAS) injection and suprascapular nerve block (SSNB) has shown improved functional outcomes. We aimed to assess whether providing both IAS injection and SSNB improved outcomes compared with IAS injection alone.

Methods: Ninety-six patients with adhesive capsulitis were randomized into three groups consisting of group IAS, group IAS+SSNB and group PT (control). All patients were assessed on day 0, week 2, 6 and 12 postintervention. The primary outcome was an improvement in Shoulder Pain and Disability Index (SPADI) scores at week 12 postintervention. Secondary outcomes were Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, Constant-Murley Range of Motion (ROM) scores, Quality of life (QoL) and Medication Quantification Scale (MQS) 3.

Results: On combining IAS and SSNB, we found a statistically significant improvement in SPADI scores over IAS only at week 2 postintervention (33.6±8.0 vs 38.3±8.9, p=0.04) but not beyond. A significant reduction in SPADI, VAS and QuickDASH scores, along with an improvement in Constant-Murley ROM scores, was observed on day 0 and at weeks 2, 6 and 12 in both group IAS and group IAS+SSNB (p<0.05). MQS 3 scores significantly decreased up to week 6 in both groups. However, the addition of SSNB to IAS did not demonstrate a clinically significant difference in the study outcomes, except for a notable decrease in VAS in the immediate postintervention period. Additionally, no significant changes in QoL were observed among the groups (p>0.05).

Conclusion: Both IAS and IAS+SSNB improved analgesia, reduced disability and enhanced ROM. However, adding SSNB to IAS did not yield a clinically meaningful benefit in the study outcomes.Trial registration number TRIAL REGISTRATION NUMBER: CTRI/2022/08/044519.

Keywords: Nerve Block; Pain Management; Physical and Rehabilitation Medicine; Ultrasonography.