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Background: Primary adhesive capsulitis of the shoulder is a common pathology of the glenohumeral joint characterized by shoulder pain and progressive restriction of the range of motion,its treatment options either medication, local injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic and open capsular release 1 .
Subcutaneous prolotherapy injections can reduce vascular endothelial growth factor levels and restore effective repair processes so induce apoptosis of proliferating peptidergic noceffectors and neovessels and inhibit TRPV1 receptors resulting to reduction of pain 2,3 .
Objectives: To assess the effectiveness of perineural injection therapy in management of pain and physical function in Primary adhesive capsulitis of the shoulder.
Methods: One hundred patients with primary adhesive capsulitis in the freezing stage were selected in this study according to the classification of Hannafin and Chiaia and had restriction of passive motion of greater than 30°in 2 or more planes of movement. Patients with previous corticosteroid injection or previous surgery in the affected shoulder, secondary adhesive capsulitis including inflammatory or infectious arthritis,previous fracture, rotator cuff lesions were excluded from this study.
Ptients were randomly devided into two equal groups; Group I received 6 weekly subcutaneous injections of 0.5-1 ml of buffered dextrose 5% in each chronic constriction injury points and tender points at shoulder and along course of suprascapular, supraclavicular, axillary, musculocutanous and radial nerves. Group II received oral NSAIDs and muscle relaxants for 6 weeks. All patients in both groups received the same stretching and exercise therapy during the period of treatment. All procedures were done after informed consent. Assessments were performed at baseline, at the end of the treatment and after three and six months using visual analog scale (VAS) for pain, range of mvement measurements by goniometer, Shoulder Pain and Disability Index (SPADI) & the Western Ontario Rotator Cuff (WORC) Index.
Results: Patients in Group I had more rapid relief of pain and better functional improvement compared with group II (p<0.05). There was significant improvement in both groups (p<0.05) after 3 and 6 months with significant difference between the 2 groups indicated that better results in perineural group. Results were summarized in
| Baseline GI | Baseline GII | After end of treatment GI | After end of treatment GII | After 3ms GI | After 3ms GII | After 6ms GI | After 6ms GII | |
|---|---|---|---|---|---|---|---|---|
| VAS | 8.7±0.9 | 8.4±1.0 | 5.0±1.5 * ¶ | 5.7±1.1 * | 4.4±1.5 * ¶ | 5.1±1.6 * | 3.8±1.2 * ¶ | 4.9±1.3 * |
| SPADI | 80.4±9.8 | 78.9±10.7 | 41.5±10.2 * ¶ | 50.4±8.8 * | 35.8±7.5 * ¶ | 46.6±7.9 * | 32.6±10.2 * ¶ | 44.5±8.7 * |
| WORC | 28.5±10.6 | 26.5±11.5 | 60.4±9.8 * ¶ | 55.9±10.5 * | 67.9±9.7 * ¶ | 57.3±10.3 * | 71.5±12.3 * ¶ | 60.1±9.6 * |
*significant improvement after treatment
¶ significant difference between the two studied groups
Conclusion: Perineural injection therapy is an effective modality in management of pain and physical function of Primary adhesive capsulitis of the shoulder.
REFERENCES:
[1]Franz A, Klose M, Beitzel K. Conservative treatment of frozen shoulder. Unfallchirurg. 2019;122(12):934-940.
[2]Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain. Australasian Musculoskeletal Medicine. 2007; 12(2):110-112
[3]Abu-Zaid MH, Tabra SA, Elmorsy S. FRI0687 Effect of perineural injection therapy in moderate and severe knee osteoarthritis; a comparative study. Annals of the Rheumatic Diseases 2018;77:862-863.
Disclosure of Interests : None declared