Clinical Outcomes of Clinico-radiologically Predetermined Patient Specific Multi-site Steroid Injection in Primary Frozen Shoulder: A Prospective Case Series.

Introduction: Frozen shoulder (FS) is characterized by shoulder pain and progressive restriction of the range of motion, for which treatment is aimed at pain relief, improving shoulder function and shortening the course of the condition. Consensus does indeed lean significantly toward conservative management, but choosing the best non-surgical modality can be overwhelming with regards to the myriads of options available and the lack of homogeneity in the literature, which precludes comparability. This led us to design the present case series. Clinico-radiologically predetermined intra-articular and landmark-based multisite betamethasone injection technique yields satisfactory pain relief and improves range of motion (ROM) and clinical outcomes in FS. Materials and Methods: Patients clinically diagnosed as having primary FS, confirmed by an ultrasound and X-ray of the affected shoulder, were included in the study over a span of 3 years (n - 94). During clinical examination, joint line and bursae were palpated for tenderness. The steroid preparation consisted of 8 mg of betamethasone (4 mg/mL vial) diluted with 8 mL of 2% plain lignocaine. 5 mL of this steroid preparation was injected intra-articularly and the remaining divided among the areas of tenderness and inflammation pre-determined clinically or radiologically by ultrasound. The injections were administered by a single shoulder surgeon, after which physiotherapy was performed for 8 weeks. Follow-up was done at 2, 4, and 8 weeks, during which ROM, Visual Analog Scale (VAS), American Shoulder and Elbow Scoring System (ASES) and Shoulder Pain and Disability Index (SPADI) were evaluated. Results: Statistically significant differences in pre-injection and post-injection values for the following parameters were noted: Mean abduction, forward flexion and external rotation improved from 124 to 167 degrees (P = 0.001), from 123 to 169 degrees (P = 0.040) and from 26 to 50 degrees (P = 0.009), respectively. The mean ASES score improved from 28.8 to 88.9 (P = 0.001), the mean VAS score decreased from 6.7 to 0.7, while the mean internal rotation improved by 3.5 vertebral levels during the same timelines. Conclusion: The results of our study demonstrate that intra-articular combined with clinico-radiologically predetermined patient-specific landmark-based multisite steroid infiltration using betamethasone leads to a remarkable reduction in pain as well as significant improvement in ROM and clinical outcomes in FS.