Does the Injection Environment of Intra-Articular and Radiofrequency Procedures Affect Treatment Response in Patients with Frozen Shoulder? A Retrospective Study

Öz

Aim: This study aims to investigate the effects of intra-articular injection and suprascapular nerve pulsed radiofrequency (PRF) procedures on clinical, psychological, and functional outcomes in patients with frozen shoulder based on the treatment setting (operating room vs. outpatient clinic). Materials and Methods: Data from 40 patients diagnosed with frozen shoulder were retrospectively reviewed. Procedures were performed under fluoroscopy in the operating room or ultrasonography in the outpatient clinic. Before treatment and at 1 and 3 months after treatment, patients were evaluated using the Numerical Rating Scale (NRS), Shoulder Pain and Disability Index (SPADI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Central Sensitization Inventory (CSI). Patient satisfaction was also recorded. Statistical analyses included repeated measures ANOVA, t-tests, Pearson correlation, and regression modeling. Results: All scores significantly improved over time in both groups (p < 0.001). However, improvements in NRS, SPADI, BAI, and PSQI were greater in the operating room group (p < 0.05). No significant differences were found in BDI and CSI scores. Regression analysis showed that higher initial depression scores and female gender were linked to less reduction in pain. Patient satisfaction was also higher in the operating room group. Discussion: Although both settings provided clinical benefit, procedures performed with sedation and fluoroscopic guidance in the operating room led to more pronounced improvements in pain, function, anxiety, and sleep. These results indicate that setting and psychosocial factors such as depression and gender may influence treatment outcomes.

Anahtar Kelimeler

• Frozen Shoulder
• Suprascapular Nerve
• Pulsed Radiofrequency
• Intra-articular injection
• Treatment Environment
• Pain Management

Donuk Omuz Hastalarında İntraartiküler Enjeksiyon ve Radyofrekans İşlemlerinin Uygulama Ortamı Tedavi Yanıtını Etkiler mi? Retrospektif Bir Çalışma

Öz

Giriş: Bu çalışma, donuk omuz hastalarında intraartiküler enjeksiyon ve supraskapular sinir puls radyofrekans (PRF) işlemlerinin, tedavi ortamına (ameliyathane vs. ayaktan tedavi kliniği) göre klinik, psikolojik ve fonksiyonel sonuçlar üzerindeki etkilerini araştırmayı amaçlamaktadır. Gereç ve Yöntemler Donuk omuz tanısı almış 40 hastanın verileri geriye dönük olarak incelendi. İşlemler, ameliyathanede floroskopi rehberliğinde veya ayaktan tedavi kliniğinde ultrasonografi eşliğinde gerçekleştirildi. Tedavi öncesinde ve tedaviden 1 ve 3 ay sonra hastalar; Sayısal Ağrı Skalası (NRS), Omuz Ağrı ve Disabilite İndeksi (SPADI), Beck Anksiyete Envanteri (BAI), Beck Depresyon Envanteri (BDI), Pittsburgh Uyku Kalitesi İndeksi (PSQI) ve Santral Duyarlılık Envanteri (CSI) ile değerlendirildi. Hasta memnuniyeti de kaydedildi. İstatistiksel analizlerde tekrarlayan ölçümler için ANOVA, t-testi, Pearson korelasyonu ve regresyon modellemesi kullanıldı. Bulgular: Her iki grupta da tüm skorlar zaman içinde anlamlı şekilde iyileşme gösterdi (p < 0.001). Ancak NRS, SPADI, BAI ve PSQI skorlarındaki iyileşmeler ameliyathane grubunda daha fazlaydı (p < 0.05). BDI ve CSI skorlarında gruplar arasında anlamlı fark bulunmadı. Regresyon analizi, yüksek başlangıç depresyon skorları ve kadın cinsiyetin ağrı azalmasında daha az iyileşme ile ilişkili olduğunu gösterdi. Hasta memnuniyeti de ameliyathane grubunda daha yüksekti. Tartışma: Her iki uygulama ortamı klinik fayda sağlasa da, sedasyon altında ve floroskopi rehberliğinde ameliyathanede yapılan işlemler, ağrı, fonksiyon, anksiyete ve uyku üzerinde daha belirgin iyileşmelerle sonuçlandı. Bu sonuçlar, uygulama ortamının ve depresyon ile cinsiyet gibi psikososyal faktörlerin tedavi sonuçlarını etkileyebileceğini göstermektedir.

Anahtar Kelimeler

• Donuk Omuz
• Supraskapular Sinir
• Pulse Radyofrekans
• İntraartiküler Enjeksiyon
• Tedavi Ortamı
• Ağrı Yönetimi

Kaynakça

1. 1.Challoumas D, Biddle M, McLean M, Millar NL, McConnachie A, Simpson AHRW, et al. Comparison of treatments for frozen shoulder: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. [Crossref]
2. 2.Lin YT, Kuo YC, Wu XN, Wang FS, Wu CH, Tseng IH, et al. Comparison of the efficacy of ultrasound-guided suprascapular nerve blocks and intraarticular corticosteroid injections for frozen shoulder: a randomized controlled trial. Pain Physician. 2024;27(7):415-24. [Crossref]
3. 3.Abo Elfadl GM, Osman AM, Elmasry YA, Goma SH, Abdelaleem RA, Abdelsalam EM. Effect of pulsed radiofrequency to the suprascapular nerve (SSN) in treating frozen shoulder pain: a randomised controlled trial. J Perioper Pract. 2025;35(1-2):4-10. [Crossref]
4. 4.Corban J, Shah S, Ramappa AJ. Current evidence based recommendations on rehabilitation following arthroscopic shoulder surgery: rotator cuff, instability, superior labral pathology, and adhesive capsulitis. Curr Rev Musculoskelet Med. 2024;17(7):247-57. [Crossref]
5. 5.Park KD, Ryu JW, Cho KR, Park Y, Lee J, Moon JH. Usefulness of combined handheld ultrasound and fluoroscopy-guided injection in adhesive capsulitis of the shoulder: a prospective, randomized single blind-pilot study. J Back Musculoskelet Rehabil. 2022;35(4):901-10. [Crossref]
6. 6.Haroun Y, Younis AS, Ebied WF, Awadalla MM, Ismail MA, Abdelkhalek M. Impacts of preoperative anxiety and depression on pain and range of motion after arthroscopic frozen shoulder release: a cohort study. Int Orthop. 2024;48(8):2113-9. [Crossref]
7. 7.Toprak M, Erden M. Sleep quality, pain, anxiety, depression and quality of life in patients with frozen shoulder. J Back Musculoskelet Rehabil. 2019;32(2):287-91. [Crossref]
8. 8.Healy GM, Finn DP, O'Gorman DA, Mahon N, Raftery M, Colbert D, et al. Pretreatment anxiety and pain acceptance are associated with response to trigger point injection therapy for chronic myofascial pain. Pain Med. 2015;16(10):1955-66. [Crossref]

9. 9.Mogil JS. Sources of individual differences in pain. Annu Rev Neurosci. 2021;44:1-25. [Crossref]
10. 10.Balasch-Bernat M, Dueñas L, Aguilar-Rodríguez M, Lluch-Girbes E, Struyf F, Meeus M, et al. The spatial extent of pain is associated with pain intensity, catastrophizing and some measures of central sensitization in people with frozen shoulder. J Clin Med. 2021;11(1):154. [Crossref]
11. 11.Tabachnick BG, Fidell LS. Using multivariate statistics. 6th ed. Boston, MA: Pearson; 2013.
12. 12.Liao W, He X, Du Z, Xie Y, Wang L, Wang Q. The synergistic effects of applying pulsed radiofrequency lesioning of the suprascapular nerve plus physical therapy on pain and function in patients with adhesive capsulitis: a protocol of a prospective, randomized, controlled trial. Medicine (Baltimore). 2021;100(14):e25431. [Crossref]
13. 13.Agarwal A, Rastogi S, Rai S, Kumar A, Kumar S, Singh NP. Effect of minimally invasive pain intervention in frozen shoulder patients: a cross-sectional study. Anesth Essays Res. 2020;14(4):620-6. [Crossref]
14. 14.Yan J, Zhang XM. A randomized controlled trial of ultrasound-guided pulsed radiofrequency for patients with frozen shoulder. Medicine (Baltimore). 2019;98(1):e13917. [Crossref]
15. 15.Pandey V, Madi S. Clinical guidelines in the management of frozen shoulder: an update! Indian J Orthop. 2021;55(2):299-309. [Crossref]
16. 16.Ahmad M, Khan MJ, Aziz MH, Rehman MU, Rehman SU, Saeed M. Comparative outcome of ultrasound guided vs. fluoroscopy guided hydrodilatation in adhesive capsulitis: a prospective study. Int J Burns Trauma. 2024;14(4):65-74. [Crossref]
17. 17.Brindisino F, Minnucci S, Sergi G, Lorusso M, Garbin G, Struyf F. Does the psychological profile of a patient with frozen shoulder predict future outcome? A systematic review. Physiother Res Int. 2024;29(1):e2056. [Crossref]
18. 18.Meints SM, Edwards RR, Gilligan C, Schreiber KL, Crofford LJ, Fillingim RB. Behavioral, psychological, neurophysiological, and neuroanatomic determinants of pain. J Bone Joint Surg Am. 2020;102 Suppl 1:21-7. [Crossref]
19. 19.Fillingim RB. Individual differences in pain: understanding the mosaic that makes pain personal. Pain. 2017;158 Suppl 1:S11-8. [Crossref]