The Effect of Glenohumeral Joint Injection Prior to Physical Therapy on Treatment Outcomes in Adhesive Capsulitis

Öz

Objective: The objective of this study was to evaluate whether ultrasound-guided intraarticular (IA) glenohumeral injection applied before physical therapy and exercise therapy program (PTETP) contributes to the treatment outcomes in patients with adhesive capsulitis of the shoulder (ACS). Methods: The medical records of 93 patients diagnosed with ACS who underwent the same physical therapy modalities five sessions per week for three weeks (consisted of superficial heating (infrared), transcutaneous electrical nerve stimulation, and therapeutic ultrasound) and exercise therapy program between October 1, 2019–March 1, 2020 were retrospectively evaluated. A total of 41 patients who met inclusion and exclusion criteria were divided into two groups in terms of injection application. Patients who were applied ultrasound guided IA glenohumeral injections before PTETP were considered “injection patients” (n=19), while other patients were considered “non-injection patients” (n=22). The active and passive range of motion (ROM), severity of pain, and degrees of pain and disability of the affected shoulders were assessed at baseline (day 0) and end of PTETP (day 21). Results: Physical therapy modalities and exercise therapy used in ACS treatment had a positive effect on pain scores, ROM, and disability scores at the end of three weeks. It was determined that ultrasound-guided IA injection prior to this treatment the positive effect on daytime and nighttime pain but did not provide additional benefit on ROM or disability. Conclusion:Ultrasound-guided glenohumeral IA injection therapy before PTETP may be beneficial in ACS patients with predominant symptoms of pain.

Anahtar Kelimeler

• Frozen Shoulder
• Shoulder Pain
• Ultrasonography
• Corticostreoid
• Physiotherapy

Adeziv Kapsülit Tedavisinde Fizik Tedavi Programı Öncesi Uygulanan Glenohumeral Eklem Enjeksiyonunun Tedavi Sonuçları Üzerine Etkisi

Öz

Amaç:Bu çalışmanın amacı, omuzda adeziv kapsüliti (AK) olan hastalarda fizik tedavi ve egzersiz programı (FTEP) öncesinde uygulanan ultrason eşliğinde intraartiküler (İA) glenohumeral eklem enjeksiyonunun tedavi sonuçları üzerine katkı sağlayıp sağlamadığını değerlendirmektir. Gereç ve Yöntem: 1 Ekim 2019 - 1 Mart 2020 tarihleri arasında, üç hafta boyunca haftada beş seans aynı fizik tedavi modaliteleri (yüzeyel ısıtma (infrared), transkutanöz elektriksel sinir stimülasyonu ve terapötik ultrasondan oluşan) ve egzersiz tedavisi uygulanan AK tanılı 93 hastanın tıbbi kayıtları retrospektif olarak değerlendirildi. Dahil etme ve dışlama kriterlerini karşılayan toplam 41 hasta enjeksiyon uygulaması açısından iki gruba ayrıldı. FTEP’den önce ultrason eşliğinde İA glenohumeral enjeksiyon uygulanan hastalar “enjeksiyon yapılan hastalar” (n=19), diğer hastalar “enjeksiyon yapılmayan hastalar” (n=22) olarak kabul edildi. Hastaların başlangıçta (0. gün) ve FTEP’nin sonunda (21. gün), etkilenen omuzdaki aktif ve pasif eklem hareket açıklığı (EHA), ağrı şiddeti, ağrı ve sakatlık dereceleri değerlendirildi. Bulgular: AK tedavisinde kullanılan fizik tedavi modaliteleri ve egzersiz tedavisi, üç haftanın sonunda ağrı skorları, EHA ve özürlülük skorları üzerinde olumlu bir etkiye sahipti. Bu tedaviden önce ultrason eşliğinde uygulanan İA enjeksiyonun, gündüz ve gece ağrı şiddetleri üzerinde olumlu etkisinin olduğu, ancak ROM veya sakatlık üzerine ek katkı sağlamadığı belirlendi. Sonuç: FTEP’den önce ultrason eşliğinde uygulanan glenohumeral İA enjeksiyon tedavisi, ağrı semptomlarının baskın olduğu AK hastalarında faydalı olabilir.

Anahtar Kelimeler

• Donuk Omuz
• Omuz Ağrısı
• Ultrasonografi
• Kortikostreoid
• Fizyoterapi

Kaynakça

1. Robinson C, Seah KM, Chee Y, Hindle P, Murray I. Frozen shoulder. J Bone Joint Surg Br. 2012;94: 1-9. https://doi.org/10.1302/0301-620X.94B1.27093
2. Tighe CB, Oakley JW. The prevalence of a diabetic condition and adhesive capsulitis of the shoulder. South Med J. 2008;101: 591-5. https://doi.org/10.1097/SMJ.0b013e3181705d39
3. Levine WN, Kashyap CP, Bak SF, Ahmad CS, Blaine TA, Bigliani LU. Nonoperative management of idiopathic adhesive capsulitis. J Shoulder Elbow Surg. 2007;16: 569-73. https://doi.org/10.1016/j.jse.2006.12.007
4. Leung MS, Cheing GL. Effects of deep and superficial heating in the management of frozen shoulder. J Rehabil Med. 2008;40: 145-50. https://doi.org/10.2340/16501977-0146
5. Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013;43: A1-A31. https://doi.org/10.2519/jospt.2013.0302
6. Russell S, Jariwala A, Conlon R, Selfe J, Richards J, Walton M. A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder. J Shoulder Elbow Surg. 2014;23: 500-7. https://doi.org/10.1016/j.jse.2013.12.026
7. Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis: a prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am. 2000;82: 1398.
8. Calis M, Demir H, Ulker S, Kirnap M, Duygulu F, Calis HT. Is intraarticular sodium hyaluronate injection an alternative treatment in patients with adhesive capsulitis? Rheumatol Int. 2006;26: 536-40. https://doi.org/10.1007/s00296-005-0022-2

9. Raeissadat SA, Rayegani SM, Langroudi TF, Khoiniha M. Comparing the accuracy and efficacy of ultrasound-guided versus blind injections of steroid in the glenohumeral joint in patients with shoulder adhesive capsulitis. Clin Rheumatol. 2017;36: 933-40. https://doi.org/10.1007/s10067-016-3393-8
10. Lorbach O, Kieb M, Scherf C, Seil R, Kohn D, Pape D. Good results after fluoroscopic-guided intra-articular injections in the treatment of adhesive capsulitis of the shoulder. Knee Surg Sports Traumatol Arthrosc. 2010;18: 1435-41. https://doi.org/10.1007/s00167-009-1030-7
11. Carette S, Moffet H, Tardif J, et al. Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: A placebo-controlled trial. Arthritis Rheum. 2003;48: 829-38. https://doi.org/10.1002/art.10954
12. White DJ: The shoulder. In: Norkin CC, White DJ (eds), Measurement of joint motion: a guide to goniometry. Philadelphia: F. A. Davis Company; 2016; 66-115.
13. Bumin G, Tüzün EH, Tonga E. The Shoulder Pain and Disability Index (SPADI): Cross-cultural adaptation, reliability, and validity of the Turkish version. J Back Musculoskelet Rehabil. 2008;21: 57-62.
14. Bal A, Eksioglu E, Gulec B, Aydog E, Gurcay E, Cakci A. Effectiveness of corticosteroid injection in adhesive capsulitis. Clin Rehabil. 2008;22: 503-12. DOI: https://doi.org/10.1177/0269215508086179
15. Rizk T, Christopher R, Pinals R, Higgins A, Frix R. Adhesive capsulitis (frozen shoulder): a new approach to its management. Arch Phys Med Rehabil. 1983;64: 29-33.
16. Arslan S, Çeliker R. Comparison of the efficacy of local corticosteroid injection and physical therapy for the treatment of adhesive capsulitis. Rheumatol Int. 2001;21: 20-3. https://doi.org/10.1007/s002960100127
17. van der Windt D, Koes BW, Deville W, Boeke AJ, de Jong BA, Bouter LM. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial. BMJ. 1998;317: 1292-6. https://doi.org/10.1136/bmj.317.7168.1292
18. Ryans I, Montgomery A, Galway R, Kernohan W, McKane R. A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis. Rheumatology. 2005;44: 529-35. https://doi.org/10.1093/rheumatology/keh535
19. Bulgen D, Binder A, Hazleman B, Dutton J, Roberts S. Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens. Ann Rheum Dis. 1984;43: 353-60. https://doi.org/10.1136/ard.43.3.353
20. Yoon S-H, Lee HY, Lee HJ, Kwack K-S. Optimal dose of intra-articular corticosteroids for adhesive capsulitis: a randomized, triple-blind, placebo-controlled trial. Am J Sports Med. 2013;41: 1133-9. https://doi.org/10.1177/0363546513480475
21. De Jong BA, Dahmen R, Hogeweg JA, Marti RK. Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens. Clin Rehabil. 1998;12: 211-5. https://doi.org/10.1191/026921598673772420
22. Rizk TE, Pinals RS, Talaiver AS. Corticosteroid injections in adhesive capsulitis: investigation of their value and site. Arch Phys Med Rehabil. 1991;72: 20-2.