Comparison of the Effects Suprascapular Nerve Block and Intra-articular Shoulder Injection

Study Overview
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Brief Summary
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Objectives: In this study, we aimed to compare the efficacy of ultrasonography-guided suprascapular nerve block and intra-articular shoulder injection treatment in terms of joint range of motion, pain and functional status in patients with adhesive capsulitis (AC). Patients and Methods: 60 patients AC were included in our study. The patients were randomized into two groups according to the sealed envelope method. In the evaluation of the patients before the injection, age, gender, body mass index (BMI), occupation, education, duration of complaint, symptomatic side and dominant hand information were recorded. In the first group, 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine injection were mixed with the posterior approach method into the shoulder joint under the guidance of ultrasonography (USG). The second group underwent suprascapular nerve block (SSNB) injection with 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine under USG guidance. Shoulder range of motion (ROM), visual analog scale (VAS) scores and Shoulder Pain and Disability Index (SPADI) scores were compared before the injection, on the tenth day after the injection and at the third month after the injection. Conclusion: As a result of our study, although it was observed that both methods provided improvement in the treatment process, the significant improvement in the SSNB group indicates that it is a more reliable treatment method in AC treatment.

Detailed Description
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Sixty patients AC who applied to our Orthopedics-Traumatology and Physical Medicine-Rehabilitation Outpatient Clinic were included in our study. The study was approved by the Hitit University Clinical Research Ethics Committee (Decision number:2023-56). A well-informed written consent was obtained from all participants according to the principles of the Declaration of Helsinki. Patients with an age range of 18-65 years, adapting to the treatment program to be applied, diagnosed with unilateral stage 2-3 AC, no shoulder trauma in the last 3 months, no shoulder injections, no bleeding disorder, no history of malignancy, inflammatory disease and stroke were included in the study. The patients were randomized into two groups according to the sealed envelope method. In the evaluation of the patients before the injection, age, gender, body mass index (BMI), occupation, education, duration of complaint, symptomatic side and dominant hand information were recorded. Injections were made to the patients by the physiatrist and anesthetist researcher under the guidance of Logiq V2 portable USG device. In the first group, 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine injection were mixed with the posterior approach method into the shoulder joint under the guidance of USG. The second group underwent suprascapular nerve block injection with 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine under USG guidance. In addition, pendulum and ladder-finger exercises were given to both groups as a home exercise program. Shoulder range of motion (ROM), visual analog scale (VAS) scores and Shoulder Pain and Disability Index (SPADI) scores were compared before the injection, on the tenth day after the injection and at the third month after the injection.

Official Title
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Comparison of the Effects of Ultrasonography-guided Suprascapular Nerve Block and Intra-articular Shoulder Injection on Pain, Functional Status and Range of Motion in Patients With Adhesive Capsulitis; Randomized, Controlled Trial

Conditions
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Adhesive Capsulitis

Intervention / Treatment
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* Drug: 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: unilateral stage 2-3 AC no shoulder trauma in the last 3 months no shoulder injections no bleeding disorder no history of malignancy no history of inflammatory disease Exlusion Criteria: malignancy inflammatory disease

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Single Group Assignment
Interventional Model Description: randomized, controlled trial
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: suprascapular verve block<br>2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine | Drug: 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine<br>* ultrasonography-guided suprascapular nerve block and intra-articular shoulder injection<br>* Other names: intra-articular shoulder injection;|
| Experimental: intraarticular shoulder injection<br>2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine | Drug: 2 ml of 40 mg triamcinolone acetonide and 4 ml of 1% lidocaine<br>* ultrasonography-guided suprascapular nerve block and intra-articular shoulder injection<br>* Other names: intra-articular shoulder injection;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes from baseline in pain on The Shoulder Pain and Disability Index (SPADI) at the tenth day after the injection | SPADI is a valid and reliable questionnaire used in shoulder disorders. Possible scores range from 0 (no pain) to 100 (severe shoulder pain)= Changes tenth day after the injection-baseline | baseline and on the tenth day after the injection | 
| The effectiveness of suprascapular nerve block on pain is higher than intra-articular | Shoulder Pain and Disability Index | between before treatment and on the tenth day after the injection | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Adhesive capsulitis, suprascapular nerve block, intra-articular shoulder injection, ultrasonography.