Ultrasound-guided Shoulder Intraarticular Ozone Injection Versus Pulsed Radiofrequency Application for Shoulder Adhesive Capsulitis: A Randomized Controlled Trial.

BACKGROUND: A diseased shoulder due to pain, stiffness, or weakness negatively affects patients' quality of life and their ability to carry out activities of daily living. Adhesive capsulitis is a disease characterized by shoulder pain and global limitation of movement in the shoulder joint. Many interventions have been proposed for the treatment of primary adhesive capsulitis. The current study compares the effect of ultrasound-guided intraarticular injection of ozone versus steroid versus intraarticular application of pulsed radiofrequency. OBJECTIVES: The primary outcome of the current study was to compare the improvement in the Visual Analog Scale (VAS) after the 3 treatment modalities. The secondary outcomes included functional improvement measured by the Shoulder Pain and Disability Index (SPADI) and level of inflammatory biomarkers measured by serum intercellular adhesion molecule (ICAM-1) and high-sensitivity C-reactive protein(hs-CRP). STUDY DESIGN: The current study is a prospective, double blinded, randomized controlled trial. We employed a double blinding technique for both the patients and the outcome assessors. SETTING: Our study was carried out at the Medical Research Institute, Alexandria University, Egypt, after approval of the local ethical committee (IORG0008812). The study was registered in the "clinical trials library for protocol registration and results system" with number NCT04724317.The study included 45 patients with a diagnosis of primary adhesive capsulitis. METHODS: Patients were randomly assigned to 3 equal groups: steroid group, ozone group, and pulsed radiofrequency group. Pain and global shoulder functions were assessed using the VAS at rest and with movement, range of motion (ROM), and the SPADI. Moreover, ICAM-1 and hs-CRP were measured as inflammatory markers. RESULTS: The results of the current study reveal that all patients in all groups have had a statistically significant improvement after their intervention regarding pain, disability, ROM, and inflammatory markers. Pairwise comparisons revealed that improvement of the VAS during movement had a statistically significant improvement starting from the second week and continuing to the fourth and eighth week. VAS during rest had a significant improvement starting from follow-up week one in the steroid group. Moreover, improvement in the ROM and SPADI scores started from the second week follow-up. Percent improvement was calculated for each group and there was a statistically significant difference between groups in VAS at rest and ROM in the pulsed radiofrequency group compared to the steroid group.Regarding inflammatory markers, both ICAM-1 and hs-CRP had a significant improvement after all 3 interventions with no statistically significant difference among the groups. LIMITATIONS: This study is a single-center study. A shortage of previously published data, and heterogeneity in the published methodology of the 3 interventions limited our discussion data for comparison with the previous literature. CONCLUSION: Ultrasound-guided shoulder joint intraarticular injection of steroid, ozone, or pulsed radiofrequency application all result in a significant improvement in pain, disability, and ROM in primary adhesive capsulitis. They can be used as an effective treatment modality for this condition. Comparing groups statistically, the pulsed radiofrequency group had a more delayed, but statistically better long-term improvement compared to the other 2 groups.

Relief of chronic shoulder pain: a comparative study of three approaches.

BACKGROUND: Shoulder pain is one of the most common complaints in pain clinics and rheumatology departments, usually originates from trauma, degeneration, inflammation, vascular disease and also be referred from the hand and neck pain or headache. OBJECTIVES: The aim of this study was to compare the effectiveness of continuous suprascapular nerve block under ultrasound guidance versus intra-articular corticosteroid injection of the shoulder and/or physiotherapy in management of chronic shoulder pain and to assess the effectiveness of these methods for relieving pain, improve range of movement of the shoulder and to demonstrate the most suitable method for treatment of such patients. SUBJECTS & METHODS: 50 patients with a total of 63 shoulders were randomly divided into Group 1 (23 shoulders) received continuous suprascapular nerve block under ultrasound guidance in addition to rehabilitation program. Group II (20 shoulders) received intra-articular injection of steroid in addition to rehabilitation program. Group III (20 shoulders) received rehabilitation program only. The patients were followed up for 12 weeks and reviewed for Pain, disability, and range of movement data at weeks 1, 4, and 12 after each treatment. RESULTS: The result of our study demonstrates that, from the first week to 12 weeks, there was marked improvement in pain score in all times of follow up, and the best improvement in group I versus group II or III. The disability score showed improvement of non significant difference over the three time periods. Highly significant mean changes were found in group I versus group II & III (p = 0.001) as regard SPADI pain, disability, total SPADI score and active movements. After 12 weeks of follow up, RA patients reported significant differences between 3 approaches of treatment (SSNB was the most effective one) as regard SPADI pain and total SPADI scores but frozen shoulder patients showed significant difference between three groups as regard SPADI pain only. CONCLUSION: Combination of physical treatment with Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in frozen and arthritis. It improves pain, disability, and range of movement of the shoulders compared with intra-articular corticosteroid injection of the shoulder and/or physiotherapy alone. SSNB is a useful adjunct treatment for management of chronic shoulder pain. Direct ultrasound visualization significantly improve outcome.