Anterior vs Posterior vs Combined Intra-Articular Injections for Adhesive Capsulitis

Aslinur Keles Ercisli, MD, PhD

Status: Not yet enrolling

Conditions: Adhesive Capsulitis of the Shoulder; Intra Articular Injection

Treatments: Drug: Combined Anterior + Posterior Intra-articular Injection; Drug: Anterior Intra-articular Injection; Drug: Intervention Name: Posterior Intra-articular Injection

Study type: Interventional

Funder types: Other

Identifiers

NCT07364227

ADC2025

Details and patient eligibility

About

This randomized controlled clinical trial aims to compare the efficacy of three different intra-articular injection approaches (anterior, posterior, and combined anterior-posterior) in patients with adhesive capsulitis of the shoulder. Thirty participants will be randomly assigned to one of three groups and treated with a standardized injection solution consisting of corticosteroid, lidocaine, and saline. Clinical outcomes will be evaluated using pain scores, functional scales, and imaging parameters.

Full description

Adhesive capsulitis (frozen shoulder) is a disabling condition characterized by progressive pain and stiffness of the glenohumeral joint. Intra-articular corticosteroid injections are frequently used to reduce pain and improve mobility; however, the optimal injection approach remains controversial.

This single-center randomized controlled trial will investigate three different approaches: posterior, anterior, and combined anterior-posterior injections. The primary endpoint is improvement in active and passive range of motion. Secondary endpoints include pain scores (VAS), functional outcome measures (SPADI, qDASH, ASES, Constant-Murley, Scratch Test, Subjective Shoulder Value), and ultrasound evaluation of axillary capsule thickness. Assessments will be performed at baseline, immediately after injection, and at weeks 3, 6, and 12.

Enrollment: 30 estimated patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria Age 18-70 years Unilateral shoulder pain and stiffness (symptom duration 1-9 months) NRS pain score ≥ 7/10 Passive range of motion limitation >50% in at least two planes, or >30° restriction in ≥2 planes "Freezing stage" (stage 2 adhesive capsulitis) No analgesic use (NSAIDs, opioids, acetaminophen) within 12 hours before intervention Radiography and/or MRI excluding other pathologies (rotator cuff tear, labral lesion, osteoarthritis, etc.) Exclusion Criteria Secondary adhesive capsulitis (trauma, surgery, systemic disease) Prior shoulder surgery or intra-articular steroid injection within 3 months Bilateral frozen shoulder Neurological disorders (Parkinson's disease, ALS, neuropathies) Malignancy, infection, cellulitis, septic arthritis, acute fracture Cognitive impairment, psychiatric disorders, pregnancy Steroid or local anesthetic allergy Poor glycemic control or other contraindications to steroid injections

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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30 participants in 3 patient groups

Arm A: Posterior Injection

Experimental group

Description:

Single intra-articular injection with corticosteroid + lidocaine + saline via the posterior glenohumeral approach.

Treatment:

Drug: Intervention Name: Posterior Intra-articular Injection

Arm B - Anterior Injection

Experimental group

Description:

Same injection solution administered via the anterior (rotator interval) approach.

Treatment:

Drug: Anterior Intra-articular Injection

Arm C - Combined Anterior + Posterior Injection

Experimental group

Description:

Same injection solution administered using both anterior and posterior approaches.

Treatment:

Drug: Combined Anterior + Posterior Intra-articular Injection