Ultrasonographic Guided Intra Articular Steroid versus Hyaluronic Acid in Adhesive Capsulitis with and without Suprascapular Nerve Block: a Randomized Controlled Trial

Objective. To compare the effictiveness of intra articular injection (IAI) of steroid and HA with or without Suprascapular nerve block (SSNB) in the management of AC. Patients and methods. Randomized controlled trial involved 80 patients (62 women and 18 men) clinically diagnosed as having adhesive capsulitis divided into 2 main groups: intra articular injection with SSNB (40 cases) and without SSNB (40 cases), each group divided into 2 subgroups. Twenty patients were treated with ultrasound guided intra articular injection of steroid (4 ml of 2% lidocaine and 2 ml of 40 mg/ml triamcinolone) and another twenty patients were treated with ultrasound guided intra articular injection of hyaluronic acid (4 ml of 2% lidocaine and 2 ml hyaluronic acid). Results. Intra articular shoulder injection with SSNB has higher significant visual analogue scale (VAS) score at baseline and lower significant VAS score at 1st and 3rd week (p < 0.001). However, there was no significance between both groups regarding disability score at 3rd week (p = 0.316). In contrast, there was a high significance between them considering disability score at baseline, 1st, 6th week (p < 0.001 and 0.008, respectively). Conclusions. In patients with adhesive capsulitis, both a combination an IAI alone or with SSNB dramatically improved pain and functional results. The use of an SSNB in conjunction with an IAI especially with steroid enhanced therapeutic effectiveness.