Ann Rehabil Med.  2016 Jun;40(3):520-527. 10.5535/arm.2016.40.3.520.

Usefulness of a Hanging Position With Internal Rotation of Shoulder in Ultrasonography-Guided Intra-articular Steroid Injection for Adhesive Capsulitis

• Lee CH
• Nam HS
• Lee SU

• KMID: 2327615
• DOI: http://doi.org/10.5535/arm.2016.40.3.520

Abstract

OBJECTIVE
To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position.
METHODS
A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection.
RESULTS
The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively.
CONCLUSION
For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in internal rotation with hanging position may be a useful alternative.

Keyword

Adhesive capsulitis; Posture; Intra-articular injections; Ultrasonography

MeSH Terms

Abdomen
Adhesives*
Arm
Bursitis*
Hand
Humans
Injections, Intra-Articular
Joints
Posture
Prospective Studies
Range of Motion, Articular
Shoulder Joint
Shoulder Pain
Shoulder*
Thigh
Treatment Outcome
Ultrasonography
Adhesives

Figure

• 

  Fig. 1 Three positions of the shoulder during intra-articular injection are shown. (A) Hands on abdomen (abdomen position), (B) hands on opposite shoulder (cross position), and (C) internal rotation with hanging (hanging position).

• 

  Fig. 2 Method used to measure the length of glenohumeral joint in ultrasonography. A line was drawn from the lateral edge of the labrum (point 1) along the inferior margin of labrum (line A, red line). From the lateral edge of the labrum, a line (line B, yellow line) was drawn perpendicular to the line A. The distance from the lateral edge of the labrum (point 1) to the corresponding cortical echo of the humerus (point 2) on the line B was defined as the length of glenohumeral joint. HH, humeral head; Gl, bony glenoid.

• 

  Fig. 3 The length of glenohumeral joint space in ultrasonography for each arm position.

• 

  Fig. 4 The joint capsule was distended (arrowheads) after successful needle placement and injection.

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