A comparison of the effectiveness of therapies for frozen shoulder (FS): mobilization with continuous interscalene block (CISB) and mobilization with intra-articular steroid injection (IASI)

Document Type : Original Article


1 Professor, Dept. of Orthopedics, Govt. Medical College, Kozhikkode, Kerala, India

2 Post-doctoral fellow in Arthroscopy, Ganga Hospital, Coimbatore, Tamilnadu, India

3 Associate consultant, Bone and Joint Care, Meitra Hospital Kozhikkode, Kerala, India

4 Assistant Professor, Department of Orthopedics, Govt. Medical College, Kozhikkode, Kerala, India


Background: Frozen shoulder (FS) can cause significant discomfort and limited range of motion for the affected individual. Early and painless mobilization of the shoulder has been shown to yield positive results in treating the condition.
Objectives: The aim of this study was to evaluate and compare the effectiveness of two therapies for frozen shoulder (FS): mobilization with continuous interscalene block (CISB) and mobilization with intra-articular steroid injection (IASI). Specifically, we aim to determine the effectiveness of both interventions in improving clinical and functional outcomes and to evaluate the impact of adding IASI to mobilization with CISB.
Methods: We conducted a prospective comparative study. The participants were divided into three groups of 20 patients each. The distribution was performed by simple randomization. The primary outcomes of pain and patient satisfaction were assessed using VAS scores. Outcome measures such as pain, patient satisfaction, range of motion, and UCLA scores within groups were assessed.
Results: The majority of patients were women. There was a significant improvement in early pain relief and range of motion in patients treated with mobilization in the CISB setting. Late functional outcomes were similar in all groups, regardless of treatment modality. IASI did not have a significant impact on the early or late outcomes of CISB mobilization.
Conclusion: Mobilization under CISB provides early pain relief, improvement in range of movements, and good long-term functional results for frozen shoulders. IASI has no effect on early pain relief or improving range of motion.


Main Subjects

  1. Amstutz HC, Hoy ALS, Clarke IC. Ucla anatomic total shoulder arthroplasty. Clin Orthop Relat Res. 1981; 155: 720. doi:10.1097/00003086-198103000-00002
  2. D'Amato KE, Rogers M. "Frozen Shoulder"-A Difficult Clinical Problem. Osteopath Fam Physician. 2012;4(3):72-80. doi:10.1016/j.osfp.2011.12.001
  3. Bhatia M, Singh B, Nicolaou N, Ravikumar KJ. Correlation between rotator cuff tears and repeated subacromial steroid injections: a case-controlled study. Ann R Coll Surg Engl. 2009;91 (5):414-6. doi:10.1308/003588409X428261 PMid:19409148 PMCid:PMC2758443
  4. Bridgman J. Periarthritis of the shoulder and diabetes mellitus. Ann Rheum Dis. 1972;31(1):69-71. doi:10.1136/ard.31.1.69 PMid:5008469 PMCid:PMC1005864
  5. Brue s, valentin a, forssblad m, werner s, mikkelsen c, cerulli g. Idiopathic adhesive capsulitis of the shoulder: a review. Knee Surg Sports Traumatol Arthr. 2007;15(8):1048-54. doi:10.1007/s00167-007-0291-2 PMid:17333122
  6. Bunker T, Anthony P. The pathology of frozen shoulder. A dupuytren-like disease. J Bone Jt Surg Br. 1995;77-b(5):677-83. doi:10.1302/0301-620X.77B5.7559688
  7. Codman E. Obscure lesions of the shoulder; rupture of the supraspinatus tendon. Boston Med Surg J. 1927;196(10):381-7. doi:10.1056/NEJM192703101961001
  8. Kumar S, Khuba S, Gautam S, Agarwal A, Chatterjee A, Goyal N, et al. Comparative efficacy of ultrasound-guided combined suprascapular and axillary nerve block with suprascapular nerve block alone in patients with frozen shoulder: a prospective, double-blinded randomized, single-centre trial. Interv Pain Med. 2023;2(3):100265. doi:10.1016/j.inpm.2023.100265
  9. Lierz P, Hoffmann P, Felleiter P, Spacek A, Hoerauf K. Treatment of frozen shoulder with interscalene blockade of the brachial plexus. Anesth Analg. 1998;86(2s):284s. doi:10.1097/00000539-199802001-00282
  10. Diklic Id, Ganic Zd, Blagojevic Zb. Treatment of resistant frozen shoulder by manipulation under anethesia, intermittent interscalene blocks and protocol of kinesitherapy (banjica). Acta Chir Iug. 2006;53(4):69-72. doi:10.2298/ACI0604069D PMid:17688037
  11. Dodenhoff R, Levy O, Wilson A, Copeland S. Manipulation under anesthesia for primary frozen shoulder: effect on early recovery and return to activity. J Shoulder Elb Surg. 2000; 9(1):23-6. doi:10.1016/S1058-2746(00)90005-3 PMid:10717858
  12. Gam, Pierre Schydlowsky, Ib Rossel, A. Treatment of 'frozen shoulder' with distension and glucorticoid compared with glucorticoid alone: a randomised controlled trial. Scand J Rheumatol. 1998;27(6):425-30. doi:10.1080/030097498442244 PMid:9855212   
  13. Gavant Ml, Rizk Te, Gold Re, Flick Pa. Distention arthrography in the treatment of adhesive capsulitis of the shoulder. J Vascu Interv Radiol. 1994;5(2):305-8. doi:10.1016/S1051-0443(94)71488-3 PMid:8186599
  14. Hazleman Bl. The painful stiff shoulder. Rheumatology. 1972;11 (8):413-21. doi:10.1093/rheumatology/11.8.413 PMid:4646489
  15. Klein S, Greengrass R, Steele S, D'ercole F, Speer K, Gleason D, et al. A comparison of 0.5% bupivacaine, 0.5% ropivacaine, and 0.75% ropivacaine for interscalene brachial plexus block. Anesth Analg. 1998;87(6):1316-9. doi:10.1213/00000539-199812000-00019
  16. Lierz P, Hoffmann P, Felleiter P, Spacek A, Hoerauf K. Treatment of frozen shoulder with interscalene blockade of the brachial plexus. Anesth Analg. 1998;86(2s):284s. doi:10.1097/00000539-199802001-00282
  17. Lundberg B. The frozen shoulder: clinical and radiographical observations the effect of manipulation under general anesthesia structure and glycosaminoglycan content of the joint capsule local bone metabolism. Acta Orthop Scand. 1969; 40 (sup119):1-59. doi:10.3109/ort.1969.40.suppl-119.01
  18. Nutton R, Mcbirnie J, Phillips C. Treatment of chronic rotator-cuff impingement by arthroscopic subacromial decompression. J Bone Jt Surg Br. 1997;79-b(1):73-6. doi:10.1302/0301-620X.79B1.0790073
  19. Ogilvie-Harris D, Biggs D, Fitsialos D, Mackay M. The resistant frozen shoulder. Clin Orthop Relat Res. 1995;(319):238-248. doi:10.1097/00003086-199510000-00026
  20. Tasto JP, Elias DW. Adhesive capsulitis. Sports Med Arthrosc Rev. 2007;15(4):216-21. doi:10.1097/JSA.0b013e3181595c22 PMid:18004221
  21. Roubal P, Dobritt D, Placzek J. Glenohumeral gliding manipulation following interscalene brachial plexus block in patients with adhesive capsulitis. J Orthop Sports Phys Ther. 1996; 24 (2):66-77. doi:10.2519/jospt.1996.24.2.66 PMid:8832469
  22. Van Der Windt D, Koes B, Deville W, Boeke A, De Jong B, Bouter L. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: randomised trial. BMJ. 1998;317(7168):1292-6. doi:10.1136/bmj.317.7168.1292PMid:9804720 PMCid:PMC28713
  23. Koh K. Corticosteroid injection for adhesive capsulitis in primary care: a systematic review of randomised clinical trials. Singapore Med J. 2016;57(12):646-57. doi:10.11622/smedj.2016146 PMid:27570870 PMCid:PMC5165171
  24. Ramírez J, Pomés I, Cabrera S, Pomés J, Sanmartí R, Cañete J. Incidence of full-thickness rotator cuff tear after subacromial corticosteroid injection: a 12-week prospective study. Mod Rheumatol. 2014;24(4):667-70. doi:10.3109/14397595.2013.857798 PMid:24289196