Frozen Shoulder – Just a Little Cortisone But More Blocks Help

Study found 20 mg Kenalog worked as well as 40 mg and another found you don’t even need to hit the joint. I supplement suprascapular and quadrilateral space blocks as well as subscapularis working out.
frozenshYoon, Seung-Hyun, et al.
Optimal Dose of Intra-articular Corticosteroids for Adhesive Capsulitis A Randomized, Triple-Blind, Placebo-Controlled Trial.
The American journal of sports medicine (2013): 0363546513480475.
http://ajs.sagepub.com/content/early/2013/03/18/0363546513480475.abstract

  • 53 cases
  • tried both 20 and 40 mg and used imagining to ensure injection
  • No difference in pain and mobility

Ultrasound guided intra-articular and rotator interval corticosteroid injections in
adhesive capsulitis of the shoulder. A double blind, sham controlled randomized study.
Tore Prestgaard
Pain 2015 in press
http://www.ncbi.nlm.nih.gov/pubmed/25919473

  • compared 40 mg kenalog injected into posterior joint capsule with “interval injection” – “space between the subscapularis and supraspinatus tendons, including the long head of the biceps tendon, the coracohumeral and the superior glenohumeral ligaments, and parts of the joint capsule” – made up with local to 3.5 mls
  • Had a sham injection group
  • no difference between the 2 placement sites  but were better than sham up to 12 weeks

Comment –

  • going to switch to 20 mg kenalog which will allow me to repeat the shot at 2-3 weeks if still suffering.
  • Looks like it is ok to do shot without imaging as placement may not be critical.
  • Shoulder nerve root blocks have been shown to be helpful before. You can get near complete relaxation of shoulder muscles and much greater mobility
  • Both suprascapular and quadrilateral space nerve injections:quadrangular-space-shoulder1
  • Suprascapular is in outer third scapula and put in vertically so it runs just behind scapula
  • Quadrilateral space is just by humerus (so between humerus and triceps) and between Teres major and minor. Injecting the nerve there, relieves deltoid spasm which contributes to contracture.
    Shoulder_blocks
  • I use 5% lidocaine and put 1 cc in suprascapular and 0.5-1 cc in quadrilateral space. If you are a novice,  try 1% –  5 – 10 mls of each
  • I then put my hand in axilla and palpate posteriorly on under surface scapula -can feel sucbscapularis – rub over it 120 times (invariably it does not soften up until 110 rubs)
  • Following such, patient will be amazed at how well one can elevate arm and you can appreciate any knots left in levator scapula and medial scapula.
  • Physio would help remove any other restrictions
  • I only once had to give over 1 shot but with only 20 mg, one could easily give another in several weeks.

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