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.
Yoon, 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.
- 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.
Pain 2015 in press
- 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
- 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:
- 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.
- 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.