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Background: Painless and early aggressive mobilization of the shoulder can give good outcomes in a frozen shoulder (FS).Objectives: Our objective is to compare the early and late clinical and functional outcomes of mobilization under continuous interscalene block (CISB) and mobilization and intraarticular steroid injection (IASI) and to determine the effect of the addition of IASI on mobilization and CISB in adults with FS.Methods: We conducted a prospective comparative study. Participants were divided into 3 groups of 20 patients. The allocation 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 the groups were assessed.Results: The majority of patients were females. There was a significant improvement in early pain relief and range of motion in patients treated using mobilization under CISB. The late functional outcomes were similar in all groups irrespective of the method of treatment. The IASI had no significant effect on the early or late outcomes of mobilization under CISB.Conclusion: Mobilization under CISB provides early pain relief, improvement in the range of movements, and good long-term functional outcomes in frozen shoulders. IASI does not affect early pain relief or improvement in the range of movements.

Objectives: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular Nerve block and Intra-articular steroid injection in patients with hemiplegic shoulder pain. Study Design: Randomized Controlled Trial Place and Duration of Study: Pain Clinic, Armed Forces Institute of Rehabilitation Medicine Rawalpindi from 25th October 2017 to 24th April 2018 Patients & Methods: 60 patients with CVA and shoulder pain on hemiplegic side for at least 2 weeks were included in study after non-probability consecutive sampling after meeting inclusion criteria. Subjects were randomized by lottery into two groups; Group A receiving Suprascapular Nerve block with 5ml of 1% Lignocaine with Group B receiving Intra-articular 40mg Triamcinolone Acetonide plus 1 ml of 1% Lignocaine injections. Mean change in pain scores on VAS was calculated between score at baseline and at 4 weeks post-intervention Results: The mean age of patients in group A was 59.17 ± 9.81 years and in group B was 39.96 ± 11.11 years. Out of 60 patients, 34 (56.67%) were males and 26 (43.33%) were females with male to female ratio of 1.3:1. Mean duration of stroke was 7.50 ± 2.66 months. Mean pain change on VAS in Group A (Suprascapular Nerve block) was 3.83 ± 1.12 cm while in Group B (Intra-articular steroid injection) it was 2.17 ± 0.99 cm (p-value = 0.0001). Conclusion: This study concluded that Suprascapular Nerve block offered better improvement in hemiplegic shoulder pain on Visual Analogue Scale at 4 weeks as compared to intraarticular steroid inje

Introduction: Frozen shoulder is one of the most common shoulder pathologies seen by shoulder surgeons in the clinic. It is mainly seen in theelderly and diabetics. Frozen shoulder also known as adhesive capsulitis causes a restrictions in motion especially external rotation is limited thus affecting activities of daily life. Conservative management is the first line of treatment. Most patients respond well to physiotherapy but in other cases intra-articular injections may prove useful. Historically, steroids were used but steroids have harmful effect and can be chondro-toxic therefore they have been abandoned. In modern times, orthobiologics such PRP have been effective and have no side effects. This study compares outcomes of patients managed by steroids against PRP. Material and Methods: A randomised control trial was performed at lady reading hospital from13-12-2019 till 12-06-2020. Patient between 18-70 were included in study with an established clinico-radiological diagnosis of frozen shoulder. Patients treated with steroids were grouped in A whereas patients receiving PRP were labelled in group B. A total 164 patients were enrolled and followed up for the stated study period. Non probability sampling technique was utilised. Data was entered in SPSS. Chi-square was used to compare the efficacy between the groups and the confidence interval was set at 95% with a p-value of 0.05 as significant. Results: Efficacy in both groups is insignificant when stratified by age. Males have superior efficacy than females in both groups, despite being statistically insignificant. Efficacy was larger in non-diabetics than diabetics, although not statistically significant. Efficacy was higher in patients who received regular physiotherapy and lower in those who did not receive regular physiotherapy, but this was not significant in either group. Conclusion: Based on our findings, we advocate treating patients with frozen shoulder with platelet rich plasma and steroids for better outcomes. This treatment is safe, in-expensive, and gives instant symptom alleviation and early restoration to virtually full function. Our findings require more randomised, double-blind investigations. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular nerve block and Intraarticular steroid injection in patients with hemiplegic shoulder pain. Study Design: Quasi-experimental study. Place and Duration of Study: Interventional Pain Management Center, Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from Oct 2017 to Apr 2018. Methodology: A total of 60 patients with stroke and shoulder pain on hemiplegic side for at least 2 weeks were included, randomized by lottery into two groups; Group A receiving Suprascapular Nerve block with 5ml of 1% Lignocaine with Group B receiving Intra-articular 40mg Triamcinolone Acetonide plus 1ml of 1% Lignocaine injections. Mean change in pain scores on Visual Analogue Scale was calculated between score at baseline and at 4 weeks post-intervention. Results: Out of a total of 60 subjects, 34 (56.67%) were males and 26 (43.33%) were females. Mean duration of stroke was 7.50 ± 2.66 months. Mean pain change in group A (Suprascapular Nerve block) was 3.83 ± 1.12 cm while in group B (intra-articular steroid injection) was 2.17 ± 0.99 cm (p-value <0.001). Conclusion: Suprascapular Nerve block offered better improvement in hemiplegic shoulder pain on Visual Analogue Scale at 4 weeks as compared to intraarticular steroid injection. [ABSTRACT FROM AUTHOR]

Objective: To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA.Methods: Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome.Results: One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10-1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03-1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04-1.55), anserine tenderness (RR 1.27, 95% CI 1.06-1.52), and a belief that treatment would be effective [RR/unit increase (range 0-10) = 1.05 (1.01-1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66-0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44-0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0-10) = 0.83, 95% CI 0.72-0.97], chronic widespread pain (RR 0.32, 95% CI 0.10-0.98), perceived chronicity of disease [RR/unit increase (range 0-10) = 0.86, 95% CI 0.78-0.94], and a higher depression score [RR/unit increase (range 0-21) = 0.89, 95% CI 0.81-0.99] were less likely to be longer-term responders.Conclusion: Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits. [ABSTRACT FROM AUTHOR]

Objective: To describe a posterolateral fluoroscopy-guided injection technique into the posterior subtalar joint and to report patient outcomes 1 month post-injection. Materials and methods: Twenty-three consecutive adult patients who underwent fluoroscopy-guided injection into the posterior subtalar joint using a direct posterolateral approach and who returned an outcomes-based postal questionnaire after receiving this injection were included. Numerical pain rating scale (NRS) data were collected prior to injection. NRS and Patient's Global Impression of Change (PGIC) scales were completed 1 day, 1 week, and 1 month after injection. The proportion of patients who improved was calculated for each time period. Baseline NRS data were compared to each time point using the Wilcoxon test to assess differences. Spearman's correlation coefficient was used to compare the 20 min NRS score with all follow-up NRS scores. All available images were reviewed for the presence of subtalar osteoarthritis (OA). Patient charts were reviewed to identify characteristics of patients referred for subtalar injections. Risk ratios were calculated comparing presence of OA or other abnormalities with improvement. Results: A posterolateral approach for fluoroscopy-guided injections into the subtalar joint is described. There was a significant reduction in the mean NRS score at all time periods compared to baseline ( p ≤ 0.004). One-third of patients (7/21) reported clinically relevant improvement at 1 month. Conclusions: Fluoroscopy-guided puncture of the posterior subtalar joint using a posterolateral approach is possible. Clinically significant improvement is reported in 33% of patients after 1 month. [ABSTRACT FROM AUTHOR]

Background: Children with arthritis may endure a lifetime of disfigurement, dysfunction, and pain if acute inflammation progresses to chronic changes in the joint cartilage and underlying bone. Intraarticular steroids have become an integral component of treatment, but at times are difficult to deliver to joints, such as the subtalar joint, that have complex anatomies.Objective: We describe our technique and outcomes using fluoroscopically guided intraarticular subtalar steroid injection in patients with active symptoms of juvenile idiopathic arthritis (JIA).Materials and Methods: Fluoroscopically guided subtalar joint injections were performed in 38 children (mean age 6.7 years). Medical records were reviewed retrospectively and improvement was evaluated clinically by the degree of foot movement in eversion and inversion.Results: Subtalar joint injection was technically successful in 100% of the JIA patients with improvement in physical symptoms in 34/38 (89%). Of the 38 children, 32 were followed up within 13 weeks of the initial injection and, therefore, satisfied the eligibility criteria for resolution of arthritis. Of these 32 children, 14 showed clinical resolution (44%). The mean duration of improvement was 1.2 +/- 0.9 years. Children with a longer interval (>1 year) from diagnosis to treatment had significantly less resolution (P = 0.04). Local subcutaneous atrophy or hypopigmentation were observed in 53% of the children after steroid injection (20/38). These minor complications were associated with a greater volume of steroid injected into the site per child (P = 0.02).Conclusion: Fluoroscopically guided subtalar joint injection is an effective treatment for subtalar arthropathy. Prompt referral for intraarticular steroid treatment in the acute phase improves response. Skin changes often occur at the injection site, and specific precautions should be employed to reduce this risk. Prospective study is indicated to determine the most effective treatment strategy to prevent long-term pain and disability. [ABSTRACT FROM AUTHOR]