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Adhesive capsulitis (AC) is a significant cause of chronic shoulder pain and disability. Non-surgical option consisting of intraarticular corticosteroid (IA CS) injection with structured physiotherapy (PT) is the current standard of care. More recent randomized controlled trials have found that rotator interval (RI) hydro-dissection approach leads to better improvement in pain as compared to IA approach. Despite being non-inferior to surgical management, long-term outcome studies of patients treated with IA CS injection and PT have shown that patients only achieve satisfactory outcomes in 72.3% of patients after a mean symptom duration of 41.8 months. Furthermore, CS injections are associated with significant systemic and local adverse effects such as Cushing syndrome, osteopenia/ osteoporosis, infection, and hyperglycemia. In recent years, dextrose injection has emerged as an effective alternative to CS-based injections to treat chronic painful musculoskeletal conditions such as chronic low back pain, peripheral nerve entrapment and lateral epicondylitis.
The investigators aim to study the effects of RI hydro-dissection with dextrose 5% (D5%) on pain relief, shoulder ROM and shoulder function in patients with primary AC.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dextrose 5% | Experimental | Rotator interval hydro-dissection with dextrose 5% solution |
|
| Corticosteroid | Active Comparator | Rotator interval hydro-dissection with corticosteroid solution |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Rotator interval hydro-dissection with dextrose 5% | Drug | Single injection of 20ml dextrose 5% into the rotator interval around the long head biceps tendon under ultrasound guidance using a 11-14 Hz frequency linear probe |
| Measure | Description | Time Frame |
|---|---|---|
| Shoulder pain | Shoulder pain based on Shoulder Pain and Disability Index (SPADI) pain scale. The SPADI pain scale ranges from 0 to 50, with higher score indicating greater level of pain. | 1 week, 4 weeks and 12 weeks post injection |
| Measure | Description | Time Frame |
|---|---|---|
| Shoulder range of motion | Shoulder range of motion in flexion, abduction, external rotation, internal rotation | 4 weeks and 12 weeks post injection |
| Shoulder function | Shoulder function based on Shoulder Pain and Disability Index (SPADI) disability scale. The SPADI disability scale ranges from 0 to 80, with higher score indicating greater level of disability. |
| Measure | Description | Time Frame |
|---|---|---|
| Adverse events | Adverse events during or after injection | from time to injection up till 1 week post injection |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Richard Teo | Contact | richardskteo@ummc.edu.my |
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| ID | Term |
|---|---|
| D002062 | Bursitis |
| ID | Term |
|---|---|
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
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| Rotator interval hydro-dissection with corticosteroid solution | Drug | Single injection of 20ml corticosteroid solution (1 ml triamcinolone 40 mg/ml + 19 ml saline 0.9%) into the rotator interval around the long head biceps tendon under ultrasound guidance using a 11-14 Hz frequency linear probe |
|
| 4 weeks and 12 weeks post injection |