Clinical Effect Observation On Ultrasound-guided Intra-articular And Coracohumeral Ligament Injection In Frozen Shoulder

Background:Frozen shoulder(Adhesive Capsulitis)is a common cause of shoulder pain and disability.Single treatment cannot completely cure frozen shoulder,and currently combined treatment is mostly used.In the development of frozen shoulder,intra-articular inflammation and capsular contracture are the main pathological mechanisms and coracohumeral ligament also plays an important role in the development of frozen shoulder,but it is often overlooked.Existing studies have shown that thickening and decreasing elasticity of coracohumeral ligament can assist the diagnosis of frozen shoulder.In addition to assisting the diagnosis,completely releasing coracohumeral ligament can also improve shoulder pain and disability of frozen shoulder patients.But this treatment destroys the integrity of coracohumeral ligament,thus affecting the stability of shoulder joint.According to our previous studies,injection of coracohumeral ligament can still improve shoulder pain and disability of frozen shoulder patients,but there is no more favorable evidence at present.Objective: To compare the clinical effect of ultrasoud-guided intra-articular combined with coracohumeral ligament glucocorticoid injection with ultrasoud-guided intra-articular glucocorticoid injection alone in the treatment of frozen shoulder.Methods: A total of 64 patients with frozen shoulder admitted to the Rehabilitation department of Affiliated Hospital of Sichuan Nuring Vocational College from September 2019 to June 2020 were randomly divided into the experimental group(IA+CHL group)and the control group(IA group),with 32 patients in each group.The IA+CHL group received two consecutive ultrasound-guided intra-articular injection combined with coracohumeral ligament injection,while the IA group received two consecutive ultrasound-guided intra-articular injection.The shoulder passive range of motion(PROM)including abduction,flexion,external rotation and extension,The 11-point numeric rating scale(NRS)and Shoulder pain and disability index(SPADI)were evaluated before treatment(T0),1 week after the first treatment(T1),1 week after the second treatment(T2),and 10 weeks after the second treatment(T3).Results: there was no significant difference in the age,course,sex,diabetes mellitus and hyperthyroidism baseline characteristics between the IA+CHL group and the IA group(t=0.050,0.078;χ2=0.068,0.571,1.016;P=0.961,0.938,0.794,0.450,0.313).There were no significant differences in flexion,abduction,extension,external rotation,NRS and SPADI of before-treatment in two groups(t=0.257,0.678,0.542,0.942,1.542,1.116;P=0.798,0.500,0.590,0.350,0.129,0.269).Intra-group comparison showed that flexion,abduction,extension,external rotation,NRS and SPADI at each time point after treatment was significantly improved in IA+CHL group(F=49.155,83.311,120.063,97.198,278.385,387.034;P=<0.001,<0.001,<0.001,<0.001,<0.001,<0.001).The situation in the IA group was similar to that in the IA+CHL group(F=46.494,57.554,74.240,46.204,234.175,339.095;P=<0.001,<0.001,<0.001,<0.001,<0.001,<0.001).Comparison between groups,Time and groups were no interaction effect in flexion,abduction and NRS(F=1.627,0.004,1.945;P=0.207,0.960,0.135).Time and groups had interaction effects in extension,external rotation and SPADI(F=22.196,25.310,9.730;P=<0.001,<0.001,0.001).Extension at T1,T2 and T3 after treatment were significantly increased in IA+CHL(t=3.660,4.307,4.584;P=0.001,<0.001,<0.001).External rotation of the IA+CHL group was the same(t=3.124,3.380,3.656;P=0.003,0.001,0.001).There was no significant difference in SPADI between IA+CHL group and IA group at T1 and T2(t=0.371,1.157;P=0.712,0.252),and at T3,SPADI in IA+CHL group was significantly lower than the IA group(t=2.125,P=0.0.38).There were no allergic reactions in the two groups during the treatment,2 and 1patients in the IA+CHL group and IA group respectively showed facial flushing,and 1 patient in the IA+CHL group and IA group each showed increased pain and gradually relieved pain after 1 day.No serious adverse reactions occurred in the two groups.Conclusion: Ultrasound-guided intra-articular injection and Ultrasound-guided intra-articular injection combined with coracohumeral ligament injection can effectively improve patients with frozen shoulder pain and dysfunction,and combined with coracohumeral ligament injection in the extension and external rotation function is more significant.For patients with obvious extension and external rotation restriction,combined coracohumeral ligament injection may achieve better clinical efficacy and The operation is simple,safe and worthy of clinical application.