title: Effects of Ultrasound-guided intra-articular ketorolac injection with capsular distension.
abstract: OBJECTIVE
  Frozen shoulder is a painful condition with gradual onset and loss of range of motion in the glenohumeral joint. To investigate the efficacy of ultrasound(US)-guided intra-articular (IA) ketorolac injection with capsular distension compared with steroid injection alone in patients with frozen shoulder by assessing pain relief, functional improvements, and range of motion at 1,3 and 6 months after the last injections.
  
  
  METHODS
  Between January 2009 and December 2012, 121 patient were treated with US-guided IA steroid injection or IA ketorolac injection with capsular distension for frozen shoulder. Patients (n= 57) of US-guided IA steroid injection group were administered with a mixture of 0.5% lidocaine (4 ml) plus triamcinolone (40 mg/ml; 1 ml) and patients (n= 64) of US-guided IA ketorolac injection with capsular distension group were administered by using 0.5% lidocaine (19 mL) plus ketorolac (30 mg/ml; 1 mL) for capsular distension. Outcome measurement was assessed by Shoulder Pain and Disability Index (SPADI), Verbal Numeric pain Scale (VNS) and passive range of motion (ROM) before injections and at 1, 3 and 6 months after the last injections. We regarded the outcomes as a success if patients obtained significant pain relief (as measured by > 50% improvement in the VNS score and 20 point improvement in the SPASI) at 1, 3 and 6 months after the last injections.
  
  
  RESULTS
  SPADI, VNS and passive ROM were improved 1, 3 and 6 months after the last injections in both groups. The statistical differences were not observed in SPADI, VNS between groups (p< 0.05). Successful treatment rate were not significantly different between the groups as well as in 1, 3 and 6 month outcomes. However, greater improvement was found in a matter of range of motion in patients receiving IA ketorolac injection with capsular distension than participants receiving US-guided IA steroid injection alone. Significant differences in improvement at 3 and 6 months were observed for shoulder passive abduction and external rotation (p< 0.05).
  
  
  CONCLUSIONS
  IA ketorolac injection with capsular distension was shown to be a treatment method as effective as the steroid injection alone in pain relief and functional improvement in patient with frozen shoulder and more improvement in passive abduction and external rotation than steroid injection alone at 3 and 6 months.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, South Korea.
authors.forename: Jae Ki
authors.initials: JK
authors.lastname: Ahn
authors.affiliation: Department of Family Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, South Korea.
authors.forename: Jongwoo
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Physical Medicine and Rehabilitation, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, South Korea.
authors.forename: Sang Jae
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, South Korea.
authors.forename: Yongbum
authors.initials: Y
authors.lastname: Park
authors.affiliation: Institute of Rehabilitation Medicine, SRC Rehabilitation Hosipital Gwangju, Gyeonggi-do, South Korea.
authors.forename: Byung
authors.initials: B
authors.lastname: Bae
authors.affiliation: Department of Anesthesiology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, South Korea.
authors.forename: Woo
authors.initials: W
authors.lastname: Lee
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002062:Bursitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000187:drug effects*; D012785:Shoulder Joint / Q000000981:diagnostic imaging*; D020069:Shoulder Pain / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020910:Ketorolac
keywords: Frozen shoulder; ketorolac; steroid