title: Usefulness of a Hanging Position With Internal Rotation of Shoulder in Ultrasonography-Guided Intra-articular Steroid Injection for Adhesive Capsulitis.
abstract: OBJECTIVE
  To evaluate the feasibility of a new position (internal rotation in hanging) in ultrasonography, we compared the length of the glenohumeral joint space and the effectiveness of steroid injection with the hanging position and with the commonly used abdomen or cross position.
  
  
  METHODS
  A prospective, randomized controlled trial was performed in 42 patients with adhesive capsulitis of shoulder. We used three arm positions for the posterior approach as follows: the patient's palm on thigh, other hand on abdomen (abdomen position); hand on patient's opposite shoulder (cross position); arm in hanging position with internal rotation of shoulder (hanging position). The order of shoulder position was randomized and blinded. Real-time ultrasonography-guided intra-articular steroid injection was performed by posterior approach at the first position in each patient. The Brief Pain Inventory (BPI), the Shoulder Pain and Disability Index (SPADI), and range of motion (ROM) were measured before steroid injection and 2 weeks after injection.
  
  
  RESULTS
  The lengths of the joint space were 2.88±0.75, 2.93±0.89, and 2.82±0.79 mm in abdomen, cross, and hanging position respectively, with no significant difference among the three positions (p=0.429). Treatment efficacy was significantly improved in ROM, total BPI, and SPADI in all three positions (p<0.001). The changes in ROM for shoulder abduction were 23.6°±19.7°, 22.2°±20.9°, and 10.0°±7.8° in abdomen, cross, and hanging position, respectively. Changes in total BPI scores were 25.1±15.7, 23.6.±18.0, 11.6±6.1, and changes in total SPADI score were 35.0±14.2, 30.9±28.9, and 16.5±10.3 in abdomen, cross, and hanging position, respectively. There were no significant difference among the three positions for all parameters (p=0.194, p=0.121, and p=0.108, respectively.
  
  
  CONCLUSIONS
  For patients with adhesive capsulitis who cannot achieve or maintain abdomen or cross position, scanning and injection with the shoulder in internal rotation with hanging position may be a useful alternative.
authors.affiliation: Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Gyeongsang National University Graduate School of Medicine, Jinju, Korea.
authors.forename: Chang Han
authors.identifier: 0000-0001-8351-5226
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.; Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hyung Seok
authors.identifier: 0000-0002-2210-7170
authors.initials: HS
authors.lastname: Nam
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Shi-Uk
authors.identifier: 0000-0003-0850-5217
authors.initials: SU
authors.lastname: Lee
keywords: Adhesive capsulitis; Intra-articular injections; Posture; Ultrasonography