title: Thawing frozen shoulder by steroid injection.
abstract: Frozen shoulder is not an uncommon disorder, and steroid injection into the glenohumeral (GH) joint is one of the most well-known approaches for the frozen shoulder. However, their results have been varied with beneficial effects or no additional advantage. With the understanding about the pathological changes taking place in frozen shoulder and the biomechanics involved, we wanted to evaluate the short- and long-term efficacy of steroid injection by a novel three-site (NTS) injection technique and compare it with the single-site injection (SSI).
  
  
  
  This was a prospective study with 85 patients including all stages and randomized into two groups. SSI group received steroid injection through posterior approach. NTS group received the same dose of steroid in diluted doses at three sites (posterior capsule, subacromial and subcoracoid). Second sitting was repeated after 3 weeks. Both groups had received the same physiotherapy. The patients were evaluated by CONSTANT score at initial, 3 week, 6 week and 6 month.
  
  
  
  NTS group patients had significant pain relief and early improvement in activities of daily living ( p < 0.005). Both groups had improvement in shoulder movements but with NTS group, early near-normal scores were attained and sustained after 6 months. About 43% in SSI group could not attain near-normal levels and had relapses.
  
  
  
  The three-site approach to steroid instillation in frozen shoulder is a safe method and provides early recovery and better improvement in shoulder function with less relapses.
authors.affiliation: 1 Department of orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.
authors.forename: Narendran
authors.initials: N
authors.lastname: Pushpasekaran
authors.affiliation: 2 Department of orthopaedics. Central Institute of Orthopaedics, V.M.M.C & Safdarjang Hospital, New Delhi, India.
authors.forename: Narender
authors.initials: N
authors.lastname: Kumar
authors.affiliation: 2 Department of orthopaedics. Central Institute of Orthopaedics, V.M.M.C & Safdarjang Hospital, New Delhi, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Chopra
authors.affiliation: 3 Department of Physical and Medical Rehabilitation, V.M.M.C & Safdarjang Hospital, New Delhi, India.
authors.forename: Diganta
authors.initials: D
authors.lastname: Borah
authors.affiliation: 1 Department of orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Arora
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D002062:Bursitis / Q000188:drug therapy*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone
keywords: CONSTANT score; frozen shoulder; novel three-site technique; steroid instillation