A Prospective Randomized Study Comparing the Efficacy of Electrotherapy to Ultrasound - Guided Intra-Articular Steroid Injections for Frozen Shoulder

Abstract

Background: Frozen shoulder (adhesive capsulitis) is a disabling condition marked by pain and restricted range of motion (ROM). This study compares the effectiveness of electrotherapy (ET) and ultrasound-guided intra-articular steroid injections (UG-IASI), two common non-operative treatments.

Materials and methods: In this prospective, randomized trial, 60 patients with unilateral Frozen shoulder were assigned to either ET (n = 30) or UG-IASI (n = 30). Outcomes were assessed at baseline, 1, 3, and 6 months, and 1 year using the shoulder pain and disability index (SPADI) and ROM measurements. Statistical analyses included mixed-effects models and subgroup analysis for diabetes.

Results: UG-IASI resulted in significantly greater SPADI and ROM improvements than ET at 1, 3, and 6 months (P < 0.05). By 1 year, the difference was no longer significant. UG-IASI showed notable gains in abduction and flexion. Diabetic patients experienced reduced improvements across both groups.

Conclusion: UG-IASI provides superior early and mid-term outcomes in pain relief and shoulder function compared to ET. While long-term differences narrow, early intervention with UG-IASI supports faster recovery. A tailored approach, considering comorbidities and patient needs, is recommended for optimal care.

Keywords: Frozen shoulder; adhesive capsulitis; electrotherapy; range of motion; shoulder pain and disability index; steroid injection.

Figure 1

Electrotherapy modalities used in the management of shoulder periarthritis. (a) Patient receiving interferential therapy with electrodes placed over the affected shoulder region. (b) Application of therapeutic ultrasound therapy to the shoulder by a physiotherapist for targeted soft tissue stimulation.

Figure 2

Ultrasound-guided intra-articular steroid injection technique in frozen shoulder. (a) Patient positioned for ultrasound-guided injection into the shoulder joint with the transducer placed over the anterior aspect. (b) Injection being administered into the Gleno-humeral and subacromial-subdeltoid (SASD) region under real-time ultrasound visualization. (c) Ultrasound image demonstrating the anatomical structures involved, with clear delineation of the deltoid muscle, supraspinatus tendon, and SASD bursa and the red arrow mentioned is glenohumeral joint intra-articular steroid injection site. (d) Annotated image showing the targeted SASD injection site region (outlined) between the deltoid muscle and supraspinatus tendon. The intraarticular steroid injection site is indicated by a pale yellow arrow; the supraspinatus tendon is marked with a green outline, and the humeral head as labeled.

Figure 3

Sonographic guidance and confirmation during subacromial-subdeltoid injection. (a) Ultrasound image showing the needle track advancing toward the subacromial-subdeltoid (SASD) region which is marked with red arrow. (b) Post-injection view demonstrating fluid distension in the SASD space, confirming accurate intra-bursal delivery of the injectate.

Figure 4

Assessment of various shoulder range of motion using a universal goniometer in an elderly female patient after-ultrasound-guided intra-articular steroid injection.

Figure 5

Assessment of various shoulder range of motion using a universal goniometer in an elderly female patient after -electrotherapy.

Graph 1

Shoulder pain and disability index (SPADI) score comparison line graph comparing SPADI scores for ultrasound-guided intra-articular steroid injection and electrotherapy groups at multiple time points. Intra-articular steroid injection showed significantly better pain relief and functional improvement, especially in the first 6 months.