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Ultrasound Guıded Multisıte Injectıon Technıque in the Treatment of Frozen Shoulder

ABSTRACT: Frozen shoulder (FS) is an elusive condition that affects patients’ mental and emotional quality of their lives. Corticosteroid injection technique is one of the first-line treatment methods in the treatment of FS. Ultrasound (USG) guidance allows visualization of the shoulder anatomy and improves the accuracy of the injection site. This study describes an USG-guided injection technique for FS treatment. The aim of this technique was to affect glenohumeral joint and capsule, subacromial space, the long head of biceps tendon sheath, and the coracohumeral ligament. For this purpose, four different sites were injected by USG guidance. Patients with FS can be effectively treated through this technique that is detailed in this article. Technique Video Video 1 This video shows ultrasound-guided multisite injection technique. A 45-year-old male patient with frozen shoulder in a left shoulder is in a sitting position with the hands on the thighs. Anatomical landmarks are marked. Ultrasonographic examination are performed. Drug solution is prepared. After ultrasonographic examination, intrarticular and posteroinferior capsule injection is administered posteriorly in a sterile manner, while screening the glenohumeral joint and capsule by the transducer. Then, the posterosuperior capsule is injected from 2 cm proximal to the midpoint of the spina scapula from the supraspinatus fossa, when the probe is placed posterior aspect of the shoulder. Finally, for the subacromial space injection by lateral approach, the long head of biceps tendon sheath and coracohumeral ligament injections by anterior approach are applied under real-time ultrasound guidance.

SUBMITTER: Koraman E

PROVIDER: S-EPMC9596867 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Project description:IntroductionFrozen shoulder is a common, fibro-proliferative disease characterised by the insidious onset of pain and progressively restricted range of shoulder movement. Despite the prevalence of this disease, there is limited understanding of the molecular mechanisms underpinning the pathogenesis of this debilitating disease. Previous studies have identified increased myofibroblast differentiation and proliferation, immune cell influx and dysregulated cytokine production. We hypothesised that subpopulations within the fibroblast compartment may take on an activated phenotype, thus initiating the inflammatory processes observed in frozen shoulder. Therefore, we sought to evaluate the presence and possible pathogenic role of known stromal activation proteins in Frozen shoulder.MethodsShoulder capsule samples were collected from 10 patients with idiopathic frozen shoulder and 10 patients undergoing shoulder stabilisation surgery. Fibroblast activation marker expression (CD248, CD146, VCAM and PDPN, FAP) was quantified using immunohistochemistry. Control and diseased fibroblasts were cultured for in vitro studies from capsule biopsies from instability and frozen shoulder surgeries, respectively. The inflammatory profile and effects of IL-1β upon diseased and control fibroblasts was assessed using ELISA, immunohistochemistry and qPCR.ResultsImmunohistochemistry demonstrated increased expression of fibroblast activation markers CD248, CD146, VCAM and PDPN in the frozen shoulder group compared with control (p < 0.05). Fibroblasts cultured from diseased capsule produced elevated levels of inflammatory protein (IL-6, IL-8 & CCL-20) in comparison to control fibroblasts. Exposing control fibroblasts to an inflammatory stimuli, (IL-1ß) significantly increased stromal activation marker transcript and protein expression (CD248, PDPN and VCAM).ConclusionsThese results show that fibroblasts have an activated phenotype in frozen shoulder and this is associated with inflammatory cytokine dysregulation. Furthermore, it supports the hypothesis that activated fibroblasts may be involved in regulating the inflammatory and fibrotic processes involved in this disease.

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Ultrasound Guıded Multisıte Injectıon Technıque in the Treatment of Frozen Shoulder

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