Corticosteroid Injections For Frozen Shoulder: A Global Online Survey Of Health Professionals’ Current Practice And Opinion

Background: Frozen shoulder is a disabling condition characterised by persistent and severe pain and loss of shoulder movement. Corticosteroid injections
are targeted at reducing pain in the earlier painful phase (Ahn et al., 2018; Sun, Liu, Chen, & Chen, 2018). Currently, there are no clear guidelines regarding
medicines and dose to inject and if this should be under ultrasound or landmark guidance or if an injection should even be considered. This uncertainty
results in a range of methods of injections for frozen shoulder.

Purpose: To investigate the current practice and opinion of global healthcare providers on injections for frozen shoulder.

Methods: Methods
An online questionnaire survey was used to investigate current practice and opinions on injections for frozen shoulder. The survey used JISC
https://www.onlinesurveys.ac.uk/ and was disseminated via the social media platform Twitter™. It was available for 5 weeks in spring 2022. Further
recruitment involved sharing the link once completed creating a ‘snowball’ effect.
Results: The total number of respondents was 235 from 33 different countries across 6 continents of which (n=213, 90.6%) were Physical
Therapists/Physiotherapists. Other professions were Orthopaedic Consultant (n=10, 4.3%), Sports and Medicine Doctor (n=4, 1.7%), Osteopath (n=3, 1.3%),
Physiatrist (n=2, 0.9%), myotherapist (n=1, 0.4%), Radiologist (n=1, 0.4%), Sonographer (n=1, 0.4%).
Most people (n=154, 65.5%) reported seeing between one and two cases of FS a week.
Only (n=35, 14.9%) respondents neither injected nor referred for injection.
The majority (n =155, 66%) reported injections have an important role in the management of frozen shoulder and 191 (81.3%) reported that corticosteroid
injections are best administered only during the pain greater than stiffness phase. The glenohumeral joint (GHJ) was most frequently reported as the site to
inject (n=136, 57.9%).
Triamcinolone Acetonide (TA) was the most frequently reported (n=66, 28.1%) corticosteroid to inject the GHJ and of these, the most frequently reported
dose was 40 mg/ml (n= 52, 78.8%). Doses ranged from 10mg/ml to 40mg/ml.
Triamcinolone Acetonide was the most frequently reported (n=44, 18.7%) substance to inject for the subacromial space and of these, the most frequently
reported dose was 40mg/ml (n=27, 61.4%). Doses ranged from 10mg/ml to 40mg/ml.
Lidocaine was the most frequently reported anaesthetic: GHJ (n= 109, 46.4%).
Of those who expressed an opinion (n=96, 40.7%) reported the injection should be performed under ultrasound guidance.
Conclusion(s): There was overall consensus for the use of corticosteroid injections in frozen shoulder. However, the wide variety of doses and lack on
convincing consensus on method of delivery, mirrors the uncertainty in the literature. In some respects, the delivery of injection therapy is probably based
on personal preference or local guidance in the absence of universally agreed guidance.
Further research should investigate medicine, dose, and method of delivery of corticosteroid injection. Other treatments such as hydrodistension or
suprascapular nerve blocks were reported by respondents, and it would be of value to investigate current practice and opinion for both interventions.
Implications: This survey highlights the need for injectors to ensure they are benchmarking their practice against current best evidence whilst
acknowledging there are gaps in the literature.
Keyword 1: Online survey
Keyword 2: Corticosteroid injections
Keyword 3: Frozen shoulder
Funding acknowledgements: No funding was received for this project.
Did this work require ethics approval?: Yes
Institution: University of Hertfordshire
Ethics committee: University of Hertfordshire ECDA
Ethical approval number: Ethical approval was granted by Ref: HSK PRG UH 04693
Has any of this material been/due to be published or presented at another national or international conference prior to the World
Physiotherapy Congress 2023?: No
Consent: Yes
Consent: Yes