frozen shoulder - Glenohumeral IA vs subacromial bursa

[Timeoutofmind]

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Seems there are people doing either of these for frozen shoulder without much rhyme or reason.

Maybe some of the PMR folks could chime in as far as what is more appropriate?

Do u typically combine with suprascapular?

 

[SSdoc33]

Seems there are people doing either of these for frozen shoulder without much rhyme or reason.

Maybe some of the PMR folks could chime in as far as what is more appropriate?

Do u typically combine with suprascapular?

do an early intra-articular. some advocate for high-volume, but the pathology is in the joint. go intra-articular

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268082/

 

[Taus]

If pain limiting aggressive rom in PT go fluoro or us guided intra artic joint.


I've heard of some adding supra scap block but not familiar w lit or benefit for this indication. Not common to do though.


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[freddydpt]

Intraarticular high volume meaning up to 15 cc include at least 8 cc of local. If you have a mechanism to warm the solution do that, too. Then mobilize it as a PT would to break adhesions. Tried it a couple times. Works very well. Patients tend to be anxious about it but in the end it works well. I'd love to do a study on this procedure.

 

[slinte]

Has anyone heard about legal cases in regards to intrarticular chondrotoxicity from injections?

 

[Dr. Ice]

Has anyone heard about legal cases in regards to intrarticular chondrotoxicity from injections?

Don't use bupivavaine. I find the high volume injection concept interesting. Doesn't the large volume of injectate run the risk of irritating the joint more?

 

[lobelsteve]

Chondrotoxicity is concentration dependent. Greater than .25%bupi or 1% lido are toxic. But less was not. And still numbs the tissues.

 

[Doctodd]

Chondrotoxicity is concentration dependent. Greater than .25%bupi or 1% lido are toxic. But less was not. And still numbs the tissues.

Id ask you for studies, but i wont read them. But based on cartilage toxicity studies, I dont ever use bupivacaine unless im doing mbb's where i want to fry the nerve.

 

[lobelsteve]

http://www.healio.com/orthopedics/a...ons-of-local-anesthetics-how-much-is-too-much

 

[jesspt]

do an early intra-articular. some advocate for high-volume, but the pathology is in the joint. go intra-articular

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4268082/

I listened to an Adhesive Capsulitis webinar a while back. Jo Hannafin was one of the moderators. Early IA injections was her recommendation and I think this was echoed by most of her HSS colleagues. here's a link to one of their studies:

http://www.drrmarx.com/pdf/Intra-ar...athic-Adhesive-Capsulitis-of-the-Shoulder.pdf

 

[Doctodd]

http://www.healio.com/orthopedics/arthroscopy/news/print/orthopedics-today/{168f1bc3-a516-43e1-af4a-506e93ebfb27}/intra-articular-injections-of-local-anesthetics-how-much-is-too-much

Ok so u got me.....i read it. Good read. I use diluted 0.5% PF lido for everything except RF....0.5% bupiv for that.

 

[epidural man]

Suprascapular for this. Try it - you will likely be surprised.

 

[Timeoutofmind]

Ok so u got me.....i read it. Good read. I use diluted 0.5% PF lido for everything except RF....0.5% bupiv for that.

PF in joints? Why?

 

[Doctodd]

so i dont have to buy different lido bottles

 

[IN2B8R]

If you only do an IA injection for these, then you will not get sufficient analgesia to all patients to participate in aggressive PT--which is the ultimate treatment for adhesive capsulitis. This is the reason why many people do combined IA injection with suprascapular nerve block. As for what to inject IA: surgeons routinely inject IA high concentrations of LA post RCR/SAD/labrum repairs without fear of chondrotoxicity. Guarantee you that we would see a lot more cases of chondrotoxicity post-op if this was the case....there's more to this than what we know....


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[Doctodd]

my approach to frozen shoulder injections is usually regenerative, so i wont be much help with these

 

[ateria radicularis magna]

my approach to shoulder injections is usually regenerative, so i wont be much help with these

What product do you use?

 

[Doctodd]

What product do you use?

the patient's product

 

[ateria radicularis magna]

the patient's product

Prp? How did you first get into this? Who pays for it? Have you compared it to other products out there in "regenerative medicine"?
Just curious.
Thank you!

 

[bedrock]

I like regenerative medicine, but I'm not sure it's necessary for frozen shoulder unless they failed a GH steroid injection + PT.

 

[nvrsumr]

I also am confused about the reasoning behind regen med injection for adhesive capsulitis. Had a patient I considered doing it for but changed gears and went for subscap insertion.

 

[lonelobo]

I also am confused about the reasoning behind regen med injection for adhesive capsulitis. Had a patient I considered doing it for but changed gears and went for subscap insertion.

Agreed not sure how this would help?

 

[IN2B8R]

Many surgeons who operate on shoulders inject PRP intra-op. If a patient ends up with a frozen shoulder post-op, I fail to see how more PRP is going to help....


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