Shoulder Anterior Capsular Block and Intraarticular Steroid Injection Versus Intraarticular Steroid Injection for Enhancing Pain Relief in Adhesive Capsulitis

Comparing between combined shoulder anterior capsular block and intraarticular steroid injection versus intraarticular steroid injection for enhancing pain relief in adhesive capsulitis as regards:

• To measure analgesic parameters including: assessment of pain score by using Visual Analogue Score during 8 weeks follow up in comparison to baseline and total amount of rescue analgesic (ibuprofen) consumption.
• To assess the Shoulder pain and Disability Index
• To record complications of the block (local anesthetic toxicity, infection, bleeding, nerve injury)
• Over all patient's satisfaction: The patients will be asked to rate the overall degree of satisfaction of the analgesia by using a 5-points likert-like verbal scale (1 = very dissatisfied analgesia, 2 = dissatisfied analgesia, and 3 = neutral, 4=satisfied analgesia, and 5=very satisfied analgesia).

Inclusion criteria

• Patients acceptance
• Age: 41-65 years old
• Sex: both sex (males or females).
• Physical status: American Society of Anesthesiologist (ASA) І, II.
• Patients attend orthopedic or pain clinic with complaint of shoulder pain and stiffness. These patients received conservative management of pain with no relief of symptoms for at least 2 weeks.

Exclusion criteria

• Shoulder pain due to secondary causes, e.g. acute trauma, fractures, bony deformity, glenohumeral joint pathology, acromioclavicular joint pathology and rotator cuff disorder.

• Patient with any contraindications of regional blocks (as coagulopathy or local infection at injection site)
• Patients with known history of allergy to the study drugs (bupivacaine and methylprednisolone).
• Advanced hepatic, renal, cardiovascular, neurologic and respiratory diseases, uncontrolled diabetes mellitus and thyroid.
• History of neuropathy in the involved limb or previous revision surgery.