Frozen ShoulderNCT06129006
Ultrasound Guided Shoulder Anterior Capsular Infiltration Plus Hydrodilatation With Steroid Versus Hyalase in Patients With Frozen Shoulder
A study testing hydrodilatation with steroid in group A versus hyalase in group B in people with Frozen Shoulder, run by Assiut University.
Trial summary
To compare ultrasound-guided shoulder anterior capsular infiltration plus hydrodilatation with a steroid versus hyalase in patients with frozen shoulders Read more about this study
- Who is it for?
- Ages 30 to 70 years
- Conditions the study is for
- Frozen Shoulder
- What is being tested?
- hydrodilatation with steroid in group A versus hyalase in group B
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 50 participants
- Where
- No sites listed yet
- Study dates
- 25 Nov 2023to 5 Dec 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 30 to 70 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
None listed.
Who cannot join
- History of trauma to the shoulder.
- History of fracture or dislocation around the shoulder.
- Inflammatory arthritis
- coagulation disorders
- History of previous injections within three months.
- Cervical radiculopathy.
About this study
To compare ultrasound-guided shoulder anterior capsular infiltration plus hydrodilatation with a steroid versus hyalase in patients with frozen shoulders
Read the detailed description
Frozen shoulder (FS) is a self-limiting pathology of the shoulder joint causing restriction in both the active and passive range of movements associated with pain (Konarski et al., 2020).
A frozen shoulder is a common condition causing severe pain and a reduced range of motion in the shoulder. It can result in detrimental effects on quality of life and the ability to perform activities of daily living (ADLs). It affects 2% to 5% of the global population and is more common in diabetic patients. There are a variety of treatment options available for patients with frozen shoulders as part of the management ladder of interventions. FS may persist for more than three years or may never resolve (Sam et al., 2023).
Conservative management includes physiotherapy, NSAIDs, Hydrodilatation (HD), intra-articular steroids, manipulation under anesthesia, and arthroscopic, or open capsular release. Distension of the shoulder capsule with normal saline and steroid infusion has been suggested to benefit by changing the biochemical properties of the capsule in FS (Cho et al., 2019).
Hydrodilatation of the shoulder joint capsule was a novel treatment to alleviate the pain of the affected shoulder. The procedure may be given with or without an adjuvant corticosteroid. Hydrodilatation, using saline and a corticosteroid, was superior in short-term pain reduction and range of motion improvement compared to management using only physiotherapy and corticosteroid injection in patients treated for frozen shoulder (Prasetia et al., 2022).
The proposed hypothesis regarding the mechanism of action in hydrodilatation and pain reduction in patients with frozen shoulder was associated with synovitis and fibrosis removal. Previous studies also noted better pain reduction in patients receiving hydrodilatation with adjuvant corticosteroid than only corticosteroid injection (Albana et al., 2022).
Several other adjuvants were studied in frozen shoulder treatment using hydrodilatation. The hydrodilatation method can cause pain in the shoulder during the intervention, so early manual exercise after the intervention is required to inhibit pain (Wang et al., 2021).
Hyaluronidases are a family of enzymes that catalyze the degradation of hyaluronic acid. By catalyzing the hydrolysis of hyaluronan, a constituent of the extracellular matrix, hyaluronidase lowers the viscosity of hyaluronan, thereby increasing the tissue permeability of injected solutes (Lee et al., 2021).
Accordingly, hyaluronidase is used in medicine in conjunction with other drugs, including steroids, to speed their dispersion and delivery. There is growing evidence that using a steroid in combination with hyaluronidase in shoulder joints or spinal epidural spaces both maximizes the anti-inflammatory properties of the steroid and minimizes the side effects of steroid therapy (Manna et al., 2020).
- Conditions
- Frozen Shoulder
- Being tested
- hydrodilatation with steroid in group A versus hyalase in group B
- Medical subject headings
- Bursitis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
hydrodilatation with steroid in group A versus hyalase in group BProcedure or surgery
Hydrodilatation technique:
the ultrasound transducer will be placed on the posterior surface of the shoulder in the longitudinal plane to identify the posterior glenohumeral joint, bony glenoid, humeral head, and infraspinatus muscle.Then, after sterilizing the area to be injected, the needle will be advanced to the target point between the humeral head cartilage and the infraspinatus tendon using the ultrasound-guided in-plane technique.To ensure the injection into the glenohumeral joint, the Doppler mode will be used to confirm the widening of the space between the humeral cartilage and the innermost synovial line of the infraspinatus muscle by the injected solution.
| Study group | Role | What they receive |
|---|---|---|
| group A shoulder anterior capsular infiltration plus hydrodilatation with steroids. | Active comparator | 25 patients with frozen shoulders treated with ultrasound-guided shoulder anterior capsular infiltration plus hydrodilatation with steroids. Receives: Procedure: hydrodilatation with steroid in group A versus hyalase in group B |
| groupB shoulder anterior capsular infiltration plus hydrodilatation with hyalase. | Active comparator | 25 patients with frozen shoulders treated with ultrasound-guided shoulder anterior capsular infiltration plus hydrodilatation with hyalase. Receives: Procedure: hydrodilatation with steroid in group A versus hyalase in group B |
What is being measured
The primary outcome is the main question the study is designed to answer.
The Shoulder Pain and Disability Index (SPADI)
The Shoulder Pain and Disability Index (SPADI) will be used to evaluate pain and disability at baseline and 3 weeks, 3 months, and 12 months after the intervention
Measured: baseline and 3 weeks, 3 months, and 12 months after the intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Nov 2023
- Study start25 Nov 2023 (estimated)
- Primary completion24 May 2025 (estimated)
- Study completion5 Dec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for Frozen ShoulderStudies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 50 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ahmed Yehia Mohamed, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06129006
- Sponsor's protocol ID
- frozen shoulder
- Status last verified
- Nov 2023
- First submitted
- 8 Nov 2023
- Last updated
- 13 Nov 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Konarski W, Pobozy T, Hordowicz M, Pobozy K, Domanska J. Current concepts of natural course and in management of frozen shoulder: A clinical overview. Orthop Rev (Pavia). 2021 Jan 28;12(4):8832. doi: 10.4081/or.2020.8832. eCollection 2020 Dec 31.
PubMed 33585024Sam N, Yusuf I, Idris I, Adnan E, Haryadi RD, Hamid F, Usman MA, Johan MP, Zainuddin AA. A Case Series: Effect of Comorbidities on the Outcomes of Prolotherapy Injection for Frozen Shoulder Patients. Int Med Case Rep J. 2023 Apr 28;16:257-263. doi: 10.2147/IMCRJ.S407723. eCollection 2023.
PubMed 37143964Cho CH, Bae KC, Kim DH. Treatment Strategy for Frozen Shoulder. Clin Orthop Surg. 2019 Sep;11(3):249-257. doi: 10.4055/cios.2019.11.3.249. Epub 2019 Aug 12.
PubMed 31475043Prasetia R, Albana R, Herman H, Lesmana R, Chernchujit B, Rasyid HN. Ultrasound-Guided Suprascapular Nerve Block at Spinoglenoid Notch and Glenohumeral Joint Hydrodilation. Arthrosc Tech. 2022 Jun 14;11(7):e1233-e1238. doi: 10.1016/j.eats.2022.03.009. eCollection 2022 Jul.
PubMed 35936858Albana R, Prasetia R, Primadhi A, Rahim AH, Ismiarto YD, Rasyid HN. The role of suprascapular nerve block in hydrodilatation for frozen shoulder. SICOT J. 2022;8:25. doi: 10.1051/sicotj/2022026. Epub 2022 Jun 14.
PubMed 35699461Cravioto A, Reyes RE, Ortega R, Fernandez G, Hernandez R, Lopez D. Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolated pathogens during the first two years of life. Epidemiol Infect. 1988 Aug;101(1):123-34. doi: 10.1017/s0950268800029289.
PubMed 3402544Lee JH, Choi EJ, Han SC, Chung HS, Kwon MJ, Jayaram P, Lee W, Lee MY. Therapeutic efficacy of low-dose steroid combined with hyaluronidase in ultrasonography-guided intra-articular injections into the shoulder for adhesive capsulitis. Ultrasonography. 2021 Oct;40(4):555-564. doi: 10.14366/usg.20199. Epub 2021 Feb 22.
PubMed 34399045
Study at a glance
From the registry record, last updated by the sponsor on 13 Nov 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Ultrasound Guided Shoulder Anterior Capsular Infiltration Plus Hydrodilatation With Steroid Versus Hyalase in Patients With Frozen Shoulder
- ClinicalTrials.gov ID
- NCT06129006
- Acronym / sponsor ID
- frozen shoulder
- Conditions
- Frozen Shoulder
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 50 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- 25 Nov 2023 (estimated)
- Primary completion
- 24 May 2025 (estimated)
- Study completion
- 5 Dec 2026 (estimated)
- First posted
- 13 Nov 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
To compare ultrasound-guided shoulder anterior capsular infiltration plus hydrodilatation with a steroid versus hyalase in patients with frozen shoulders
Detailed description
Frozen shoulder (FS) is a self-limiting pathology of the shoulder joint causing restriction in both the active and passive range of movements associated with pain (Konarski et al., 2020).
A frozen shoulder is a common condition causing severe pain and a reduced range of motion in the shoulder. It can result in detrimental effects on quality of life and the ability to perform activities of daily living (ADLs). It affects 2% to 5% of the global population and is more common in diabetic patients. There are a variety of treatment options available for patients with frozen shoulders as part of the management ladder of interventions. FS may persist for more than three years or may never resolve (Sam et al., 2023).
Conservative management includes physiotherapy, NSAIDs, Hydrodilatation (HD), intra-articular steroids, manipulation under anesthesia, and arthroscopic, or open capsular release. Distension of the shoulder capsule with normal saline and steroid infusion has been suggested to benefit by changing the biochemical properties of the capsule in FS (Cho et al., 2019).
Hydrodilatation of the shoulder joint capsule was a novel treatment to alleviate the pain of the affected shoulder. The procedure may be given with or without an adjuvant corticosteroid. Hydrodilatation, using saline and a corticosteroid, was superior in short-term pain reduction and range of motion improvement compared to management using only physiotherapy and corticosteroid injection in patients treated for frozen shoulder (Prasetia et al., 2022).
The proposed hypothesis regarding the mechanism of action in hydrodilatation and pain reduction in patients with frozen shoulder was associated with synovitis and fibrosis removal. Previous studies also noted better pain reduction in patients receiving hydrodilatation with adjuvant corticosteroid than only corticosteroid injection (Albana et al., 2022).
Several other adjuvants were studied in frozen shoulder treatment using hydrodilatation. The hydrodilatation method can cause pain in the shoulder during the intervention, so early manual exercise after the intervention is required to inhibit pain (Wang et al., 2021).
Hyaluronidases are a family of enzymes that catalyze the degradation of hyaluronic acid. By catalyzing the hydrolysis of hyaluronan, a constituent of the extracellular matrix, hyaluronidase lowers the viscosity of hyaluronan, thereby increasing the tissue permeability of injected solutes (Lee et al., 2021).
Accordingly, hyaluronidase is used in medicine in conjunction with other drugs, including steroids, to speed their dispersion and delivery. There is growing evidence that using a steroid in combination with hyaluronidase in shoulder joints or spinal epidural spaces both maximizes the anti-inflammatory properties of the steroid and minimizes the side effects of steroid therapy (Manna et al., 2020).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| group A shoulder anterior capsular infiltration plus hydrodilatation with steroids. | Active comparator | Procedure: hydrodilatation with steroid in group A versus hyalase in group B25 patients with frozen shoulders treated with ultrasound-guided shoulder anterior capsular infiltration plus hydrodilatation with steroids. |
| groupB shoulder anterior capsular infiltration plus hydrodilatation with hyalase. | Active comparator | Procedure: hydrodilatation with steroid in group A versus hyalase in group B25 patients with frozen shoulders treated with ultrasound-guided shoulder anterior capsular infiltration plus hydrodilatation with hyalase. |
Who may qualify
- Ages
- 30 to 70 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (0 listed)
Key exclusion criteria (6 listed)
- History of trauma to the shoulder.
- History of fracture or dislocation around the shoulder.
- Inflammatory arthritis
- coagulation disorders
- History of previous injections within three months.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| hydrodilatation with steroid in group A versus hyalase in group BHydrodilatation technique: the ultrasound transducer will be placed on the posterior surface of the shoulder in the longitudinal plane to identify the posterior glenohumeral joint, bony glenoid, humeral head, and infraspinatus muscle.Then, after sterilizing the area to be injected, the needle will be advanced to the target point between the humeral head cartilage and the infraspinatus tendon using the ultrasound-guided in-plane technique.To ensure the injection into the glenohumeral joint, the Doppler mode will be used to confirm the widening of the space between the humeral cartilage and the innermost synovial line of the infraspinatus muscle by the injected solution. | Procedure or surgery | group A shoulder anterior capsular infiltration plus hydrodilatation with steroids., groupB shoulder anterior capsular infiltration plus hydrodilatation with hyalase. |
Primary outcome
The Shoulder Pain and Disability Index (SPADI)
Time frame: baseline and 3 weeks, 3 months, and 12 months after the intervention
The Shoulder Pain and Disability Index (SPADI) will be used to evaluate pain and disability at baseline and 3 weeks, 3 months, and 12 months after the intervention
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 13 Nov 2023.
- Background: PubMed 33585024Konarski W, Pobozy T, Hordowicz M, Pobozy K, Domanska J. Current concepts of natural course and in management of frozen shoulder: A clinical overview. Orthop Rev (Pavia). 2021 Jan 28;12(4):8832. doi: 10.4081/or.2020.8832. eCollection 2020 Dec 31.
- Background: PubMed 37143964Sam N, Yusuf I, Idris I, Adnan E, Haryadi RD, Hamid F, Usman MA, Johan MP, Zainuddin AA. A Case Series: Effect of Comorbidities on the Outcomes of Prolotherapy Injection for Frozen Shoulder Patients. Int Med Case Rep J. 2023 Apr 28;16:257-263. doi: 10.2147/IMCRJ.S407723. eCollection 2023.
- Background: PubMed 31475043Cho CH, Bae KC, Kim DH. Treatment Strategy for Frozen Shoulder. Clin Orthop Surg. 2019 Sep;11(3):249-257. doi: 10.4055/cios.2019.11.3.249. Epub 2019 Aug 12.
- Background: PubMed 35936858Prasetia R, Albana R, Herman H, Lesmana R, Chernchujit B, Rasyid HN. Ultrasound-Guided Suprascapular Nerve Block at Spinoglenoid Notch and Glenohumeral Joint Hydrodilation. Arthrosc Tech. 2022 Jun 14;11(7):e1233-e1238. doi: 10.1016/j.eats.2022.03.009. eCollection 2022 Jul.
- Background: PubMed 35699461Albana R, Prasetia R, Primadhi A, Rahim AH, Ismiarto YD, Rasyid HN. The role of suprascapular nerve block in hydrodilatation for frozen shoulder. SICOT J. 2022;8:25. doi: 10.1051/sicotj/2022026. Epub 2022 Jun 14.
- Background: PubMed 3402544Cravioto A, Reyes RE, Ortega R, Fernandez G, Hernandez R, Lopez D. Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolated pathogens during the first two years of life. Epidemiol Infect. 1988 Aug;101(1):123-34. doi: 10.1017/s0950268800029289.
- Background: PubMed 34399045Lee JH, Choi EJ, Han SC, Chung HS, Kwon MJ, Jayaram P, Lee W, Lee MY. Therapeutic efficacy of low-dose steroid combined with hyaluronidase in ultrasonography-guided intra-articular injections into the shoulder for adhesive capsulitis. Ultrasonography. 2021 Oct;40(4):555-564. doi: 10.14366/usg.20199. Epub 2021 Feb 22.
Related trials for Frozen Shoulder
Not yet recruiting
Effects of Clinic Versus mHealth Application-Based Shoulder Rehabilitation in Patients With Adhesive Capsulitis
Adhesive Capsulitis
Active, not recruiting
Effects of Injection Combined With Spencer Technique on Painful Frozen Shoulder
Frozen Shoulder
Not yet recruiting
Effect of Hormone Replacement Therapy on Physiotherapy Outcomes in Postmenopausal Women With Frozen Shoulder
Frozen Shoulder, Adhesive Capsulitis
Not yet recruiting
Effects of Posterior Capsular Stretching With and Without Dynamic Neuromuscular Stabilization Exercises in Frozen Shoulder
Frozen Shoulder
RecruitingPhase 4
Ultrasound-Guided Intra-Articular vs Gluteal Intramuscular Corticosteroid Injection for Frozen Shoulder
Frozen Shoulder
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A study testing hydrodilatation with steroid in group A versus hyalase in group B in people with Frozen Shoulder, run by Assiut University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 0 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 13 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The Shoulder Pain and Disability Index (SPADI) (time frame: baseline and 3 weeks, 3 months, and 12 months after the intervention). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06129006, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Nov 2023.