The Predicting Value Of MRI In The Effect Of Corticosteroid Injection In Early Stage Frozen Shoulder

Objective: To observe the clinical effect of early stage frozen intra-articular corticosteroid injection,and to explore the predicting value of MRI of shoulder joint before injection in pain relief.Methods: From October 2019 to June 2021,a total of 89 patients with early stage frozen shoulder were clinical diagnosed（38 males and 51 females;aged38 ～ 72 years）.All patients received intraarticular corticosteroid injection.Visual analogue scale of shoulder pain（VAS）,shoulder range of motion（ROM）,Constant Murley score（CMS）and shoulder pain and function index（SPADI）were used to evaluate the efficacy of patients before injection and 1,3 and 6months after injection.According to the VAS score before and 1 month after injection,all patients were divided into two groups,pain relief group（n = 53）and non pain relief group（n = 36）.The MRI findings before injection,including the thickness of coracohumeral ligament（CHL）,rotator interval（RI）and axillary capsule,as well as the fat triangle under coracoid process.All patients were followed up regularly after injection.The degree of shoulder pain was evaluated by VAS,the degree of shoulder activity range was evaluated by ROM,and the comprehensive shoulder function was evaluated by CMS and SPADI.The preoperative and postoperative indexes were statistically analyzed,and the indexes before injection between the two groups were compared and analyzed by multivariate logistic regression.Results: All patients achieved good pain relief and functional recovery after injection,and there were no complications such as intra-articular infection occuring.The VAS score improved from 7.84 ± 0.7 before injection to 5.16 ±0.74 one month after injection（P < 0.01）;The range of motion of shoulder joint was improved from 105.44 ± 16.04° before injection to 136.54 ± 19.25°degrees one month after injection（P < 0.01）;Abduction improved from 70.48± 24.00° before injection to 98.76 ± 26.80° one month after injection（P <0.01）;External rotation improved from 19.61 ± 4.95° before injection to 29.45± 6.86° one month after operation（P < 0.01）;CMS improved from 37.98 ± 9.19 before injection to 56.33 ± 11.16 after injection（P < 0.01）;SPADI improved from 60.27 ± 10.25 before injection to 41.62 ± 11.74 one month after injection（P < 0.01）.The external rotation angle of patients in the pain relief group was significantly better than that in the non pain relief group one month after injection,and there was no significant difference in other clinical indexes between the two groups;The thickness of CHL,joint capsule thickness of rotator cuff space,joint capsule thickness of axillary joint capsule and fat triangle under coracoid process were compared between the two groups.The CHL of the pain relief group was thicker than that of the non pain relief group（3.87±1.18 mm vs 3.13±1.41mm）,and the results were statistically significant（P =0.009）.There was no significant difference in other preoperative MRI indexes.Logistic regression was used to analyze the relationship between pain relief and various indexes before injection.The results showed that the thickening of CHL before injection was the protective factor of obvious pain relief.Conclusion: The effect of early stage frozen shoulder intra-articular corticosteroid injection is accurate;The thickening of CHL before injection has predicting value for the effect of intra-articular corticosteroid injection,and the pain relief of patients with CHL thickening is significantly improved.