Estimated to affect 2–5% of the population, adhesive capsulitis is a common cause of shoulder pain and dysfunction. The objective of this study is to determine if arthrographic injection of the shoulder joint with steroid, local anesthetic and contrast is an effective treatment modality for adhesive capsulitis and whether it is superior to arthrographic injection with local anesthetic and contrast alone.

This is a double-blinded RCT of patients with a diagnosis of adhesive capsulitis who were randomly assigned to receive an image guided arthrographic glenohumeral injection with either triamcinalone (steroid), lidocaine (local anesthetic) and contrast or lidocaine and contrast alone. Outcome measures included active and passive shoulder range of motion (ROM) and functional outcomes assessed using the Shoulder Pain and Disability Index (SPADI), the Constant Score and a Visual Analog Scale for pain. Post-operative evaluation occurred at 3 weeks, 6 weeks and 12 weeks. Descriptive statistics were utilised to summarise patient demographics and other study parameters. One-way ANOVAs compared the VAS, Constant and SPADI scores across the different time points for both study groups. The post hoc Bonferroni correction was used to adjust for multiple comparisons.

There were 37 shoulders injected with follow-up visits at 12 weeks. Twenty shoulders were randomised to receive local plus steroid and 17 shoulders received local anesthetic only. There were 21 females and 14 males with an average age of 54 years (range, 42–70). VAS scores for both patient groups were significantly improved (p<0.05) at all follow-up times. Goniometric testing demonstrated significant improvements in forward flexion and internal rotation at 90 degrees in the local group and only abduction in the local plus steroid group. There were no significant changes in the Constant scores for the local group (p=0.08), however, the Constant scores showed significant improvement for the local plus steroid group (p=0.003) at all follow-up time points. The local group showed significant improvement in their SPADI pain scores at the 12 week follow-up only (p=0.01). There were no significant differences in their SPADI disability scores (p=0.09). The local plus steroid group had significant improvement in SPADI pain and disability scores at all follow-up time points (p=0.001).

The optimal treatment for adhesive capsulitis remains unclear. Our study demonstrated that patients receiving an arthrographic injection of either steroid and local anesthetic or local anesthetic alone had significantly improved post-injection pain scores. However, only the steroid and local anesthetic group demonstrated improved SPADI disability and Constant scores. Thus, we believe that either treatment may be a good option for patients with adhesive capsulitis and can reliably relieve pain, but we would recommend the steroid with local anesthetic over the local anesthetic alone as it may provide improved function.

Image guided navigation systems for total knee replacement surgery (TKR) are gaining popularity in an effort to improve both alignment and functional outcome. This trial was undertaken to compare one year functional outcome and radiological alignment of TKRs inserted with and without an image guided navigation system.

Patients were randomised to undergo surgery using either an image guided navigation system or traditional instrumentation. Pre and post-operative Knee Society (KSS), WOMAC and SF-36 scores were collected. Postoperatively, limb and implant alignment & rotation were assessed using both full-length films and CT scans.

One hundred and twenty-three patients (one hundred and forty-five knees) were enrolled: eighty-one females, forty-two males, mean age sixty-seven years. Age, gender and pre-operative range of motion, KSS WOMAC and SF-36 scores did not differ between the groups. While there was no statistically significant difference in postoperative KSS, WOMAC and seven of eight SF-36 subscales, the navigated group demonstrated better post-operative SF-36 General Health Scores. Mean postoperative flexion in all patients was 115°, and did not differ between groups. Mean post-operative leg alignment demonstrated more varus in the navigated group (2.1°) versus the non-navigated group (0.9°, p=0.02), however there was a trend towards a smaller standard deviation in the navigated group. Rotational alignment of the femoral component relative to the femur, tibial component relative to the tibia, and tibial component relative to the femoral component were not statistically different between groups; however, there were larger standard deviations of these measures in the non-navigated group. Pre-operative alignment appeared to affect tibial component placement; varus knees had a mean of 3° of tibial component internal rotation while valgus knees had a mean of 12° external rotation.

Imaged guided navigation systems appear to reduce the variability in TKR component placement and limb alignment. However, this may not necessarily translate into better mean limb alignment or early functional outcome.