A randomized controlled trial of brachial plexus block manipulation versus steroid injection in conscious patients for moderate to severe shoulder stiffness

This single-center RCT in China randomized 112 patients with moderate-to-severe frozen shoulder to either an 'Enhanced Recovery After Manipulation' (ERAM) protocol (ultrasound-guided brachial plexus block plus manipulation under anesthesia, intra-articular steroid, and rehab) or standard intra-articular steroid injection plus rehab alone. At every follow-up point through 6 months, the ERAM group had better Constant-Murley shoulder scores, pain scores, and range of motion than the steroid-only group (all P<0.05), and imaging at 8 weeks showed no rotator cuff injury from the manipulation.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersFrozen shoulder is extremely common and often slow to resolve with steroid injection alone, so a same-day, ultrasound-guided manipulation protocol that avoids general anesthesia could change how orthopedic surgeons manage refractory stiffness in the clinic.

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• ?The trial is single-center, unblinded (patients could tell which treatment they received), and reports only 'P<0.05' rather than exact effect sizes and confidence intervals in the text; does the lack of blinding and precise numbers undermine confidence in the magnitude of benefit?
• ?If ERAM is adopted, what training, ultrasound equipment, and anesthesia support would a typical orthopedic clinic need to replicate this protocol safely, especially given the one reported case of transient nerve-related weakness?