A randomised controlled trial of brachial plexus block manipulation versus steroid injection in conscious patients for moderate to severe shoulder stiffness
BMC Musculoskeletal Disorders · 20 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Frozen shoulder is extremely common and often slow to resolve with steroid injection alone, so a same-day, ultrasound-guided manipulation protocol that avoids general anaesthesia could change how orthopaedic surgeons manage refractory stiffness in the clinic.
The evidence
This single-centre RCT in China randomised 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 anaesthesia, 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.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
RCT
Methods at a glance
Recorded assessment- Outcome assessors blindedNot reported
- Allocation concealedNot reported
- Random sequence generatedNot reported
- Intention-to-treat analysisNot reported
- Adequate statistical powerNot reported
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.The trial is single-centre, 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?
2.If ERAM is adopted, what training, ultrasound equipment, and anaesthesia support would a typical orthopaedic clinic need to replicate this protocol safely, especially given the one reported case of transient nerve-related weakness?
Original publication title
A randomized controlled trial of brachial plexus block manipulation versus steroid injection in conscious patients for moderate to severe shoulder stiffness