Figure 1.
Ultrasound-guided dextrose PIT at quadrangular space (pAxN) white arrowhead, needle; pAxN, proximal part of the axillary nerve.
Figure 2.
Ultrasound-guided injection at the superior lateral humeral level (dAxN) white arrowhead, needle; dAxN, distal part of the axillary nerve.
Figure 3.
Study flow diagram. dAxN, distal part of the axillary nerve; pAxN, proximal part of the axillary nerve.
Table 1.
Baseline characteristics of participants
| Variables | Treatment groups | ||
|---|---|---|---|
| Control (n = 13) | pAxN (n = 13) | dAxN (n = 13) | |
| Demographic data | |||
| Age, mean (SD) | 45.77 (11.95) | 44.31 (13.17) | 45.23 (8.49) |
| Sex, n (%) | |||
| Female | 10 (77) | 8 (62) | 8 (62) |
| Male | 3 (23) | 5 (38) | 5 (38) |
| Duration of shoulder pain, n (%) | |||
| <6 months | 6 (46) | 7 (54) | 5 (38) |
| ≥6 months | 7 (54) | 6 (46) | 8 (62) |
| Dominant side affected, n (%) | 10 (77) | 7 (54) | 5 (38) |
| Prior treatments, n (%) | |||
| Medications | 4 (31) | 5 (38) | 5 (38) |
| Manual exercise | 6 (46) | 5 (38) | 6 (46) |
| Physical modality | 3 (23) | 2 (15) | 3 (23) |
| Focus shock wave therapy | 1 (8) | 0 (0) | 1 (8) |
| Subacromial corticosteroid injection | 1 (8) | 2 (15) | 2 (15) |
| Dry needling | 3 (23) | 4 (31) | 4 (31) |
| Outcomes at baseline | |||
| VAS, mean (SD) | 6.01 (1.56) | 6.35 (1.82) | 7.29 (1.86) |
| OSS-TH, mean (SD) | 33.15 (3.85) | 34.46 (6.98) | 32.92 (9.14) |
| Active shoulder ROM, mean (SD) | |||
| Forward flexion | 151.92 (15.35) | 154.46 (25.52) | 143.85 (24.85) |
| Abduction | 137.69 (31.07) | 140.00 (43.83) | 136.15 (37.03) |
| Internal rotation | 74.62 (19.73) | 68.85 (25.18) | 73.85 (16.85) |
| External rotation | 76.92 (14.94) | 67.69 (28.48) | 51.15 (31.70) |
Figure 4.
Estimated mean difference of VAS in pAxN and dAxN group compared with the sham group. dAxN, distal axillary nerve; pAxN, proximal axillary nerve; VAS, visual analog scale.
Table 2.
Comparison of the effects of pAxN and dAxN with the sham group immediately posttreatment and at 2- and 4-weeks follow-ups, as well as with in-group comparisons with baseline
| Outcomes/time | Study groups | Comparison with the sham group | |||||
|---|---|---|---|---|---|---|---|
| Sham (n = 13) estimated mean (95% Cl) | pAxN (n = 13) estimated mean (95% Cl) | dAxN(n = 13) estimated mean (95%CI) | pAxN – Sham | dAxN – Sham | |||
| Mean difference (95% Cl) | P | Mean difference (95% Cl) | P | ||||
| VAS† | |||||||
| Baseline | 6.31 (5.52, 7.09) | 6.47 (5.69, 7.24) | 6.87 (6.08, 7.66) | ||||
| Immediate | 4.81 (4.03, 5.60)** P = 0.003 | 5.48 (4.71,6.26) P = 0.052 | 4.22 (3.43,5.01)*** P < 0.001 | 0.51 (−0.90,1.92) | 0.480 | −1.15(2.56,0.25) | 0.108 |
| 2 weeks | 4.42 (3.63,5.21)*** P < 0.001 | 4.68 (3.91,5.46)*** P < 0.001 | 2.52 (1.73,3.31)*** P < 0.001 | 0.10 (−1.31,1.51) | 0.889 | −2.46 (−3.87,-1.05)” | 0.001 |
| 4 weeks | 2.84 (2.05, 3.62)*** P < 0.001 | 3.67 (2.90,4.45)*** P < 0.001 | 1.91 (1.12,2.70)*** P < 0.001 | 0.68 (−0.73, 2.08) | 0.346 | −1.49 (−2.89, −0.08)’ | 0.039 |
| OSS-TH‡ | |||||||
| Baseline | 33.17 (30.18, 36.17) | 33.83 (30.88, 36.78) | 33.54 (30.55,36.53) | ||||
| 4 weeks | 22.94 (19.95,25.94)*** P < 0.001 | 24.21 (21.26,27.17)*** P < 0.001 | 24.38 (21.40,27.37)*** P < 0.001 | 0.62 (−5.28,6.51) | 0.836 | 1.08 (−4.82,6.97) | 0.717 |
| Forward flexion ROM† | |||||||
| Baseline | 149.97 (144.64,155.30) | 150.77 (145.48,156.06) | 149.50 (144.17,154.82) | ||||
| Immediate | 155.35 (150.02,160.68) P = 0.140 | 154.39 (149.09,159.68) P = 0.322 | 150.50 (145.17,155.82) P = 0.784 | −1.77 (−11.89,8.35) | 0.732 | −4.39 (−14.50,5.73) | 0.396 |
| 2 weeks | 162.66 (157.33,167.99)** P = 0.001 | 157.46 (152.17,162.76) P = 0.067 | 156.03 (150.71,161.36) P = 0.073 | −6.0 (−16.12,4.12) | 0.245 | −6.15 (−16.27, 3.96) | 0.233 |
| 4 weeks | 166.89 (161.56,172.22)*** P < 0.001 | 160.92 (155.63,166.22)** P = 0.005 | 161.03 (155.71,166.36)** P = 0.002 | −6.77 (−16.89,3.35) | 0.190 | −5.39 (−15.50,4.73) | 0.297 |
| Abduction ROM† | |||||||
| Baseline | 136.72 (126.53,146.91) | 138.47 (128.43,148.51) | 138.66 (128.51,148.81) | ||||
| Immediate | 157.10 (146.91,167.30)** P = 0.001 | 144.62 (134.58,154.67) P = 0.332 | 146.74 (136.59,156.88) P = 0.203 | −14.23 (−31.83, 3.37) | 0.113 | −12.31 (−29.91,5.29) | 0.171 |
| 2 weeks | 157.80 (147.61,167.99)** P = 0.001 | 154.62 (144.58,164.67)* P = 0.011 | 147.51 (137.36,157.65) P = 0.164 | −4.92 (−22.52,12.68) | 0.584 | −12.23 (−29.83, 5.37) | 0.173 |
| 4 weeks | 163.26(153.07,173.45)*** P < 0.001 | 168.47(158.43,178.51)*** P < 0.001 | 155.97(145.82,166.11)** P = 0.006 | 3.46 (−14.14,21.06) | 0.700 | −9.23 (−26.83,8.37) | 0.304 |
| Internal rotation ROM† | |||||||
| Baseline | 72.73 (66.84, 78.63) | 71.00 (65.14, 76.85) | 73.58 (67.69, 79.47) | ||||
| Immediate | 73.12 (67.22, 79.01) P = 0.923 | 82.15(76.30,88.00)** P = 0.005 | 80.50 (74.62,86.39) P = 0.080 | 10.77 (−0.19,21.73) | 0.054 | 6.54 (−4.42,17.50) | 0.242 |
| 2 weeks | 69.81 (63.91,75.71) P = 0.460 | 78.69 (72.84,84.54) P = 0.052 | 75.50 (69.62,81.39) P = 0.627 | 10.62 (−0.35,21.58) | 0.058 | 4.85 (−6.12,15.81) | 0.386 |
| 4 weeks | 84.27(78.37,90.17)** P = 0.004 | 85.23(79.38,91.08)*** P < 0.001 | 82.81 (76.92,88.70)* P = 0.020 | 2.69 (−8.27,13.65) | 0.630 | −2.31 (−13.27,8.65) | 0.680 |
| External rotation ROM† | |||||||
| Baseline | 66.49 (61.65,71.34) | 65.43 (60.65, 70.20) | 63.85(59.00,68.71) | ||||
| Immediate | 68.03 (63.18, 72.87) P = 0.638 | 66.97(62.19,71.74) P = 0.638 | 65.78 (60.92, 70.63) P = 0.557 | 0.00 (−9.07,9.07) | 1.000 | 0.39 (−8.69,9.46) | 0.934 |
| 2 weeks | 71.11 (66.26,75.95) P = 0.158 | 65.04 (60.27,69.82) P = 0.906 | 73.08 (68.23, 77.94)** P = 0.005 | −5.00(14.07,4.07) | 0.280 | 4.62 (−4.46,13.69) | 0.319 |
| 4 weeks | 71.26 (66.41,76.11) P = 0.145 | 65.81 (61.03,70.59) P = 0.906 | 70.39 (65.53, 75.25)* P = 0.046 | −4.39 (−13.46,4.69) | 0.344 | 1.77 (−7.30,10.84) | 0.702 |
Figure 5.
Estimated mean difference of ROM in pAxN and dAxN group compared with the sham group. dAxN, distal axillary nerve; pAxN, proximal axillary nerve; ROM, range of motion.