BMC Musculoskeletal Disorders · IF 2.3 · July 20, 2026 · LoE I
A randomized controlled trial of brachial plexus block manipulation versus steroid injection in conscious patients for moderate to severe shoulder stiffness
Zheng Yan, Yinzhe Cui, Kairui Zhang, Jia Ma, Zhefeng Jin, Jiangtao Si, Zhijun Zhang, Jiawen Zhan, Xu Wei, Jie Yu, Yongli Dong, Liguo Zhu — Chinese Academy of Medical Sciences & Peking Union Medical College
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. Over 6 months of follow-up, the ERAM group had significantly better Constant-Murley function scores, pain scores, and range of motion at every time point, with the ERAM group's 1-week scores resembling the control group's 6-month scores, and no serious complications occurred.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersIf durable, this combined nerve-block-and-manipulation protocol could dramatically compress the recovery timeline for a common, disabling condition currently managed with slower steroid-injection-based care.
Conclusion strengthPotentially practice-changing
Prospectively registered and compared against current standard of care, offset by 6-month follow-up and requires equipment most centres do not have.
Presenting this at rounds? Start here
- ?The trial was single-center, unblinded to treatment allocation (patients and assessors could likely tell which arm they were in), and reports only 'all P<0.05' without giving exact effect sizes or confidence intervals in the text; how might this affect confidence in the magnitude of benefit?
- ?Given that ERAM requires ultrasound-guided regional anesthesia expertise and manipulation under anesthesia (resources not universally available), how would you weigh adopting this protocol versus continuing steroid injection plus rehab in a typical community orthopedic practice?