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 randomized 112 patients with moderate-to-severe shoulder stiffness (including some with partial-thickness rotator cuff tears) to either an "Enhanced Recovery After Manipulation" (ERAM) protocol, combining an ultrasound-guided nerve block, manipulation under anesthesia, a steroid injection, and rehab, versus a standard steroid injection plus rehab alone. At every follow-up point through 6 months, the ERAM group had significantly better Constant-Murley shoulder function scores, pain scores, and range of motion than the steroid-only group, with the ERAM group reaching 1-week function comparable to the control group's 6-month function, and imaging showed no rotator cuff injury from the manipulation.

AI summary · from the full text · reviewed before publishing

Why it mattersThis introduces a minimally invasive, conscious-patient alternative to arthroscopic capsular release for stiff, painful shoulders that trainees will frequently encounter and may need to counsel patients about.

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• ?Because ERAM involves an added procedure (nerve block plus manipulation) that is inherently obvious to both patients and assessors compared with a simple injection, how might the lack of blinding have inflated the large, consistent between-group differences seen in subjective outcomes like VAS pain and PGI-C?
• ?Given that ERAM adds anesthesia, procedural time, and at least one reported nerve-related adverse event compared with a simple steroid injection, what magnitude of functional benefit would be needed to justify its routine adoption over standard steroid injection plus rehab?