Mens JMA, Van Kalmthout RTM. Improving accuracy for intra-articular injections for capsulitis of the shoulder by changing the injection technique. World J Orthop 2025; 16(11): 111903 [DOI: 10.5312/wjo.v16.i11.111903]
Corresponding Author of This Article
Jan M A Mens, Senior Researcher, Department of Huisartsgeneeskunde, Erasmus University Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, Zuid-Holland, Netherlands. info@janmens.nl
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Orthopedics
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 18, 2025 (publication date) through Nov 20, 2025
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World Journal of Orthopedics
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2218-5836
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Mens JMA, Van Kalmthout RTM. Improving accuracy for intra-articular injections for capsulitis of the shoulder by changing the injection technique. World J Orthop 2025; 16(11): 111903 [DOI: 10.5312/wjo.v16.i11.111903]
World J Orthop. Nov 18, 2025; 16(11): 111903 Published online Nov 18, 2025. doi: 10.5312/wjo.v16.i11.111903
Improving accuracy for intra-articular injections for capsulitis of the shoulder by changing the injection technique
Jan M A Mens, Ronald T M Van Kalmthout
Jan M A Mens, Department of Huisartsgeneeskunde, Erasmus University Rotterdam, Rotterdam 3015 GD, Zuid-Holland, Netherlands
Ronald T M Van Kalmthout, MSK-Clinic Leiden, VAOG, Leiden 2332 AA, Zuid-Holland, Netherlands
Author contributions: Mens JMA was responsible for the statistical analysis, the raw writing of the manuscript and the correspondence; Van Kalmthout RTM was responsible for the final version of the manuscript; all authors contributed to the formulating of the hypothesis and the collection of the data.
Institutional review board statement: The research Ethics Committee of Erasmus University Rotterdam declared that, since the study was retrospective, no permission was needed.
Informed consent statement: The research Ethics Committee of Erasmus University Rotterdam decided that no written consent was required, because it was a retrospective study and the data were anonymized.
Conflict-of-interest statement: Both authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jan M A Mens, Senior Researcher, Department of Huisartsgeneeskunde, Erasmus University Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, Zuid-Holland, Netherlands. info@janmens.nl
Received: July 14, 2025 Revised: September 22, 2025 Accepted: October 23, 2025 Published online: November 18, 2025 Processing time: 125 Days and 12.5 Hours
Abstract
BACKGROUND
The accuracy of blind intra-articular injections in the shoulder is rather low. Inaccurate injections tend to lead to poorer treatment outcomes. The “Delaware posterior bone touch technique” has shown higher accuracy in young, slender, healthy volunteers than the classical “Cyriax technique”.
AIM
To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.
METHODS
We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone, lidocaine, and air. After the injection, the shoulder was moved to determine whether a squishing sound could be produced. The squishing sound was interpreted as an accurate injection. The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.
RESULTS
Squishing was heard after 87% of the injections. This was 13% (10% points) more than the 77% in the previous study (P = 0.004).
CONCLUSION
The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis. We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.
Core Tip: Some of the fluid injected with the intention of injecting into the shoulder joint appears to end up next to the joint. This is often attributed to leakage. It appears that in a part of the injections, the fluid doesn't leak out of the joint, but is deposited next to it if part of the needle opening is located outside the capsule. A different injection technique appears to have significantly reduced this risk. Based on this idea, a different injection technique was chosen: The Delaware method. This significantly increases the chance of accurate injection compared to the traditional method.
