A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis

Abstract

Corticosteroid injection is effective in improving shoulder-related disability, and physiotherapy is effective in improving the range of movement in external rotation 6 weeks after treatment.

Shoulder Pain and Mobility Deficits: Adhesive Capsulitis

“…Although this study was well controlled, the placebo group (intra-articular saline injection and a HEP) is considered by others to be an effective treatment for adhesive capsulitis. 19,61 Ryans et al 117 also investigated the effect of steroid injections and physiotherapy, performing both glenohumeral joint intra-articular and subacromial injections. Patients were classified as having adhesive capsulitis and included in this study if they had a painful shoulder in the fifth cervical nerve root dermatome distribution of more than 4 weeks and less than 6 months in duration, and a limitation of active and passive range of movement greater than 25% in abduction and external rotation compared to the uninvolved, contralateral shoulder.…”

“…Results are inconsistent across multiple studies, demonstrating that stretching results in minimal or no difference in outcomes (at 3-6 months) in patients treated with a therapistdirected HEP or other interventions. 19,23,61,117 There is only 1 study 45 for which the authors fully described the exercises performed, with the other studies simply describing the program as active and/or passive exercises. No evidence exists to guide the optimal frequency, number of repetitions, or duration of stretching exercises.…”

Identification of prognostic factors for the nonoperative treatment of stiff shoulder

“…The median time to recovery was 10-12 months and operative cases were 4.8 to 8.8 % in this study, which were superior or equivalent to the previous reports. The type of corticosteroid, the dosage, and frequency of the injection vary from study to study [10,12,14]. The injections of 4-mg dexamethasone were conducted once a week in this study until pain was relieved, which had the effect of reducing synovial inflammation and subsequent capsular fibrosis and allowed improvement of motion with a decreased time to functional recovery [24].…”

“…Shaffer et al reported persistence of symptoms and impaired range of motion especially in external rotation in over 50 % of cases at a seven-year follow-up [3]. Conservative treatment for stiff shoulder includes oral administration of non-steroidal anti-inflammatory drugs, oral administration or intra-articular injection of corticosteroid, and physiotherapy [2,[10][11][12][13][14][15]. During these treatment modalities, the efficacy of intra-articular injection of corticosteroid for patients in the freezing phase and that of physiotherapy for patients in the frozen phase are well described [12][13][14].…”

“…Conservative treatment for stiff shoulder includes oral administration of non-steroidal anti-inflammatory drugs, oral administration or intra-articular injection of corticosteroid, and physiotherapy [2,[10][11][12][13][14][15]. During these treatment modalities, the efficacy of intra-articular injection of corticosteroid for patients in the freezing phase and that of physiotherapy for patients in the frozen phase are well described [12][13][14]. The efficacy of oral corticosteroid medication is also reported [2,15].…”