Corticosteroid Injections for Adhesive Capsulitis

Xiao, Ryan; Walley, Kempland C.; DeAngelis, Joseph P.; Ramappa, Arun J.

doi:10.1097/jsm.0000000000000358

Cited by 36 publications

(29 citation statements)

References 46 publications

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“…Glenohumeral corticosteroid injection is routinely performed to treat idiopathic adhesive capsulitis and has been shown to provide symptomatic relief by inhibiting inflammation and production of prostaglandin 9 . However, the therapeutic benefits of the injection are largely affected by injection accuracy 6, 7.…”

Section: Discussionmentioning

confidence: 99%

Transcoracoacromial Ligament Glenohumeral Injection Technique Using Bony Surface Landmarks

Shi

Sohn

Shao

et al. 2019

Arthroscopy Techniques

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Intra-articular glenohumeral injection is an important technique used to diagnose and treat shoulder disorders. However, it is frequently performed as an image-guided technique with the use of fluoroscopy, ultrasound, computed tomography, or magnetic resonance. The purpose of this Technical Note is to describe a transcoracoacromial ligament glenohumeral injection technique that uses anatomic surface landmarks to avoid the need for radiographic guidance. After identification of the anterolateral corner of acromion, the superior lateral border of the coracoid tip, and the curved depression of the distal clavicle, the needle entry site is determined at the trisection point between the distal and middle thirds of the line formed by the superior lateral border of the coracoid tip and the curved depression of the distal clavicle. The needle is first inserted perpendicular to the triangular plane of the 3 points and is then advanced toward the humeral head. This injection technique is highly accurate and reproducible and can be done in the outpatient clinic without the use of imaging guidance, reducing the costs and barriers of intra-articular glenohumeral injections for patients.

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Section: Discussionmentioning

confidence: 99%

Transcoracoacromial Ligament Glenohumeral Injection Technique Using Bony Surface Landmarks

Shi

Sohn

Shao

et al. 2019

Arthroscopy Techniques

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“…A landmark-guided injection was used initially because there is insufficient evidence to justify the increased cost and inconvenience associated with image-guided injections given the lack of clearly defined benefit in terms of increased accuracy. 1 , 20 , 21 , 25 , 40 , 43 , 46 If patients do not improve after a landmark-guided injection and supervised PT, then a second, fluoroscopically guided glenohumeral joint injection followed by additional supervised PT is administered. At this point in the algorithm, a fluoroscopically guided injection is used because it is unlikely to be less accurate than a landmark-guided injection 1 , 20 , 21 , 40 , 43 , 46 and because we believe it is important to exhaust nonoperative therapies before considering surgical intervention.…”

Section: Methodsmentioning

confidence: 99%

“… 7 , 45 The greatest improvement occurs following early treatment of this condition, which can hasten resolution of symptoms sooner than if the condition is not treated. 16 , 28 , 44 – 46 This condition is most frequently treated conservatively with a combination of anti-inflammatory medications, home exercises, physical therapy, 10 , 15 , 36 and glenohumeral intra-articular corticosteroids. 31 , 34 , 38 Operative treatment consisting of manipulation under anesthesia with or without arthroscopic capsular release may be considered if patients do not improve with nonoperative measures.…”

mentioning

confidence: 99%

“… 27 Although it is universally agreed that the first-line therapies are nonoperative, surgeons and the existing literature disagree on which conservative treatments are most effective. 46 Additionally, the risk factors associated with the development of contralateral disease are not well-studied. Therefore, the purpose of this study was to report outcomes following a conservative treatment protocol for idiopathic adhesive capsulitis and to report factors associated with outcomes and the incidence of contralateral disease.…”

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confidence: 99%

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Outcomes From Conservative Treatment of Shoulder Idiopathic Adhesive Capsulitis and Factors Associated With Developing Contralateral Disease

Lamplot

Lillegraven

Brophy

2018

Orthopaedic Journal of Sports Medicine

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Background:Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion without other identifiable shoulder abnormality. First-line therapies for this condition are nonoperative, but limited data are available regarding which treatments are most effective. Factors associated with contralateral disease are not well established.Hypothesis:Younger patients will have a better response to treatments, and older patients and patients with diabetes will be more likely to develop contralateral disease.Study Design:Cohort study; Level of evidence, 3.Methods:Patients diagnosed with idiopathic adhesive capsulitis were treated with a single intra-articular glenohumeral injection of local anesthetic and corticosteroid as well as 4 weeks of supervised physical therapy (PT). Patients were re-evaluated monthly and received additional conservative treatment based on failure to restore normal motion. Patient-reported outcome scores and range of motion were used to assess treatment efficacy.Results:Minimum 2-year follow-up data (mean, 3.4 years) were available for 60 of 75 eligible patients (80%). Patients who did not attend supervised PT as prescribed were more likely to undergo repeat injection due to a lack of adequate range of motion at follow-up (P = .003). Conservative therapy failed in 2 patients (3.3%), and they underwent arthroscopic release and manipulation under anesthesia. Twenty-two patients (36.7%) were subsequently diagnosed with contralateral idiopathic adhesive capsulitis, with a higher incidence in patients with diabetes (P = .009) and patients younger than 50 years (P = .005). American Shoulder and Elbow Surgeons score improved from 41.2 (95% CI, 33.0-49.4) at baseline to 92.0 (95% CI, 88.4-95.6) at final follow-up (P < .0001). Patients with diabetes had a decrease in Shoulder Activity Scale score at final follow-up (P = .049).Conclusion:Conservative treatment for idiopathic adhesive capsulitis resulted in good clinical outcomes with a low incidence of surgical intervention. Physical therapy reduced the use of a second injection as part of treatment in this treatment algorithm. Young patients and patients with diabetes may be more likely to develop contralateral disease.

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“…Different studies have shown that image-guided intra-articular steroid injections provide significant short-term benefits with regard to pain, ROM, and shoulder function compared with physical therapy alone 13,14,15 . This short-term improvement is clinically relevant because pain reduction not only alleviates symptoms but allows patients to move faster in the stages of rehabilitation and thus return to their daily life activities more rapidly 13,14 .…”

Section: Corticosteroid Injectionsmentioning

confidence: 99%

Current Concepts in the Treatment of adhesive capsulitis of the Shoulder

Rossi

Ranalletta

2019

ijmsci

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Adhesive capsulitis is characterized by chronic inflammation of the capsular subsynovial layer, which produces capsular fibrosis, contracture, and adherence of the capsule to itself and to the anatomic neck of the humerus. Physical therapy is the mainstay of treatment, regardless of stage. Based on the natural history of the disease, early corticosteroid injection has a role in shortening the overall duration of symptoms allowing patients to move faster in the stages of rehabilitation and thus return to their daily life activities more rapidly. Most patients will see complete resolution of symptoms with nonsurgical management. In cases with refractory stiffness, manipulation under anesthesia or arthroscopic capsular release may be indicated. Because of various potential risks of complications with manipulations, arthroscopic capsular release is preferred. There is a lack of high level studies comparing different techniques for capsular release. Both circumferential and limited release have proven to be effective. Regarding postoperative rehabilitation, arthroscopic release should be followed by early, diligent, and directed therapy to prevent recurrent stiffness.

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Corticosteroid Injections for Adhesive Capsulitis

Abstract: Corticosteroid injections for AC demonstrate short-term efficacy, but may not provide a long-term benefit. More high quality, prospective studies are needed to determine whether corticosteroid injections using ultrasound guidance significantly improve outcomes.

Cited by 36 publications

References 46 publications

Transcoracoacromial Ligament Glenohumeral Injection Technique Using Bony Surface Landmarks

Transcoracoacromial Ligament Glenohumeral Injection Technique Using Bony Surface Landmarks

Outcomes From Conservative Treatment of Shoulder Idiopathic Adhesive Capsulitis and Factors Associated With Developing Contralateral Disease

Current Concepts in the Treatment of adhesive capsulitis of the Shoulder

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