Adhesive Capsulitis & Corticosteroid ...To inject or not to inject
Reference:Buchbinder R, et al Arthrographic joint distension with saline and steroid improves function and reduces pain in patients with painful stiff shoulder: results of a randomised, double blind, placebo controlled trial. Ann Rheum Dis. 2004 Mar;63(3):302-9.
A few past studies have shown little or no difference between steroid injection and placebo with respect to improvements in shoulder pain and function. One trial actually ironically demonstrated significantly greater improvements in pain scores at 3 and 12 months in the placebo group!
(This goes to show that perhaps steroids injections may not be effective for all individuals with shoulder pain.)
The purpose of this double blind RCT was to compare the effectiveness of arthrographic distension (using intra-articular saline and corticosteroid injection) to placebo injection for those with clinical signs of ‘frozen’ shoulder.
Result:The researchers demonstrated significantly better pain and functional outcomes after capsular distension and cortisone injection therapy at 3 and at 6 weeks.
Clinical Relevance #3: As physical therapists we generally follow a rule that steroid injections are to be a ‘last resort’ option for patients presenting with various musculoskeletal pain. Clinically, I make an exception to the rule for my patients presenting with adhesive capsulitis during the inflammatory or the freezing phase.
Personal Comment:I am quite content that this study has supported my personal clinical practice. I am comfortable to recommend and refer this specific group of patients to a physician experienced in intra-articular corticosteroid injections. This particular study regrettably didn’t allow the patients to receive any therapy or mobilizations during the study’s 12 weeks duration. A previous study showed that a combination of capsular distension with corticosteroid injection followed by a course of PT was more effective than either one alone. In summary, this study clearly demonstrates the short-term benefit of shoulder joint distension with steroid injection for frozen shoulders, with little risk of adverse effects.
Posted on: May 09, 2007