Optimal Dose of Intra-articular Corticosteroids for Adhesive Capsulitis: A Randomized, Triple-Blind, Placebo-Controlled Trial
Yoon SH, Lee HY, Lee HJ, Kwack KS. Am J Sports Med. 2013 Mar 18. [Epub ahead of print]
Adhesive capsulitis is very difficult to treat due to the active inflammation within the capsule and high intensity of pain. Corticosteroid injections are commonly used as a treatment; however, clinicians have used a variety of doses – with no scientific justification. Therefore, the authors investigated the optimal dose (20 mg or 40 mg) of corticosteroids among a group of 53 patients with stage 2 adhesive capsulitis. Participants were randomly divided into 3 groups (high dose, low dose, and placebo) and received a single ultrasound-guided injection. The participants, injection operator, and evaluator were blinded to the group allocations. The participants also received a home exercise program to increase both active and passive range of motion. They performed the exercises 3 times a day and each session lasted 10 minutes. Participants maintained an exercise log and these logs were used to check compliance at the end of the study. Shoulder function (Shoulder Pain and Disability Index) and clinical measures (visual analog scale for shoulder pain and shoulder range of motion) were evaluated prior to treatment and at 1, 3, 6, and 12 weeks following the injection. At the time of follow-up, the investigators excluded two participants in the placebo group because they sought additional treatment. Both corticosteroid groups improved more in shoulder function, shoulder pain, flexion, abduction, and internal rotation compared with the placebo group. There were no differences between the high- and low-dose groups.
Adhesive capsulitis is a very challenging disease to treat due to the severe pain and dysfunction. Corticosteroid injections can be used to help reduce pain and inflammation prior to rehabilitation. This will give clinicians a window of time to improve range of motion without worsening pain. This study demonstrated that both a low and high dose of corticosteroids reduce pain, restore function, and improve range of motion. Both high and repeated doses of corticosteroids may lead to cartilage damage and tendon degeneration. Since the results demonstrated that the high dose was not superior to the lower dose for treating adhesive capsulitis a low dose should be used. It should also be noted that participants were only in stage 2 (frozen stage) of adhesive capsulitis. Future research should evaluate the effectiveness of corticosteroids in the other two stages and if those stages are dose dependent. It would be more beneficially to treat patients in stage 1 (freezing stage) since that is the initiation of the disease. Do you have any experience using corticosteroids to treat adhesive capsulitis? Does it work well in all stages of the disease? Has a single dose been enough to reduce pain and restore function?
Written by: Stephen Thomas