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
Reviewed by:  Jeffrey

Related Posts

Yoon SH, Lee HY, Lee HJ, & Kwack KS (2013). Optimal Dose of Intra-articular Corticosteroids for Adhesive Capsulitis: A Randomized, Triple-Blind, Placebo-Controlled Trial. The American Journal of Sports Medicine PMID: 23507791