Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections

J Shoulder Elbow Surg. 2010 Mar;19(2):172-9. doi: 10.1016/j.jse.2009.06.013. Epub 2009 Oct 1.

Abstract

Hypothesis: Oral and intra-articular injections of cortisone will lead to significant improvement and comparable results in the treatment of adhesive capsulitis of the shoulder.

Materials and methods: In a prospective randomized evaluation, 40 patients with idiopathic adhesive capsulitis of the shoulder were treated with an oral corticoid treatment regimen or 3 intra-articular injections of corticosteroids. Follow-up was after 4, 8, and 12 weeks, and 6 and 12 months. For the clinical evaluation, the Constant-Murley (CM) score, the Simple Shoulder Test (SST) and visual analog scales (VAS) for pain, function, and satisfaction were used.

Results: In the patients treated with oral glucocorticoids, significant improvements were found for the CM score (P < .0001), SST (P=.035), VAS (P < .0001), and range of motion (P < .05) at the 4-week follow-up. The patients treated with an intra-articular glucocorticoid injection series also significantly improved in the CM score (P < .0001), SST (P < .0001), the VAS (P < .0001), and range of motion (P < .05) after 4 weeks. These results were confirmed at all other follow-up visits. Superior results were found for intra-articular injections in range of motion, CM score, SST, and patient satisfaction (P < .05). Differences in the VAS for pain and function were not significant (P > .05).

Discussion: The use of cortisone in the treatment of idiopathic shoulder adhesive capsulitis leads to fast pain relief and improves range of motion. Intra-articular injections of glucocorticoids showed superior results in objective shoulder scores, range of motion, and patient satisfaction compared with a short course of oral corticosteroids.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Oral
  • Adult
  • Anti-Inflammatory Agents / therapeutic use
  • Bursitis / complications
  • Bursitis / drug therapy*
  • Bursitis / pathology
  • Bursitis / rehabilitation
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Humans
  • Injections, Intra-Articular
  • Male
  • Middle Aged
  • Pain Measurement
  • Patient Satisfaction
  • Prednisolone / therapeutic use*
  • Probability
  • Prospective Studies
  • Range of Motion, Articular / drug effects*
  • Range of Motion, Articular / physiology
  • Recovery of Function
  • Severity of Illness Index
  • Shoulder Joint*
  • Shoulder Pain / diagnosis
  • Shoulder Pain / drug therapy
  • Shoulder Pain / etiology
  • Shoulder Pain / rehabilitation
  • Tissue Adhesions / pathology

Substances

  • Anti-Inflammatory Agents
  • Prednisolone