DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20181046

Single intra-articular steroid injection of the glenohumeral joint in management of adhesive capsulitis: a comparison between approaches

Surykanth Kalluraya, Anand Varma, Jayaram P. H.

Abstract


Background: Adhesive capsulitis is a common, painful musculoskeletal condition of the shoulder associated with loss of range of motion in the glenohumeral joint resulting from contraction of the glenohumeral joint capsule and adherence to the humeral head. Earlier stages of adhesive capsulitis can be treated by intra-articular steroid injections into the glenohumeral joint. This study was designed to study the role of long acting intra-articular corticosteroid injections in combination with simple therapeutic exercises while comparing the outcome of blinded anterior and posterior injection approaches in the management of adhesive capsulitis.

Methods: The study comprised of 60 subjects aged 18 years and above who were diagnosed with primary adhesive capsulitis. They were randomly divided into 2 groups i.e., Group A who received blind intra-articular steroid injections via standard anterior approach and group B who received blind intra-articular steroid injection via standard posterior approach. Both groups followed up with a simple home based exercise program. Outcome measures assessed were visual analog scale (VAS) score, shoulder pain assessment disability index (SPADI) and passive shoulder range of motion (ROM).

Results: At last follow up, both groups showed statistically significant improvements in all outcome measures i.e., VAS score, SPADI, shoulder ROM. However, comparison between groups did not reveal any statistically significant differences between the two groups.

Conclusions: Intra-articular steroid injections into the glenohumeral joint in conjunction with simple physiotherapy are effective in improving pain, function and shoulder ROM in adhesive capsulitis. Both the anterior and posterior injection approaches provide good results.


Keywords


Adhesive capsulitis, Corticosteroids, Glenohumeral joint

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References


Manske CR, Prohaska D. Clinical commentary and literature review: diagnosis, conservative and surgical management of adhesive capsulitis. Shoulder and Elbow. 2010;2:238-54.

Ewald A. Adhesive Capsulitis: A Review. Am Fam Physician. 2011;83:417-22.

Uppal HS, Evans JP, Smith C. Frozen shoulder:A systematic review of therapeutic options. World J Orthop 2015;6:263-8.

D’Orsi GM, Via AG, Frizziero A, Oliva F. Treatment of adhesive capsulitis:a review. Muscles, Ligaments and Tendons J. 2012;2:70-8.

Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database of Systematic Reviews 2003;1:CD004016.

Marx RG, Malizia RW, Kenter K, Wickiewicz TL, Hannafin JA. Intra-articular Corticosteroid Injection for the Treatment of Idiopathic Adhesive Capsulitis of the Shoulder. HSSJ. 2007;3:202–7.

Tallia AF, Cardone DA. Diagnostic and Therapeutic Injection of the Shoulder Region. Am Fam Physician. 2003;67:1271-8.

Carette S, Moffet H, Tardif J, Bessette L, Morin F, Frémont P, et al. Intraarticular Corticosteroids, Supervised Physiotherapy, or a Combination of the Two in the Treatment of Adhesive Capsulitis of the Shoulder. Arthritis Rheumatism. 2003;48:829–38.

Van der Windt DA, Koes BW, Devillé W, Boeke AJ, de Jong BA, Bouter LM. Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care:randomised trial. BMJ. 1998;317:1292–6.

Koh KH. Corticosteroid injection for adhesive capsulitis in primary care:a systematic review of randomised clinical trials. Singapore Med J 2016;57:646-57.

Mussa M, Dar IH, Rafeeq SA, Lone AH. Role of Intra-articular Steroid Injection in the Management of Idiopathic Adhesive Capsulitis of the Shoulder. Int J Contemporary Med Res. 2016;3:3222-3.

Lorbach O, Anagnostakos K, Scherf C, Seil R, Kohn D, Pape D. Non operative management of adhesive capsulitis of the shoulder:oral cortisone application versus intra-articular cortisone injections. J Shoulder Elbow Surg. 2010;19:172-9.

Esenyel CZ, Ozturk K, Demirhan M, Sonmez M, Esenyel M, Ozbaydar MU. Accuracy of anterior glenohumeral injections:a cadaver study. Arch Orthop Trauma Surg. 2010;130:297-300.

Kraeutler MJ, Cohen SB, Ciccotti MG, Dodson CC. Accuracy of intra-articular injections of the glenohumeral joint through an anterior approach: arthroscopic correlation. J Shoulder Elbow Surg. 2012;21:380-3.

Sidon E, Velkes S, Shemesh S, Levy J, Glaser E, Kosashvili Y. Accuracy of non-assisted glenohumeral joint injection in the office setting. Eur J Radiol. 2013;82:829-31.

Daley EL, Bajaj S, Bisson LJ, Cole BJ. Improving injection accuracy of the elbow, knee, and shoulder: does injection site and imaging make a difference? A systematic review. Am J Sports Med. 2011;39:656-62.

Sonachand GS, Singh NY, Singh BN, Touthang AT, Tamphaleima KH. Intra-articular Steroid in the Management of Adhesive Capsulitis of Shoulder:A Comparison of the Anterior and Posterior Approaches. IJPMR. 2013;24:99-103.

Do-Young K, Sang-Soo L, Otgonsaikhan N, Myung-Guk C, Jae Jun L, Jung-Taek H, et al. Comparison Between Anterior and Posterior Approaches for Ultrasound-Guided Glenohumeral Steroid Injection in Primary Adhesive Capsulitis:A Randomized Controlled Trial. JCR J Clin Rheumatol. 2017;23:51-7.

Ahn JH, Lee DH, Kang H, Lee MY, Kang DR, Yoon SH. Early intraarticular corticosteroid injection improves pain and function in adhesive capsulitis of the shoulder:1 year retrospective longitudinal study. PM&R. 2017;10:1-9.