Intraarticular Corticosteroid Injection for the Treatment of Idiopathic Adhesive Capsulitis of the Shoulder

HSS Journal


Robert G. Marx, MD, MSc, FRCSC

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery and Professor of Public Health, Weill Cornell Medical College

Thomas L. Wickiewicz, MD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College

Jo A. Hannafin, MD, PhD

Attending Orthopedic Surgeon, Hospital for Special Surgery
Senior Clinician Scientist, Research Division, Hospital for Special Surgery
Director of Orthopaedic Research, Hospital for Special Surgery
Professor of Orthopedic Surgery, Weill Cornell Medical College

Robert W. Malizia, MD
Sports Medicine and Shoulder Service, Hospital for Special Surgery

Keith Kenter, MD
Sports Medicine & Shoulder Reconstruction, Department of Orthopaedic Surgery,
University of Cincinnati, Cincinnati, OH

Abstract:
Treatment for idiopathic adhesive capsulitis or frozen shoulder of the shoulder is controversial. The hypothesis of the study is that intraarticular corticosteroid injection in the early stages of idiopathic adhesive capsulitis will lead to a rapid resolution of stiffness and symptoms.

Methods:
This is a retrospective cohort study of only patients with Stage One or Stage Two adhesive capsulitis. The diagnosis was made by history and physical examination, and only when other causes of pain and motion loss were eliminated. Stage One adhesive capsulitis was defined as significant improvement in pain and normalization of motion following intraarticular injection. Stage Two included patients who had significant improvement in pain and partial improvement in motion following injection. Seven patients with Stage One and fifty-three patients with Stage Two comprised the baseline cohort. The mean age was fifty-two years (range: thirty to seventy-eight); forty-six patients were female and nine patients had diabetes mellitus. Patients completed a physical examination as well as a shoulder rating questionnaire for symptoms and disability.

Criteria for resolution were defined as forward flexion and external rotation to within fifteen degrees of the contralateral side, and internal rotation to within three spinal levels of the contralateral side.

Results:
Forty-four of the patients out of 60 met the criteria for recovery at a mean of 6.7 months. The mode and median time to recovery was three months. The mean score at final follow-up for forty-one patients using the shoulder rating questionnaire of L’Insalata was 90 (range 52-100).

The mean time to recovery for the Stage One patients was six weeks (range: two weeks to three months), and seven months for Stage Two patients (range: two weeks to two years).

Conclusions:
Glenohumeral corticosteroid injection for early adhesive capsulitis may have allowed patients to recover motion at a median time of three months. In many cases, the patients had improvement prior to the three-month mark; however that was the routine time for follow-up. Patients with Stage One disease tended to resolve more rapidly than Stage Two patients. Prompt recognition of Stage One and Stage Two idiopathic adhesive capsulitis and early injection of corticosteroid with local anesthesia may be both diagnostic and therapeutic.

This article appears in HSS Journal: Volume 3, Number 2.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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