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

作者：Lorbach Olaf^*; Anagnostakos Konstantinos; Scherf Cornelia; Seil Romain; Kohn Dieter; Pape Dietrich

来源：Journal of Shoulder and Elbow Surgery, 2010, 19(2): 172-179.

DOI：10.1016/j.jse.2009.06.013

• Adhesive capsulitis
• frozen shoulder
• intra-articular
• corticosteroids

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.
Level of evidence: Level I, Randomized Clinical Trial, Treatment Study.

• 出版日期2010-3