Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens

Abstract

Background and purpose: Although corticosteroid injections have been reported to be effective in capsulitis of the shoulder, the optimal dose has not been established. The purpose of this study was to compare relief of symptoms following a lower dose with that following a higher dose of triamcinolone acetonide given intra-articularly.

Subjects: Thirty-two patients were given low dose suspension; 25 patients were given high dose suspension.

Method: Randomized, double-blind clinical trial. Each patient was given a course of three injections. Pain, sleep disturbance, functional impairment and passive range of motion (ROM) were assessed at intake and at one, three and six weeks after the initial injection. Data were analysed by independent sample t-tests and nonparametric Mann–Whitney U-tests.

Results: The group which received the 40 mg dose showed significantly greater improvement than the group receiving the 10 mg dose.

Conclusions: The study shows that in the treatment of frozen shoulder greater symptom relief is obtained with a dose of 40 mg triamcinolone acetonide intra-articularly than with a dose of 10 mg. The effect on pain and sleep disturbance was more marked than on ROM. Intra-articular injections with triamcinolone acetonide appear to be an effective method to obtain symptom relief for patients with painful capsulitis of the shoulder.

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References

Ogilvy-Harris DJ , D'Angelo G . Arthroscopic surgery of the shoulder [Review] Sports Med 1990; 9: 120–128 .

Melzer C , Wallny T , Wirth CJ , Hoffmann S . Frozen shoulder – treatment and results . Arch Orthop Trauma Surg 1995; 114: 87–91 .

Anton HA . Frozen shoulder. [Review] Can Fam Physician 1993; 1773–1778.

Emig EW , Schweitzer ME , Karasick D , Lubowitz J . Adhesive capsulitis of the shoulder: MR diagnosis . AJR Am J Roentgenol 1995; 164: 1457–1459 .

Reeves B . The natural history of the frozen shoulder syndrome . Scand J Rheumatol 1975; 4: 193–196 .

Roy S , Oldham R . Management of the painful shoulder . Lancet 1976; 1: 1322–1324 .

Binder AL , Bulgen DY , Hazleman BL , Roberts S . Frozen shoulder: a long-term prospective study . Ann Rheum Dis 1984; 43: 361–364 .

Waldburger M , Meier JL , Gobelet C . The frozen shoulder: diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis . Clin Rheumatol 1992; 11: 364–368 .

Shaffer B , Tibone JE , Kerlan RK . Frozen shoulder. A long term follow-up . J Bone Joint Surg [Am] 1992; 74: 738–746 .

10.

Cyriax JC . Textbook of orthopaedic medicine, eighth edition. London: Baillière Tindall , 1984.

11.

Dacre JE , Beeney N , Scott DL . Injections and physiotherapy for the painful stiff shoulder . Ann Rheum Dis 1989; 48: 322–325 .

12.

Rizk TE , Christopher RP , Pinals RP , Higgins AC , Frix RF . Adhesive capsulitis (frozen shoulder): a new approach to its management . Arch Phys Med Rehabil 1983; 64: 29–33 .

13.

Gavant ML , Rizk TE , Gold RE , Flick PA . Distension arthrography in the treatment of adhesive capsulitis of the shoulder . J Vasc Interv Radiol 1994; 5: 305–308 .

14.

Mulcahy KA , Baxter AD , Oni OO , Finlay D . The value of shoulder distension arthrography with intra-articular injection of steroid and local anaesthetic: a follow-up study . Br J Radiol 1994; 67: 263–266 .

15.

Sharma RK , Bajekal RA , Bhan S . Frozen shoulder syndrome. A comparison of hydraulic distension and manipulation . Int Orthop 1993; 17: 275–278 .

16.

Hsu SY , Chan KM . Arthroscopic distension in the management of frozen shoulder . Int Orthop 1991; 15: 79–83 .

17.

Wiley AM . Arthroscopic appearance of frozen shoulder . Arthroscopy 1991; 7: 138–143 .

18.

Jacobs LGH , Barton MAJ , Wallace WA , Ferrousis Jdunn NA , Bossingham DH . Intra-articular distension and steroids in the management of steroids of the shoulder . Br Med J 1991; 302: 1498–1501 .

19.

Quigley TB . The use of corticosteroids in the treatment of painful and stiff shoulders . Clin Orthop 1957; 10: 182–185 .

20.

Steinbrocker O , Argyros TG . Frozen shoulder treatment by local injections of depot corticosteroids . Arch Phys Med Rehabil 1974; 55: 209–213 .

21.

Rizk TE , Pinals RS , Talaiver AS . Corticosteroid injections in adhesive capsulitis: investigation of their value and site . Arch Phys Med Rehabil 1991; 72: 20–22 .

22.

Bulgen DY , Binder AL , Hazleman BL , Dutton J , Roberts S . Frozen shoulder: prospective clinical study with an evaluation of three treatment regimens . Ann Rheum Dis 1984; 43: 353–360 .