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

Lorbach, Olaf; Anagnostakos, Konstantinos; Scherf, Cornelia; Seil, Romain; Kohn, Dieter; Pape, Dietrich

doi:10.1016/j.jse.2009.06.013

« Previous Next »Journal of Shoulder and Elbow Surgery
Volume 19, Issue 2 , Pages 172-179, March 2010

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

Olaf Lorbach, MD
- Department of Orthopedic and Trauma Surgery, Klinikum Osnabrück, Handsurgery, Osnabrück, Germany
- Department of Orthopedic Surgery, Saarland University, Homburg/Saar, Germany
- Reprint requests: Olaf Lorbach MD, Klinikum Osnabrück, Department of Orthopedic and Trauma Surgery, Handsurgery, Am Finkenhügel 1-3, 49076 Osnabrück, Germany.
Konstantinos Anagnostakos, MD
- Department of Orthopedic Surgery, Saarland University, Homburg/Saar, Germany
Cornelia Scherf
- Department of Orthopedic Surgery, Saarland University, Homburg/Saar, Germany
Romain Seil, MD, PhD
- Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Luxembourg, Luxembourg
Dieter Kohn, MD, PhD
- Department of Orthopedic Surgery, Saarland University, Homburg/Saar, Germany
Dietrich Pape, MD, PhD
- Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Luxembourg, Luxembourg

published online 05 October 2009.

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 1, Randomized Clinical Trial, Treatment Study

Keywords: Adhesive capsulitis, frozen shoulder, intra-articular, corticosteroids