A randomized controlled trial of intra-articular triamcinolone and/or physiotherapy in shoulder capsulitis

• Published in: Rheumatology (Oxford, England) Vol. 44; no. 4; pp. 529 - 535
• Main Authors: Ryans, I., Montgomery, A., Galway, R., Kernohan, W. G., McKane, R.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2005; Oxford Publishing Limited (England)
• Subjects: Adhesive capsulitis; Adult; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Bursitis - drug therapy; Bursitis - physiopathology; Bursitis - rehabilitation; Diseases of the osteoarticular system; Double-Blind Method; Factor Analysis, Statistical; Female; Glucocorticoids - therapeutic use; Humans; Injections, Intra-Articular; Juxtaarticular diseases. Extraarticular rhumatism; Male; Medical sciences; Middle Aged; Pain Measurement - methods; Pharmacology. Drug treatments; Physical Therapy Modalities; Physiotherapy; Randomized controlled trial; Range of Motion, Articular; Shoulder Joint - physiopathology; Single-Blind Method; Treatment Outcome; Triamcinolone; Triamcinolone - therapeutic use; Juxtaarticular disease; Corticosteroid; Diseases of the osteoarticular system; Antiinflammatory agent; Physiotherapy; Randomized controlled trial; Treatment; Shoulder; Adrenal hormone; Triamcinolone; Adhesive; Periarthopathy; Adhesive capsulitis
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keh535

Objective. To assess the effectiveness of intra-articular triamcinolone injection and physiotherapy singly or combined in the treatment of adhesive capsulitis of the shoulder. Methods. Eighty patients with adhesive capsulitis of less than 6 months duration were randomized to one of four groups: Group A, injection of triamcinolone 20 mg and eight sessions of standardized physiotherapy; Group B, injection of triamcinolone 20 mg alone; Group C, placebo injection and eight sessions of standardized physiotherapy; or Group D, placebo injection alone. All subjects were given an identical home exercise programme. Outcome measures were assessed at 6 weeks and 16 weeks. The primary outcome measure was Shoulder Disability Questionnaire (SDQ) score. Secondary outcomes were measurement of pain using a visual analogue scale (VAS), global disability using VAS and range of passive external rotation. A two-way analysis of variance was used to explore the effects of corticosteroid injection and physiotherapy. Results. At 6 weeks, the SDQ had improved significantly more in the groups receiving corticosteroid injection (P = 0.004). Physiotherapy improved passive external rotation at 6 weeks (P = 0.02) and corticosteroid injection improved self-assessment of global disability at 6 weeks (P = 0.04). There was no interaction effect between injection and physiotherapy. At 16 weeks, all groups had improved to a similar degree with respect to all outcome measures. Conclusion. Corticosteroid injection is effective in improving shoulder-related disability, and physiotherapy is effective in improving the range of movement in external rotation 6 weeks after treatment.