Programme no. 231-OP
Adhesive shoulder capsulitis, treatment with corticosteroid, corticosteroid with distension or wait and see; a randomized controlled trial in primary care.
Satya Sharma*1, Alice Kvåle2, Anders Bærheim3
1Department of Public Health and Primary Care,University of Bergen ,Bergen N- 5018,Norway, 2Department of Public Health and Physiotherapy Research Group,University of Bergen ,Bergen N- 5018,Norway, 3Department of Public Health and Primary Care,University of Bergen ,Bergen N- 5018,Norway
* = Presenting author
Objectives: To find out whether treating adhesive shoulder capsulitis (frozen shoulder) by corticosteroid and distension is more effective than treating with corticosteroids alone or wait and see in a primary care setting.
Background: Shoulder adhesive capsulitis, also called frozen shoulder, is a painful chronic condition causing reduced movement at gleno-humeral joint in several planes. Inspite of various conservative treatments available there is still lack of evidence of efficacy of coservative treatment regimes.
Results: Out of the 216 patients referred, 146 met the inclusion criteria, 40 patients declined to participate. There is no statistical significant difference between the groups in SPADI, NPRS and ROM at baseline. There is statistically significant difference between group 1 & 3 and groups 2 and 3 at 4 and 8 weeks for SPADI (p<0.001) & NPRS (p<0.01)and ROM (p<0.01 to 0.05). Six patients were lost to follow at 1 year follow up.There is no statistical significant difference between the groups at one year for SPADI.
Material/Methods: This is a prospective intention to treat study between 2010 and 2013. All 105 recruited patients were randomized to one of three groups by block randomization, Group 1 received intra-articular corticosteroid injection, group 2 received sodium chloride as distension of varying volume from 8 ml to 20 ml. The third group was control group. Thirty five patients in group 1 and 34 patients in group 2 received 4 injections each within the time frame of 8 weeks. All patients assessed on 1st visit, at 4th week and 8th week with Shoulder pain and Disability score (SPADI), numerical pain rating scale (NPRS) and range of motion (ROM). Postal assessment was repeated at 1 year for SPADI.
Conclusion: Intervention by corticosteroid injection is better than “wait and see” policy in adhesive shoulder capsulitis at short term.
Points for discussion:
- is it worth while troubling patients with injections when it only is efefctive at short term
- is treating frozen shoulder with intraarticular injection better than other conservative modalities as NSAIDs, Oral corticosteorids and physiotherapy