Intra-articular Corticosteroid with Physiotherapy Versus Physiotherapy alone for the Treatment of Frozen Shoulder: A Randomized Controlled Trial
Objective: To compare the treatment outcome of combination of corticosteroid injection with physiotherapy and physiotherapy alone in patients with adhesive capsulitis in term of shoulder pain and disability index (SPADI) score.
Methods: This was a randomized controlled trail conducted using probability simple random sampling technique at the Department of Orthopedic Surgery, Fatima Jinnah Medical University, Sir Ganga Ram Hospital, and King Edward Medical University, Mayo Hospital Lahore from February 2106 to September 2018. All patients of frozen shoulder fulfilling the inclusion criteria were randomly divided into two groups as A & B by lottery method. Pre treatment shoulder pain and disability index (SPADI) was calculated. Group-A was given intra-articular corticosteroid and physiotherapy while group-B received only physiotherapy. Post intervention SPADI score of both groups were calculated 6-week after the treatment on follow-up in the out-patient department. Independent sample t-test was used to compare the SPADI score between two groups and p-value <0.05 was taken significant.
Results: Out of the total 80 patients in both groups(40 in each group), the mean age of the patients in group-A was 45.18±7.29year while in group-B it was 43±7.43year. The mean duration of the symptoms in group-A was 3.29±1.62month while in group-B it was 3.25±1.69year. In group A, SPADI score at baseline was 71.68±7.67 while in group B it was 71.88±6.74 (p-value=0.902). After 6-week SPADI score in group A was 36.7±5.28 while it 39.78±5.89 in group B. It was found statistically significant in both group (p value 0.016). For age and gender stratification with SPADI score at baseline and 6-week we found statistically significant difference.
Conclusion: Combination therapy of corticosteroid injection with physiotherapy was effective treatment in patients with adhesive capsulitis in pain relieve and reduction in disability index.
1. Siraj M, Anwar W, Iqbal MJ, Rehman N, Kashif F Khan et al. effectiveness of intraarticular steroid injection in the treatment of idiopathic frozen shoulder. J Surg Pak 2012;17(2):57-60.
2. Sharma S, Jacobs L. Management of frozen shoulder-conservative vs surgical? Ann R CollSurg Engl 2010;93(5):343.
3. Maryam M, Zahra K, Adeleh B, Morteza Y. comparison of corticosteroid injection, physiotherapy and combination therapy in treatment of frozen shoulder. Pak j Med Sci 2012;28:648-51.
4. Nagy Mt, MacFarlane RJ, Khan Y, Waseem M. the frozen shoulder myth and realities. Open Orthop J 2013; 7 Suppl:S352-5.
5. Favejee MM, Huisstede BM, Koes BW. Frozen shoulder: the effectiveness of conservative and surgical interventions-systemic review. Br j Sports Med 2011;45:45-56.
6. Kormor TO, Bie RA, Bastienen CHG. Effectiveness of individualized physiotherapy on pain and functioning compared to standard exercise protocol in patients presenting with clinical signs of subacromial impingement syndrome. A randomized controleed trail. BMC Musculoskel Disord 2010;11:114.
7. Dias T, Cutts S, Massoud S. frozen Shoulder. BMJ 2005;331:1453-6.
8. Roninson CM, Seah KT, Chee YH, Hindle P, Murray IR. Frozen Shoulder. J Bone Joint Surg Br 2012; 94:1-9.
9. Depalma AF, Brand AR. Lack of scapulohumeral motion (frozen shoulder). Clin Orthop Relat Res 2008; 466:552-60.
10. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med 2008;1:180-9.
11. Tasto JP, Elias DW. Adhesive capsulitis. Sports Med Arthrosc 2007;15:216-21.
12. Page P, Labbe A. Adhesive capsulitis: use the evidence to integrate your interventions. N Am J Sports Phy Ther 2010;5:266-73.
13. Hirschhorn P, Schmidt JM. Frozen shoulder in identical twins. Joint Bone Spine 2000;67:75-6.
14. Amir-Us Saqlain H, Zubairi A, Taufiq I. Functional outcome of frozen shoulder after manipulation under anesthesia. J Pak Med Assoc 2007;54(4):181-5.
15. Blanchard V, Barr S, Cerisola FL. The effectiveness of corticosteroid injection compared with physiotherapeutic intervention for adhesive capsulitis. A systematic review. Physiotherapy 2010;96(2):85-107.
16. Current S, Moffet H, Tardif J, Bessette L, Morin F, Fremont P et al. Intraarticular corticosteroid, supervised physiotherapy or a combination of two in the treatment of ashesive capsulitis of the shoulder: a placebo controlled trail. Arthritis & Rheumatism 2003;48:829-38.
17. VanderWindt DA, Bouter LM. Physiotherapy or corticosteroid injection for shoulder pain. Ann Rheum Dis 2003;62:385-7.
18. Ryans I, Monthgomery A, Galway R, Kernohan WG, Mckane R. Randomized controlled trial of intraarticular triamcilone and or physiotherapy in shoulder capsulitis. Rheumatology (Oxford) 2005;44:529-44.
19. Arslan S, Celier R. Comaprison of efficacy of local corticosteroid injection and physiotherapy for treatment of adhesive capsulitis. Rheumatol 2001;21:21-3.