title: Intraarticular corticosteroids, supervised physiotherapy, or a combination of the two in the treatment of adhesive capsulitis of the shoulder: a placebo-controlled trial.
abstract: OBJECTIVE
  To compare the efficacy of a single intraarticular corticosteroid injection, a supervised physiotherapy program, a combination of the two, and placebo in the treatment of adhesive capsulitis of the shoulder.
  
  
  METHODS
  Ninety-three subjects with adhesive capsulitis of <1 year's duration were randomized to 1 of 4 treatment groups: group 1, corticosteroid injection (triamcinolone hexacetonide 40 mg) performed under fluoroscopic guidance followed by 12 sessions of supervised physiotherapy; group 2, corticosteroid injection alone; group 3, saline injection followed by supervised physiotherapy; or group 4, saline injection alone (placebo group). All subjects were taught a simple home exercise program. Subjects were reassessed after 6 weeks, 3 months, 6 months, and 1 year. The primary outcome measure was improvement in the Shoulder Pain and Disability Index (SPADI) score.
  
  
  RESULTS
  At 6 weeks, the total SPADI scores had improved significantly more in groups 1 and 2 compared with groups 3 and 4 (P = 0.0004). The total range of active and passive motion increased in all groups, with group 1 having significantly greater improvement than the other 3 groups. At 3 months, groups 1 and 2 still showed significantly greater improvement in SPADI scores than group 4. There was no difference between groups 3 and 4 at any of the followup assessments except for greater improvement in the range of shoulder flexion in group 3 at 3 months. At 12 months, all groups had improved to a similar degree with respect to all outcome measures.
  
  
  CONCLUSIONS
  A single intraarticular injection of corticosteroid administered under fluoroscopy combined with a simple home exercise program is effective in improving shoulder pain and disability in patients with adhesive capsulitis. Adding supervised physiotherapy provides faster improvement in shoulder range of motion. When used alone, supervised physiotherapy is of limited efficacy in the management of adhesive capsulitis.
authors.affiliation: Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. simon.carette@uhn.utoronto.ca
authors.forename: Simon
authors.initials: S
authors.lastname: Carette
authors.forename: Hélène
authors.initials: H
authors.lastname: Moffet
authors.forename: Johanne
authors.initials: J
authors.lastname: Tardif
authors.forename: Louis
authors.initials: L
authors.lastname: Bessette
authors.forename: Frédéric
authors.initials: F
authors.lastname: Morin
authors.forename: Pierre
authors.initials: P
authors.lastname: Frémont
authors.forename: Vivian
authors.initials: V
authors.lastname: Bykerk
authors.forename: Carter
authors.initials: C
authors.lastname: Thorne
authors.forename: Mary
authors.initials: M
authors.lastname: Bell
authors.forename: William
authors.initials: W
authors.lastname: Bensen
authors.forename: Caty
authors.initials: C
authors.lastname: Blanchette
mesh_terms: D002062:Bursitis / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D012785:Shoulder Joint; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide