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


CONCLUSIONS
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.
Ryans
I
I
Rheumatology Department, The Ulster Hospital, Dundonald, Belfast, UK. ianryans@doctors.org.uk
Montgomery
A
A
Galway
R
R
Kernohan
W G
WG
McKane
R
R
D000328:Adult; D002062:Bursitis / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation*; D004311:Double-Blind Method; D005163:Factor Analysis, Statistical; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology; D016037:Single-Blind Method; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use*
D005938:Glucocorticoids; D014221:Triamcinolone