Nonoperative management of adhesive capsulitis of the shoulder: oral cortisone application versus intra-articular cortisone injections.
OBJECTIVE
Oral and intra-articular injections of cortisone will lead to significant improvement and comparable results in the treatment of adhesive capsulitis of the shoulder.


METHODS
In a prospective randomized evaluation, 40 patients with idiopathic adhesive capsulitis of the shoulder were treated with an oral corticoid treatment regimen or 3 intra-articular injections of corticosteroids. Follow-up was after 4, 8, and 12 weeks, and 6 and 12 months. For the clinical evaluation, the Constant-Murley (CM) score, the Simple Shoulder Test (SST) and visual analog scales (VAS) for pain, function, and satisfaction were used.


RESULTS
In the patients treated with oral glucocorticoids, significant improvements were found for the CM score (P < .0001), SST (P=.035), VAS (P < .0001), and range of motion (P < .05) at the 4-week follow-up. The patients treated with an intra-articular glucocorticoid injection series also significantly improved in the CM score (P < .0001), SST (P < .0001), the VAS (P < .0001), and range of motion (P < .05) after 4 weeks. These results were confirmed at all other follow-up visits. Superior results were found for intra-articular injections in range of motion, CM score, SST, and patient satisfaction (P < .05). Differences in the VAS for pain and function were not significant (P > .05).


CONCLUSIONS
The use of cortisone in the treatment of idiopathic shoulder adhesive capsulitis leads to fast pain relief and improves range of motion. Intra-articular injections of glucocorticoids showed superior results in objective shoulder scores, range of motion, and patient satisfaction compared with a short course of oral corticosteroids.
Department of Orthopedic and Trauma Surgery, Klinikum Osnabrück, Handsurgery, Osnabrück, Germany. olaf.lorbach@gmx.de
Olaf
O
Lorbach
Konstantinos
K
Anagnostakos
Cornelia
C
Scherf
Romain
R
Seil
Dieter
D
Kohn
Dietrich
D
Pape
D000284:Administration, Oral; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002062:Bursitis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000534:rehabilitation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011239:Prednisolone / Q000627:therapeutic use*; D011336:Probability; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000187:drug effects* / Q000502:physiology; D020127:Recovery of Function; D012720:Severity of Illness Index; D012785:Shoulder Joint; D020069:Shoulder Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000534:rehabilitation; D000267:Tissue Adhesions / Q000473:pathology
D000893:Anti-Inflammatory Agents; D011239:Prednisolone