title: Optimal dose of intra-articular corticosteroids for adhesive capsulitis: a randomized, triple-blind, placebo-controlled trial.
abstract: BACKGROUND
  Intra-articular corticosteroid injection is a commonly used therapy for adhesive capsulitis, but there are only few studies that compare the efficacy of corticosteroids according to different doses.
  
  
  OBJECTIVE
  To determine whether intra-articular injections with a high-dose corticosteroid improves pain and function in patients with adhesive capsulitis better than a low dose or a placebo.
  
  
  METHODS
  Randomized controlled clinical trial; Level of evidence, 1.
  
  
  METHODS
  Participants (n = 53) with primary adhesive capsulitis in the freezing stage were randomly assigned to receive ultrasound-guided intra-articular injections with 40 mg triamcinolone acetonide (high-dose group, n = 20), 20 mg triamcinolone acetonide (low-dose group, n = 20), or placebo (n = 13). After a single injection, participants were all instructed to carry out a home exercise program. The outcome measures included the Shoulder Pain and Disability Index (SPADI), visual analog scale (VAS) for average shoulder pain level, and passive range of motion including flexion, abduction, extension, external rotation, and internal rotation before treatment and at weeks 1, 3, 6, and 12 after treatment.
  
  
  RESULTS
  There were no significant differences in demographic and clinical characteristics at baseline between the 3 groups. Repeated-measures analysis of variance and post hoc tests showed improvement in SPADI and VAS scores and in flexion, abduction, and internal rotation especially for the low- and high-dose groups compared with the placebo. Yet, no significant difference was found between the 2 different corticosteroid dose groups.
  
  
  CONCLUSIONS
  We assessed the efficacy of corticosteroid injections according to 2 different doses that are most widely used in intra-articular injections for adhesive capsulitis. This study shows that there were no significant differences between the high- and low-dose corticosteroid groups, indicating the preferred use of a low dose in the initial stage.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ajou University Medical Center, Worldcup-ro, Yeongtong-gu, Suwon 443-721, South Korea. yoonsh@ajou.ac.kr
authors.forename: Seung-Hyun
authors.initials: SH
authors.lastname: Yoon
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Lee
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Lee
authors.forename: Kyu-Sung
authors.initials: KS
authors.lastname: Kwack
mesh_terms: D000704:Analysis of Variance; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002062:Bursitis / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012399:Rotation; D012720:Severity of Illness Index; D012785:Shoulder Joint; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*
chemical_list: D000893:Anti-Inflammatory Agents; D014222:Triamcinolone Acetonide
keywords: adhesive capsulitis; corticosteroid; frozen shoulder; painful stiff shoulder; shoulder pain; ultrasonography