title: Corticosteroid Injections for Adhesive Capsulitis: A Review.
abstract: OBJECTIVE
  Adhesive capsulitis is a self-limiting condition in a majority of patients and is often treated nonoperatively. However, symptoms may take 2 to 3 years to resolve fully. A small, but significant, portion of patients require surgical intervention. The purpose of this systematic review is to evaluate the efficacy of corticosteroid injections for the treatment of adhesive capsulitis (AC).
  
  
  METHODS
  A review of articles indexed by the United States National Library of Medicine was conducted by querying the PubMed database for studies involving participants with AC, frozen shoulder, stiff shoulder, or painful shoulder. Articles that included corticosteroids, glucocorticoids, steroids, and injections were included.
  
  
  RESULTS
  Corticosteroid injections provide significant symptom relief for 2 to 24 weeks. Injections can be performed intra-articularly or into the subacromial space. Evidence suggests that a 20 mg dose of triamcinolone may be as effective as a 40 mg injection. It remains unclear whether image-guided injections produce a clinically significant difference in outcomes when compared with landmark-guided (blind) injections. Corticosteroids may be less beneficial for diabetic patients. Patients using protease inhibitors (antiretroviral therapy) should not receive triamcinolone because the drug-drug interaction may result in iatrogenic Cushing syndrome.
  
  
  CONCLUSIONS
  Corticosteroid injections for AC demonstrate short-term efficacy, but may not provide a long-term benefit. More high quality, prospective studies are needed to determine whether corticosteroid injections using ultrasound guidance significantly improve outcomes.
authors.affiliation: *Harvard Medical School, Brookline, Massachusetts; †Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and ‡Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Xiao
authors.forename: Kempland C
authors.initials: KC
authors.lastname: Walley
authors.forename: Joseph P
authors.initials: JP
authors.lastname: DeAngelis
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Ramappa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002062:Bursitis / Q000628:therapy*; D000075202:Contraindications; D003920:Diabetes Mellitus / Q000503:physiopathology; D006801:Humans; D007270:Injections, Intra-Articular; D011480:Protease Inhibitors; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology; D020069:Shoulder Pain / Q000628:therapy*; D014221:Triamcinolone / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D011480:Protease Inhibitors; D014221:Triamcinolone